Transitioning from punitive to healing centered healthcare for pregnant people with substance use disorder in Alabama

In 2022, the Alabama Maternal Mortality Review Committee identified that substance use disorders (SUDs) were a key contributor in almost half of all maternal deaths. Substance use disorders (SUD) are chronic, relapsing conditions, and best practice recommendations include continuous harm reduction skills training for healthcare professionals; however, punitive policies, such as Alabama's Child Endangerment Law (ACEL), diminish the availability, accessibility, and utilization of healthcare for this population. The ACEL also negatively impacts the capacity of perinatal healthcare professionals in Alabama to adequately serve and advocate for pregnant people living with a SUD. As applied medical anthropologists, we challenged the notion of “advocacy” as solely being the responsibility of the healthcare professional or the patient and reimagined it as a collective process that can challenge perceptions of moral responsibility and personhood for pregnant and postpartum people who are substance involved. With a focus on knowledge translation and multi-stakeholder advocacy, we created two-versions of the Perinatal Self-Advocacy Toolkits (PSATs) that are framed using a healing-centered approach. We discuss how the PSATs are an essential component of improving the quality of care for pregnant patients with SUDs and facilitating systems change in Alabama.