"I'm Treated Way Differently": The Intersectional Risk Environment of Maternal Cannabis Use.

Introduction: This research aimed to understand the perspectives and experiences of pregnant individuals using cannabis as they navigate healthcare settings and their pregnancies. We applied the lens of the intersectional risk environment, a harm reduction framework which explores the ways that social locations and environmental factors combine to impact health and well-being.

Methods: Using qualitative, constructivist grounded theory methods, we conducted interviews with 19 participants between December 2022 and March 2023. Individuals self-identified as racially minoritized, were 21 years of age and older, spoke English/Spanish, resided in California, and had used cannabis during pregnancy in the last 0-2 years. We used constructivist grounded theory methods to analyze the socio-structural contexts and lived experiences surrounding cannabis use and disclosure to clinicians.

Results: Participants who used cannabis during pregnancy described: 1) how their race/ethnicity, gender, and socioeconomic status impacted their care experiences together with their cannabis use, 2) their experience of poor perinatal care due to their insurance coverage and location of care, 3) worsening of care after disclosing cannabis use (e.g., being judged, ignored), and 4) removal from perinatal care after disclosing cannabis use.

Discussion: Our study showed how patients' use of cannabis during pregnancy and their insurance status, gender, race/ethnicity, and socioeconomic level impacted the care they received across the perinatal period. Our findings emphasize the need for the multi-level import of an intersectional risk environment framework which addresses health inequities via a social justice-oriented lens. This can be operationalized via interventions that take place at the patient-clinician, institutional, and policy levels which acknowledge patients' overlapping identities to mitigate experiences of stigma and discrimination which are prevalent in perinatal care spaces today.