Substance use disorder (SUD) during pregnancy, also known as maternal SUD, is a critical public health issue. In fact, maternal SUD is a leading cause of pregnancy-related death in the US. Maternal SUD can increase health risks for both the mother and the baby, including pregnancy complications, preterm birth, low birth weight, neonatal withdrawal, and fetal alcohol spectrum disorders. These health challenges often intersect with additional social determinants of health like racial and gender discrimination, financial challenges, housing instability, and limited access to health care.
To address this challenge, Karna LLC, with funding support from CDC, conducted research to identify maternal SUD resource gaps through literature reviews, environmental scans, and guided conversations with maternal health and SUD subject matter experts. To oversee and guide this work, Karna convened an expert advisory committee including academic researchers, maternal health practitioners, and people with lived maternal SUD experience. Karna’s analysis showed a need for more education and training for clinicians on stigma surrounding maternal SUD.
Defining Stigma and its Widespread Impacts on Maternal SUD
Stigma is more than negative attitudes. It’s a dynamic set of beliefs, social norms, policies, and systems that affect certain people unequally. Stigma can be reinforced through overt policies, such as turning away pregnant patients in need of SUD treatment, or subtle interpersonal interactions that make people feel judged.
For patients with maternal SUD, stigma can cause social isolation, acceptance of discrimination, fear of legal consequences (such as loss of parental rights), and judgmental treatment in clinical settings. These experiences often make pregnant patients feel unsafe, unwelcome, or discouraged from accessing prenatal care. Ultimately, stigma surrounding maternal SUD can lead to serious consequences such as delayed or missed prenatal appointments, untreated substance use during pregnancy, and poorer health outcomes for both mother and baby. Over time, stigma reinforces systemic barriers and perpetuates health disparities.
Addressing Resource Gaps
To address the gap in stigma-focused clinician resources, Karna developed a suite of tools and resources to help health care professionals provide compassionate and stigma-free pregnancy care. The maternal SUD toolkit includes a grand rounds presentation, clinician guides and scripts on screening for maternal SUD, a recorded webinar, a 2-part video series, and an infographic.
Resource Case Study: Meet Ana R.
To show how stigma can affect the patient experience, Karna developed a case study that is featured in several of the resources, including an interactive infographic. The case study follows the journey of Ana R., a pregnant patient experiencing SUD. Ana is 24 weeks pregnant, has a history of substance use, and is visiting her OBGYN clinic for her first prenatal appointment. The infographic illustrates realistic scenarios during Ana’s visit, highlighting how stigma can appear in subtle ways, and how staff can help to make her feel more comfortable in a difficult situation. It also provides best practices to help clinic staff go beyond basic care and deliver compassionate, stigma-free support so Ana can get the help she needs.
Clinician Strategies to Address Stigma
Healthcare providers play a key role in reducing stigma. In addition to Karna’s suite of resources, here are practical steps for healthcare providers to create a more supportive environment:
- Use person-first language: Say “a patient with substance use disorder” instead of “addict.” This framing reflects that the patient has a medical condition, and refrains from labeling them. Avoid other slang terms surrounding substance use.
- Focus on health, not blame: Frame conversations around treatment, wellness, and recovery rather than fault. For instance, using terms like “habit” or “abuse” in the context of substance use can imply that a patient is to blame, and that their condition is voluntary. In reality, substance use is a complex and chronic medical condition.
- Build trust through empathy: Listen actively and validate patients’ experiences. Use motivational interviewing techniques to understand where patients are in their recovery journeys.
- Offer integrated care: Pregnant patients with SUD are often turned away when they seek medical care because many providers don’t have adequate training on how to manage both conditions at the same time. Connect patients with providers who specialize in maternal SUD, behavioral health, and social support services to reduce these care barriers.
- Educate your team: Provide training for clinicians and administrative staff on stigma, trauma-informed care, and nonjudgmental communication. Education increases awareness of how subtle, unconscious bias influences the patient experience.
Access Karna’s Maternal SUD Toolkit for the full suite of tools and resources on reducing stigma for pregnant patients with SUD.