Understanding the problem

A survey (2014) of 709 Americans by Johns Hopkins University looked at stigma toward people with substance use disorders:

said they would not work with someone with an SUD.

said employers should have the right to deny employment to someone with an SUD.

said people with SUDs should not be granted the same health insurance benefits as other individuals.

Pregnancy adds an additional layer of stigma to substance use disorders.

Some people, including health professionals, may be inclined to blame mothers of children born with conditions, such as Neonatal Abstinence Syndrome or Fetal Alcohol Syndrome. However, it is often this shame that keeps women from receiving the treatment they need to address substance use disorders.

Fear of Disclosure to Providers

Many women with SUDs fear the legal and criminal consequences for them and their baby – like ending up in jail or having their babies taken away from them – if they disclose their substance use to their provider, so they skip appointments and avoid prenatal care.

According to the Guttmacher Institute (2020):

• 23 states, as well as the District of Columbia, consider substance use during pregnancy to be child abuse under civil child-welfare statutes.
• 25 states, as well as the District of Columbia, require healthcare professionals to report suspected prenatal substance use.
• 8 states require healthcare professionals to test women for prenatal drug exposure if they suspect substance use.

Fear of Losing Social Network

Also, many pregnant women with substance use disorders don’t tell their family or friends they are dealing with addiction because they’re worried about disappointing or embarrassing them. They often isolate themselves, negatively affect both their mental and physical health (White, 2009).

Because stigma is a substantial barrier to care, it has serious implications for the health of pregnant women with substance use disorders and their babies.

Exposure to substances during pregnancy can cause serious problems for newborns. Depending on the substance (e.g. opioids, alcohol, tobacco), infants may experience a range of health challenges such as

• premature birth,
• low birthweight,
• breathing problems,
• feeding problems,
• vision or hearing problems,
• abnormal facial features, and
• longer-term developmental problems.

Pregnant women, themselves, are also at risk for health problems, including complications during pregnancy and labor and delivery (Lamy et al, 2015), as well as the risk for maternal overdose depending on the substance.

1. Create safe, caring, and supportive environments and relationships that are free from stigma (Stone, 2015).
2. Eliminate blaming and shaming pregnant women with substance use disorders, as this only drives them away from the care and support they need (Thigpen et al., 2014; Krans et al., 2015)
3. Inform women with SUD that help is available and encourage them to seek treatment (FindTreatment.gov).