Reducing Stigma and Bias in Perinatal Substance Use Care: A Training for Obstetric and Neonatal Providers

Abstract

Background Accidental overdose is the second leading cause of death among pregnant and postpartum individuals in Colorado, with substance use disorders (SUD) contributing significantly to maternal morbidity. Stigma and bias from healthcare providers exacerbate these challenges, leading to suboptimal care and reduced access to essential resources. Despite extensive documentation of negative attitudes toward pregnant individuals with SUD, few interventions aim to reduce such biases in healthcare settings.

Objective To evaluate the impact of a 90-minute live, virtual or in person training on reducing stigma and bias among healthcare providers caring for patients with perinatal SUD.

Methods This pre-post intervention study enrolled healthcare professionals, including obstetric and neonatal nurses, obstetricians, midwives, and nurse educators, who provide care to perinatal patients. Participants completed a training developed by the Colorado Perinatal Care Quality Collaborative (CPCQC) in partnership with experts with lived experience of perinatal SUD (“lived-experience experts”) from HardBeauty. The training focused on evidence-based education, stigma and bias reduction, and patient-centered strategies informed by lived experiences. Outcomes were assessed, a modified pre-post-training knowledge and comfortability survey using Likert scales and open response questions, and post-training qualitative feedback.

Results Participants (n=549) demonstrated statistically significant improvements in response scores (p < 0.05), indicating reduced stigma and bias toward perinatal patients with SUD. Qualitative feedback highlighted the training’s relevance and impact, with participants emphasizing the value of integrating lived experiences into educational initiatives.

Conclusions This study demonstrates the effectiveness of a brief, virtual training in reducing stigma and bias among healthcare providers caring for patients with perinatal SUD. The findings underscore the importance of incorporating lived-experience expertise into training programs to promote equitable and compassionate care. Future research should explore long-term impacts on clinical practice and patient outcomes.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study did not receive specific funding.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study protocol was deemed quality improvement by the University of Colorado Anschutz Medical Campus (IRB approval #25-0659), though consent to participate in research was collected, nonetheless.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

Data will be made available upon reasonable request to the authors.

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