Stigma and Bias in Prenatal Care

Written By SACCounty Healthy Beginnings
 
 
 

Healthcare professionals often take pride in the compassionate care they provide. Yet, the uncomfortable truth is that stigma and bias still deeply influence the way many patients, particularly pregnant women, experience medical care. Stigma surrounding pregnancy, especially when related to substance use, is common and deeply rooted in assumptions and mistruths. We must recognize and address these biases to provide better care for patients and create a welcoming, compassionate, and just healthcare environment – including right here in Sacramento County. 

Society’s perceptions of pregnancy

Substance use during pregnancy has long been viewed as taboo and considered a moral failing. Pregnant women are frequently placed on a pedestal, expected to represent maternal virtue and health perfectly. So, when we see a struggle with substance use or misuse, rather than supporting the pregnant woman, we instead harshly judge, vilify, and criminalize her. Healthcare professionals, although committed to patient care, are not immune to these societal biases. Often unconsciously, providers may communicate judgment or disappointment, even in subtle forms such as tone of voice, body language, or the phrasing of questions. These subtle cues can have a significant impact on how patients perceive their care. Feeling judged or stigmatized can result in decreased trust, reduced honesty, and even avoidance of medical care altogether. Ultimately, the worry over how she’ll be perceived – and possibly judged – by a provider can lead the pregnant woman to delay or avoid pre- and postnatal care, putting the health of herself and her baby at risk. 

Impact of Clinician Bias:

  • Decreased access to prenatal care and mental health services

  • Heightened stress and anxiety during medical encounters

  • Increased risk of adverse pregnancy and birth outcomes

  • Higher rates of family separation and child welfare involvement

  • Deep-rooted health inequities across generations

 
 

Ways to address bias in prenatal healthcare 

To address these issues effectively, clinicians must first reflect on and acknowledge their personal biases and how these biases impact their interactions with patients. Noticing how personal values influence patient communication or regularly questioning one's initial reactions to patients who are struggling with substance use can greatly reduce these biases. Education and training that specifically address stigma and implicit bias can also help providers recognize their blind spots. 

Communication is another key area where clinicians can actively combat stigma. Approaching conversations about substance use with sensitivity, openness, and respect transforms the healthcare experience. Instead of asking leading or judgmental questions, providers can frame questions in supportive, patient-centered language. For example, asking, "Can you share your experiences or challenges with substance use?" rather than implying blame can open the door to trust and dialogue. The SACCounty Healthy Beginnings initiative offers educational resources and training for healthcare professionals and parents, focusing on improving outcomes for mothers and children affected by prenatal substance exposure.

Using a universal screening tool to identify all pregnant women at risk for substance use and then referring all women with a positive substance use screen for full assessment, regardless of race, socioeconomic status, etc., is important. Providing fair access to culturally relevant services and resources also improves outcomes for mothers and their children. Sacramento County providers are encouraged to refer pregnant and parenting women to community-based treatment partners, such as Bridges and the Behavioral Health Substance Use Prevention and Treatment, to help them navigate recovery without fear.

Additionally, clinicians can adopt harm-reduction strategies, emphasizing safety and health rather than perfection or punishment. Research indicates that punishing pregnant women for using substances during pregnancy does not actually reduce use. This is particularly important for groups that have historically faced over-policing or discrimination. Instead, providing clear information about resources, such as counseling or support groups, without judgment or coercion, demonstrates genuine care and encourages patient engagement. 

Sacramento County strengthens access through local services

In Sacramento County, providers can refer patients to Substance Use Prevention and Treatment Services, which coordinate comprehensive care tailored to each individual.

 Sacramento County offers several programs that align with national best practices for compassionate, stigma-free prenatal care:

  • Perinatal support program: Connects pregnant and parenting individuals to substance use treatment, mental health care, and social services.

  • Cultural brokers and peer support specialists: Women with lived experience help guide clients through the system, reducing fear and shame while building trust.

  • Language access: Interpreters and translated materials ensure that non-English-speaking families receive equitable and respectful care.

  • Integrated care models: Sites like Sacramento County Health Center and Birth & Beyond Family Resource Centers offer services for families, improving engagement and outcomes.

 
 

A call to action

 
 

Recognizing and reducing stigma around pregnancy and substance use in healthcare is not a simple task. However, Reflective practice, trauma-informed care, and local partnerships lay the foundation for meaningful change. Supporting pregnant women affected by substance use isn’t just the right thing to do – it’s an investment in healthier families and stronger Sacramento communities. 

 
SACCounty Healthy Beginnings
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Prenatal Substance Use and the Infant-Mother Attachment