Innovation and Advocacy in Perinatal Harm Reduction by Birth Workers and Perinatal Workforce Providers: A Qualitative Study Utilizing Narrative Inquiry
Background: The criminalization and stigmatization of perinatal substance use has created a public health crisis, isolating birthing people away from vital healthcare and social supports and separating families (Bach & Terplan, 2023a; Earnshaw et al., 2024; Kavattur et al., 2023; Merritt, 2020; Ocen, 2017). During the perinatal period, up to approximately 10% of birthing people in the United States self-report past-month use of illicit substances and/or alcohol (McCance-Katz, 2020; Rodriguez & Smith, 2019), however only approximately 60% of birthing people who use substances report being able to access any MOUD during the perinatal period (Jarlenski et al., 2021). The birth professionals who work with birthing people who use substances can influence health, social, and familial outcomes, becoming facilitators or barriers to obtaining care (Barnett et al., 2021; Puccio, 2023). Significance: This dissertation presents the perspectives of perinatal harm reduction birth professionals who work with birthing people who use substances. The perspectives and applications highlighted in this dissertation can be used as a model for more widespread implementation of perinatal harm reduction as a values-based and liberatory movement. Methods: This dissertation was done through two methods: 1) phenomenological qualitative research utilizing semi-structured interviews and thematic analysis and 2) narrative inquiry. The analysis for the first two papers in this dissertation uses data from 16 semi-structured phenomenological interviews with birth workers, peer navigators, and perinatal workforce providers. The first paper also combines multiple participants into four case studies to examine the application of PHR. In anthology format, the third paper uses co-created narratives from seven of the 16 original participants. Findings: This research aims to define perinatal harm reduction, informed by the birth professionals who practice it. After establishing a working definition and identifying the motivations and values necessary for the birth professionals, this research examines four settings in which the birth professionals apply PHR. In the second paper, the birth professionals discuss the barriers to implementing perinatal harm reduction and the opportunities for transforming the birth system. In the anthology, seven narratives are connected to Emergent Strategy frameworks to illustrate how the birth professionals view their roles as advocates and create an archive of perinatal harm reduction narratives. Future Implications: This research aims to create a cohesive foundation for the nascent area of perinatal harm reduction research. The liberatory and abolitionist frameworks that inform this work can and should influence the widespread implementation of perinatal harm reduction. This research establishes perinatal harm reduction as a values-based and justice-oriented care movement based on the radical love of birthing people who use substances. It calls for transformational shifts in how the birthing professions interact with birthing people who use substances and how these birth professionals resist systems of oppression, including those at play in the family regulation system, white supremacy, and punitive anti-drug policy.
birth professionals;criminalization;Family Regulation System;Perinatal Harm Reduction;perinatal substance use;stigmatization
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