A new study has revealed how pregnant women attempting to access treatment for opioid use disorder (OUD) are routinely met with stigma, judgement and outright denial of care across the US.
The research, published in the journal Women’s Health Issues, used a large-scale simulated patient field experiment to examine the barriers faced by women aged 25 to 30 seeking appointments for buprenorphine treatment. Callers were randomly assigned characteristics such as pregnancy status, race or ethnicity, and insurance type, and then contacted over 5,900 authorised providers to request help.
Despite buprenorphine being an evidence-based medication for treating OUD, particularly in pregnancy, the study found widespread reluctance among providers to offer care to pregnant women. Among the most frequent responses was outright refusal, often accompanied by dismissive or hostile attitudes. Many clinics informed callers that they did not treat pregnant patients or that the presence of a pregnancy was a “liability”, with some staff abruptly ending calls once pregnancy was mentioned.
The study also exposed the layered impact of stigma, especially when gender, race, and socioeconomic factors intersect. Callers simulating Black or Hispanic women encountered subtle but harmful microaggressions. Others with public insurance were questioned about their ability to pay or were told Medicaid was not accepted. Pregnant callers were judged as irresponsible or accused of waiting too long to seek care. One woman was even advised to “just Google it” when asking for treatment options.
These encounters, while only a few minutes long, reflect deeper systemic issues. Researchers highlighted how institutional culture, outdated practices, and provider bias contribute to a climate where women are dissuaded from seeking life-saving care. They also found policies such as demanding Social Security numbers before scheduling, or requiring payment upfront, often served as tools of exclusion.
Despite the supposed removal of some regulatory barriers to prescribing buprenorphine, such as the waiver requirement, many providers still operate within a framework that excludes the very people who most need support. The research points to a persistent belief that individuals with OUD, particularly pregnant women, are untrustworthy or incapable of making rational decisions about their health.
Community experts consulted as part of the study offered practical recommendations, including increased funding for clinics, wider use of peer support workers, and better training for providers. They also called for national policies to reduce stigma and expand access to care for pregnant people living with OUD.
As overdose deaths among women continue to rise, and as maternal OUD becomes more prevalent, researchers warn that failing to act could have severe consequences for both mothers and their infants. They argue that stigma is not merely a personal bias but a structural force that is shaping who receives care and who is left behind.
The authors call for urgent, multi-level interventions across clinical, community and policy settings to confront stigma and ensure equitable access to treatment for all women, regardless of pregnancy, race, or income.
