Aims: To explore the literature on strengths-based and culturally responsive care for pregnant individuals who use substances, and to identify the practice components and system enablers that reduce stigma, improve engagement, and support equitable outcomes.

Design: Narrative review with systematic features: protocolled eligibility and screening, librarian-assisted multi-database searching, transparent reporting aligned with Scale for the Assessment of Narrative Review Articles, dual independent screening, and formal quality appraisal (Mixed Methods Appraisal Tool for peer-reviewed studies; AACODS for gray literature) used to inform weighting in a reflexive thematic synthesis.

Methods: Searches were carried out on CINAHL, MEDLINE, Embase, and PsycINFO from inception to 15/02/2025, combining controlled vocabulary and free-text terms for strengths-based care, cultural safety/responsiveness, pregnancy/perinatal care, and substance use. Records were exported to Covidence, deduplicated, and screened in duplicate (title/abstract, then full text) against predefined criteria. Appraisal findings informed interpretation, not inclusion.

Results: Of 168 records (148 after deduplication), 16 met the inclusion criteria. Five themes were identified: (1) Systemic neglect; (2) Stigma and trust; (3) Culturally safe, strengths-based responses; (4) Interprofessional collaboration; and (5) Sustainability/enablers.

Conclusion: Pregnant women who use substances require care that moves beyond punitive, deficit-based systems. Emphasizing trust, cultural safety, and women’s lived experiences is key to developing equitable health care. Embedding strengths-based and culturally appropriate approaches into health policy and practice can play a critical role in reducing barriers, improving engagement, and promoting health equity for this vulnerable population.