BACKGROUND: Pregnant and parenting women who use drugs experience high rates of stigma when navigating the health care system, due to the gendered impacts of punitive drug policies and assumptions that conflate substance use with an inability to parent. There is a lack of research examining how stigma uniquely impacts pregnant and parenting women who use drugs, particularly with regards to self-efficacy and motivations to access health and social services, and other personal experiences of help-seeking processes. This study explores how stigma is internalized, anticipated, and embodied in the context of help-seeking, among pregnant and parenting women who use drugs.

METHODS: Semi-structured telephone interviews were conducted from October 2020-February 2021 with current and past clients of integrated treatment programs in Ontario, designed for women who are pregnant and parenting young children (n = 24). Participants were asked to reflect upon their service experiences prior to COVID-19.

RESULTS: Applying an interpretive description approach, the following themes emerged: (1) stigma and avoidance of help-seeking (2) stigma at the structural level: barriers to care and (3) mitigating stigma to enhance help-seeking: facilitating recovery through relationships.

CONCLUSION: Expressions of judgement have negative impacts on self-esteem and can foster internalized stigma, while disclosure of substance use in motherhood can threaten to damage interpersonal relationships. At the same time, supportive relationships can buffer against stigma-related harms. Service invisibility and implicit bias within the medical community further deter help-seeking, with negative past experiences compounding mistrust of the system. To promote conditions that are supportive of help-seeking and healthy outcomes for this population, compassion and empathy are critical.