Pregnant women and mothers who use substances often face significant barriers to accessing and engaging with substance use services. A scoping review was conducted in 2019 to understand how stigma impacts access to, retention in and outcomes of harm reduction and child welfare services for pregnant women and mothers who use substances. The forty‐two (n = 42) articles were analysed using the Action Framework for Building an Inclusive Health System developed by Canada's Chief Public Health Officer to articulate the ways in which stigma and related health system barriers are experienced at the individual, interpersonal, institutional and population levels. Many articles highlighted barriers across multiple levels, 19 of which cited barriers at the individual level (i.e., fear and mistrust of child welfare services), 18 at the interpersonal level (i.e., familial and relational influence on accessing substance use treatment), 30 at the institutional level (i.e., high organisational expectations on women) and 17 at the population level (i.e., negative stereotypes and racism). Our findings highlight the interconnectedness of stigma and related barriers and the ways in which stigma at the institutional and population levels pervasively influence individual and interpersonal experiences of stigma. Despite a wealth of literature on barriers to treatment and support for pregnant women and mothers who use substances, there has been minimal focus on how systems can address these formidable barriers. This review highlights the ways in which the barriers are connected and identifies opportunities for service providers and policymakers to better support pregnant women and mothers who use substances.

中文翻译：

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使用耻辱行动框架，检查使用物质的孕妇和母亲的减少危害和儿童福利服务的障碍

使用毒品的孕妇和母亲通常在获取和使用毒品使用服务方面面临重大障碍。2019年进行了范围界定审查，以了解耻辱感如何影响使用药物的孕妇和母亲获得减害和儿童福利服务的机会，保留和减少伤害的结果以及儿童福利服务。 使用构建包容性卫生系统的行动框架对四十二篇文章（n = 42）进行了分析由加拿大首席公共卫生官开发，旨在阐明在个人，人际关系，机构和人口层面上遭受耻辱和相关卫生系统障碍的方式。许多文章强调了跨多个层面的障碍，其中有19个列举了个人层面的障碍（即，对儿童福利服务的恐惧和不信任），人际关系层面的18个（即，对获得药物使用治疗的家庭和关系影响），30个层面的障碍。机构一级（即对妇女的高组织期望）和人口一级的17（即负面定型观念和种族主义）。我们的发现强调了污名和相关障碍的相互联系，以及机构和人口层面的污名普遍影响污名的个人和人际关系的方式。尽管有大量关于使用药物的孕妇和母亲的治疗和支持障碍的文献，但对系统如何解决这些巨大障碍的关注却很少。这篇评论强调了障碍之间的联系方式，并确定了服务提供者和政策制定者更好地支持使用药物的孕妇和母亲的机会。