One resident’s commitment to advocating for pregnant patients with opioid use disorder

September 16, 2019

Even though maternal and fetal medicine fellow Tani Malhotra, MD, knows that the stigma of substance use disorder runs deep, she knows that it’s her professional responsibility to not only have difficult conversations with her patients—but also to speak up for her patients to policymakers.

“Many of my patients feel like their medical disease is a moral failing,” she said. “They’re often very scared because they don’t know what will happen to them or their baby.”

In her work on the Pennsylvania Opioid Task Force and a leader in the AMA Resident and Fellow Section, Dr. Malhotra said that her policy research has made her more committed to advocacy. She pointed to how many states have criminally charged pregnant women for opioid use, the fear of having a child removed from the mother if he or she is born with neonatal abstinence syndrome, and the challenges new mothers face after giving birth when public benefits are stopped post-delivery.

The AMA Opioid Task Force issued a new recommendation this year to directly address maternal and fetal health. The Task Force believes it is essential to specifically highlight the important roles of physicians and policymakers in ensuring the unique needs of pregnant, postpartum and parenting women and children are met. Opioid use disorder among women of reproductive age and pregnant, postpartum and parenting women has increased over recent years, mirroring the epidemic seen in the general population. Yet, threats of incarceration, immediate loss of child custody, and other potential punishments drive pregnant, postpartum and parenting women away from vital prenatal care and treatment. The Task Force noted that research has found that non-punitive public health approaches to treatment result in better outcomes for both moms and babies.

“There are so many challenges, and we need to change a lot of state law, but there also are really great, evidence-based programs helping pregnant women and their babies,” Dr. Malhotra said, pointing to a grant program operated by Metro Health in Cleveland, the Maternal Opiate Medical Support Project (MOMS) as well as ongoing efforts at Metro Health. Promoting the positive effects of treatment, she said, is an essential part of her advocacy.

“It takes time to build trust in the community for women who are pregnant to trust us,” said Dr. Malhotra. “If a state has policies that will put them in jail or take away their baby, outcomes are going to be worse. That’s why in addition to my work as a physician, I take my responsibility as an advocate just as seriously.”

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