Strength in the Margins: A Narrative Review of Culturally Responsive and Strengths-Based Care for Pregnant Women Who Use Substances.

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.