Differential Gateways, Facilitators, and Barriers to Substance Use Disorder Treatment for Pregnant Women and Mothers: A Scoping Systematic Review

Abstract

ObjectivesAccess to substance use disorder (SUD) treatment is complex, and more so for pregnant women and mothers who experience unique barriers. This scoping systematic review aimed to summarize contemporary findings on gateways, facilitators, and barriers to treatment for pregnant women and mothers with SUD.MethodsWe used the scoping review methodology and a systematic search strategy via MEDLINE/PubMed and Google Scholar. The search was augmented by the similar article lists for sources identified in PubMed. Scholarly and peer-reviewed articles that were published in English from 1996 to 2019 were included. A thematic analysis of the selected studies was used to summarize pathways to SUD treatment and to identify research gaps.ResultsThe analysis included 41 articles. Multiple gateway institutions were identified: health care settings, social service agencies, criminal justice settings, community organizations, and employers. Some of the identified facilitators and barriers to SUD treatment were unique to pregnant women and mothers (eg, fear of incarceration for child abuse). Both personal (emotional support and social support) and child-related factors (loss of children, suspension or termination of parental rights, the anticipation of reuniting with children) motivated women to seek treatment. Major access barriers included fear, stigma, charges of child abuse, inconvenience, and financial hardship.ConclusionsThere has been progress in implementing different types of interventions and treatments for that were attentive to pregnant women and mothers’ needs. We developed a conceptual model that characterized women’s pathways to treatment by deciphering women’s potential engagement in gateway settings.

Pregnancy and Postpartum Drug Overdose Deaths in the US Before and During the COVID-19 Pandemic

“…These can be challenging because many women may conceal their drug use from clinicians during pregnancy and motherhood due to stigma and fear of prosecution and loss of custody. [23][24][25][26][27] Recent research has highlighted the importance of taking harm-reduction approaches to address the multiplicity of stigma and related barriers for pregnant and postpartum women with drug use. [27][28][29] Strategies to destigmatize pregnant and nonpregnant women with substance use disorders are necessary to improve their access to health care services, including substance use treatments.…”

“…Yet use of medications for opioid use disorder, and timely overdose treatments are critical to prevent overdose mortality. These can be challenging because many women may conceal their drug use from clinicians during pregnancy and motherhood due to stigma and fear of prosecution and loss of custody …”

Barriers and Facilitators to Substance Use Disorder Treatment: An Overview of Systematic Reviews

“…Choi et al 25 analysed 41 publications and determined that social service providers, criminal justice settings, community organisations and employers can provide health care services. Fear of incarceration, fear of stigma, charges of child abuse, inconvenience and financial difficulty, fear of losing children and suspension or termination of parental rights were cited as barriers for pregnant women and mothers with SUD.…”

A case study on variations in network structure and cross‐sector alignment in two local systems serving pregnant and parenting women in recovery

“…14 Pregnant women report low rates of treatment for SUD, 15 with identified barriers including challenges with SUD screening in women's health settings, lack of resources, social stigma, and potential legal implications. [16][17][18][19] Further, there are documented disparities between urban and rural communities in access to treatment and support services for pregnant women with SUDs. 20,21 In rural Kentucky, 80% of pregnant women seeking recovery support for SUDs experienced obstacles to obtaining needed supports.…”