Advancing Equity in Treatment Outcomes for Black Pregnant and Postpartum People Who Use Drugs and have Child Welfare and Criminal Legal Systems Involvement

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PROEJCT SUMMARY/ABSTRACT Providing substance use disorder treatment in pregnancy is an essential strategy to improve maternal and newborn wellbeing, but discriminatory policies, practice, and access to necessary resources contribute to inequities in addiction care and parenting outcomes. Many pregnant people who use drugs experience incarceration and also have involvement from the child welfare system. Policies in both the criminal legal and child welfare systems have trended toward criminalizing drug use in pregnancy rather than investing in robust treatment. Significantly, due to the structural racism that underlies incarceration and historical forces that have systematically devalued Black women’s reproduction, these policies have had a differentially negative impact on Black pregnant and parenting people, contributing to disproportionate child removals as well as disparate drug treatment outcomes. While policy, historical, and sociologic analyses have documented the links between racism and criminalizing Black pregnant individuals who use drugs, one understudied aspect is how these forces of structural and interpersonal discrimination affect the lived experiences, treatment, and recovery outcomes among pregnant and postpartum Black people with dual involvement in these systems. Understanding these intersecting systems is essential for targeting root causes of and eliminating racial disparities and discrimination in substance use treatment and maternal health. The overall objective of this NIDA Administrative Supplement on Health Equity is to examine experiences of racism and the impact on treatment, pregnancy, and parenting outcomes among a sample of pregnant and postpartum people who use drugs and who have dual involvement from criminal legal and child welfare systems. This study will also evaluate the practices and perspectives of child welfare system workers who make decisions on cases involving people who used drugs in pregnancy and who were currently or recently incarcerated. The proposal will accomplish these aims through a series of qualitative interviews that assess validated measures of racism in maternal health, and with methodological collaboration from community members with direct, lived experience. This project will enhance the training goals of the parent career development award to improve access to care for pregnant, incarcerated people with opioid use disorder by providing training opportunities in how to study and impact racism in maternal health. Data from interviews will produce actionable insights for future policy and training interventions for people who work in incarceration and child welfare systems. This research is innovative because it will add to existing understandings of racialized dimensions of incarceration and child welfare systems by examining the impact at the intersection of these systems on individuals’ treatment pathways and parenting outcomes. The work proposed for this supplement, which directly aligns with the goals of NIDA’s Racial Equity Initiative, will contribute to the long-term goal of advancing racial equity in maternal health and substance use treatment and outcomes.