Health of Pregnant Women with Substance- related Disorder, A Neglected Global Health Issue Requiring Combined Maternity Care Units

Abstract

Background: Pregnant women using substances (PWUS) are defined as women in the pregnancy and postpartum period (pregnancy to 8 weeks after the delivery) that use illicit drugs. Health of PWUS is a hidden global epidemic, becoming visible in part due to increasing numbers of street children. Lack of awareness and stigma contributes to the scarcity of research for PWUS. Combined maternity care units (CMCU) have been proposed as standard of care for PWUS and their newborns. Objective: This review aims to evaluate global awareness of PWUS’s health and proposes CMCU as an effective integrated part of the continuum of care through a health systems approach. Methods: The authors completed a critical narrative review of the available evidence about the health of PWUS and based on that, provided recommendations for health care delivery using a systems thinking approach. Findings: Determinants of health for PWUS's and their children include: economic disadvantage, poverty, homelessness, stigma, violence, sexual and emotional abuse, mental co- morbidities, history of childhood abuse and disrupted family structure, and trans-generational trauma. Although there is a scarcity of data on trends of substance use among PWUS in many regions of world, there is sufficient evidence to demonstrate the need for a standard of care. Conclusions: Increasing awareness of and providing new care options for mothers suffering from substance-related disorder- including by opening more CMCU- can help families, lower maternal and child morbidities and mortalities, and achieve Millennium Development Goals.