Grant: Doctoral Research Award - PA: Sex and gender science for health equity

Substance use during pregnancy is a significant public health and social justice concern. There is significant evidence to suggest that perinatal substance use programs, including in-rooming and outreach services, improve the health outcomes of both birthing parents and babies. Policy responses to address this issue have historically focused on the health and safety of the fetus or newborn child, without much regard for the physical and mental health of the birthing parent. This is further complicated by the intersections of race and socioeconomic status, whereby poor and racialized people experience systematic and institutional discrimination in the healthcare system, as well as issues pertaining to access to evidence-based substance use care. Over the last decade, British Columbia (BC) has established a few programs to better support pregnant and parenting people who use substances (PPWUS). However, to date, there have not been thorough analyses of the programs' policies, uptake and outcomes. Using qualitative data collected from 30 semi-structured interviews with PPWUS and staff in partnering perinatal substance use programs across BC, quantitative data extracted from three ongoing prospective cohort studies of people who use drugs in Vancouver, BC (n>2500), and guidance from a community advisory board, this study will: (1) characterize substance use during pregnancy, including conditions driving it (e.g., individual characteristics, social-structural exposures); (2) understand the experiences of PPWUS engaged and not-engaged in perinatal substance use programs, including barriers and facilitators to program retention and outcomes; and (3) investigate potential areas for improvement within programs. Using the results of my analyses, I will identify programmatic gaps and best practices and make recommendations to improve program process and outcomes.