Safer prenatal care starts with listening, not stigma

Cannabis is the most commonly used illicit substance during pregnancy. Negative health and social outcomes associated with cannabis use disproportionately affect birthing people of color, particularly Latinas. Latina birthing people face compounding barriers to prenatal care, including discrimination, immigration-related fears, and distrust of healthcare systems rooted in histories of obstetric racism. This study examines the perspectives and experiences of Latina birthing people in California as they navigate prenatal care while using cannabis. We conducted qualitative, semi-structured interviews with 20 Latina birthing people. Eligible participants reported current or previous pregnancy within the last year concurrent with cannabis use, identified as Latina, lived in California, were 21 years or older, and spoke English and/or Spanish. We used constructivist grounded theory methods to analyze the data. We found that Latina birthing people who use cannabis: 1) Perceived their intersectional identities (race/ethnicity, age, partnership status) as potential vulnerabilities to poor prenatal care, particularly around cannabis use disclosure; 2) Sought more supportive clinicians based on these intersectional identities, though financial and insurance barriers prevented them from accessing preferred clinicians; and 3) Proposed solutions to improve their care, such as identifying clinicians who looked like them or adopting a whole-person approach that contextualized their cannabis use within their lived experiences. Discrimination, stigma, and racial profiling of Latina birthing people who use cannabis contribute to unsafe prenatal care environments. Open communication about the motivations and implications of cannabis use is needed to improve prenatal experiences and outcomes for Latinas, who may be using cannabis as a form of self-medication in the context of inadequate care access. Given that Latina birthing people who use cannabis experience discrimination, stigma, and racial profiling in prenatal care settings, it is critical to build structurally competent clinical environments that foster open, nonjudgmental counseling where discussions around cannabis use can occur safely. Systems-level interventions are needed, including clinician training on cannabis use counseling and bias, expanded and diversified clinical workforces, and community-based care options, such as doula integration.