SPOTLIGHT ON ABORTION CARE & REPRODUCTIVE JUSTICE BOOK REVIEW
What Addicted. Pregnant. Poor. Teaches Us About Reproductive Justice
Written by Araam Abboud, AMSA Reproductive Health Project Intern
In the United States, substance use among pregnant and parenting individuals often goes unrecognized and untreated due to misconceptions and systemic barriers. Within this landscape—where legal threats, stigma, and disproportionate harm to non-White families persist – Kelly Ray Knight’s Addicted. Pregnant. Poor. (2015) examines pregnant individuals in San Francisco’s Mission District, amplifying their voices and showing how poverty, racism, and punitive policies shape their reproductive lives far more than any single “choice” to use substances. Knight’s work aligns closely with reproductive justice principles, emphasizing the right to have children, not have children, and raising children in safe, supportive environments. Her findings demonstrate that decisions around pregnancy rarely happen in isolation but instead, unfold within systems of inequity. When healthcare providers use stigmatizing terms like “addict” or “substance abuser,” they foster climates of fear and blame. Knight’s account of ‘Tina,’ who avoided telling healthcare providers about her substance use because she feared losing custody of her child, shows how stigma and punitive assumptions can shut down honest communication.
If providers used person-first language (e.g., pregnant person with a substance use disorder) and created a more respectful, understanding environment,
patients like Tina would be more likely to seek help without fearing judgment or reprisal.
This shift in language and attitude can foster trust, ensuring that those needing care feel safe,
rather than threatened, when they reach out for support.
Nearly a decade later, Cecily May Barber and Mishka Terplan (2023) confirm these barriers remain. Despite growing awareness and research, care models for pregnant and parenting individuals who use substances often remain punitive and fragmented. Both Knight and Barber and Terplan emphasize that these patients are not “refusing” care but instead encounter systems that are either inaccessible or dangerous. Everyday challenges, such as finding transportation or childcare, often become insurmountable barriers, leaving patients without reliable treatment pathways. This highlights a need to rethink how care is delivered to meet patients where they are.
Barber and Terplan advocate for harm-reduction approaches that acknowledge patients’ unique circumstances, focusing on incremental progress rather than immediate abstinence. Tools like the 4Ps Plus allow providers to identify substance use risks in a nonjudgmental way, fostering open communication and trust. Knight’s ethnography further emphasizes addressing underlying inequities by integrating stable housing, mental health services, and culturally informed care into healthcare systems. These supports are especially crucial for patients like “Lisa,” who use substances as a coping mechanism for unresolved trauma. Co-locating perinatal and addiction services, offering transportation support, and partnering with community organizations can help break down the barriers that prevent patients from receiving compassionate, effective care. The lessons from Knight’s work and Barber and Terplan’s evidence-based recommendations provide a roadmap for improving reproductive healthcare. Making care more accessible includes replacing stigmatizing terms with respectful language, implementing nonjudgmental screening tools, and addressing practical barriers such as transportation and childcare. By adopting trauma-informed, harm-reduction approaches, providers can create environments where patients feel supported rather than judged.
As healthcare providers, policymakers, advocates, and students, we all have a role to play in building equitable care systems. This work begins by reflecting on our language, questioning policies that punish rather than heal, and advocating for accessible care models that meet the needs of all patients. By applying the insights from Knight’s ethnography and Barber and Terplan’s recommendations, we can move beyond outdated punitive frameworks and build systems that foster dignity, equity, and healing. Together, we can create environments where pregnant and parenting people who use substances feel seen, supported, and valued, ensuring that everyone can thrive.
References:
Barber, C. M., & Terplan, M. (2023). Principles of care for pregnant and parenting people with substance use disorder: The obstetrician gynecologist perspective.
Frontiers in Pediatrics, 11, 1045745. https://doi.org/10.3389/fped.2023.1045745
Warren, N. (2018). Knight, K.R. Addicted. Pregnant. Poor. Durham, NC: Duke University Press. 2015. £21 (pbk) ISBN 978-0822359968 £70 (hbk) ISBN 978-0822359531.
Sociology of Health & Illness, 40(3), 597-598. https://doi.org/10.1111/1467-9566.12519
*Note: an excerpt of this Spotlight is included in AMSA Reproductive Health Project eNews #35: 2025 is Here! Find Connections, News & Resources, Jan 4 2025
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