Survivors seek safer, more supportive cannabis care in pregnancy

Intimate partner violence (IPV) is common during the perinatal period and is associated with increased use of nicotine and cannabis and difficulty with cessation. Despite this intersection, health care providers rarely address IPV and substance use (SU) concurrently, and there is little empirically guided information regarding how this communication should occur. This qualitative analysis explores IPV advocates' and perinatal survivors' perspectives on clinician approaches to perinatal cannabis and nicotine product use, highlighting areas for improvement. We performed semistructured, virtual 45- to 60-min interviews with IPV advocates and perinatal IPV survivors who used cannabis or nicotine. Interviews focused on: (1) how systems-level coercion related to SU manifests in health care; (2) survivors' experiences with nicotine or cannabis during the perinatal period; and (3) available resources. Interviews were audio-recorded, transcribed, and analyzed using deductive-inductive thematic analysis. Interviews with 19 IPV advocates and 15 survivors highlighted misconceptions and miscommunications about cannabis and nicotine product use during pregnancy. Gaps in knowledge related to risks of perinatal SU and best practices for cessation in pregnancy stemmed from inadequate education, inconsistent provider guidance, and limited resources. Participants stressed the need for nonjudgmental, consistent conversations and increased access to peer support and co-located IPV and cessation programs. Perinatal IPV survivors receive conflicting guidance on cannabis and nicotine product use, despite known risks. Findings reveal gaps in integrated IPV and SU support, highlighting the need for development of survivor-centered interventions that aim to improve patient-provider communication on perinatal IPV and SU.