(PS7-D100) Listening to Women and Pregnant and Postpartum People: Black Women’s Perspectives and Experiences of Perinatal Mental Health and Substance Use Disorders

Perinatal mood and anxiety disorders (PMAD) and perinatal substance use disorders (PSUD) are common and significant racial disparities exist, with Black women being less likely to have PMAD and/or PSUD detected than White women (SAMHSA, 2020). Racism and stigma at the individual, provider, community, and healthcare system levels contribute to disparities in screening and treatment of PMAD and PSUD. Disparities are further compounded within marginalized communities with less access to mental health or substance use education and services and more negative experiences seeking and receiving services (Misra et al., 2021). We conducted qualitative interviews with Black perinatal women to better understand 1) how race and stigma influence PMAD and PSUD treatment seeking, and 2) how alternative methods to screening and referral by text/phone could reduce perceived stigma and racism, and 3) facilitators of treatment receipt. Participants were 68 Black-identifying pregnant or postpartum women reporting a history of PMAD and/or PSUD who participated in semi-structured interviews about experiences with PMAD and PSUD, pregnancy, childbirth, and parenting. Women also provided feedback on a text/phone based PMAD and PSUD screening and referral to treatment program, called Listening to Women and Pregnant and Postpartum People (LTWP). Overall, 42.6% reported having a primary PMAD, 36.7% a primary PSUD, and 20.5% both PMAD and PSUD. Women described using substances to alleviate mental health and pregnancy-related symptoms. Lack of understanding and recognition of PMAD and PSUD within Black communities was described as a treatment barrier as symptoms are frequently overlooked and judged negatively, further contributing to substance use to self-medicate. Other barriers included transportation, limited provider availability, and fear of child welfare involvement. Yet, women described that learning about PMAD and PSUD was beneficial and over 60% were comfortable discussing these issues with a provider. Non-judgmental, trustworthy providers with common experiences and who provide a ‘safe space’ to share feelings were crucial to Black women engaging in treatment. Finally, LTWP was deemed convenient and beneficial for lessening stigma within Black communities, and women were comfortable using it to facilitate receipt of mental health care. Reducing stigma within individuals and their communities and providing education to dispel myths about PMAD and PSUD may facilitate perinatal Black women seeking treatment for their symptoms rather than self-medicating with substances. On an individual level, culturally competent and non-judgmental cognitive-behavioral therapy providers may facilitate engagement of Black perinatal women in behavioral health services. While previous work has demonstrated a reduction in racial disparities with the LTWP program (Guille et al., 2022), this study supports the potential mechanism through which LTWP may be effective and suggests that digital tools may reduce the stigma associated with PMAD and PSUD within the Black community. These results highlight the potential utility of leveraging digital health solutions in PMDH and PSUD care to reduce racial inequities in maternal healthcare.