Perinatal substance use is increasingly recognized as a behavioral health system challenge rather than a purely clinical issue, with implications that extend across national borders.
Recent population-level research on socioeconomic disparities in substance-related emergency department visits among pregnant and postpartum women highlights patterns relevant not only to the United States but also to Ghana and other countries facing similar pressures on maternal and behavioral health services.
Perinatal substance use refers to the use of alcohol, tobacco, prescription medicines in non-prescribed ways, or illicit drugs during pregnancy and after childbirth, typically up to one year postpartum (after childbirth).
This period is medically and emotionally sensitive, and substance use during this time can affect not only the mother’s health, but also pregnancy outcomes, infant development, and family stability. Despite its impact, perinatal substance use is often misunderstood, hidden, or addressed only when it becomes a crisis.
Why perinatal substance use is a behavioral health issue
Behavioral health is a broad term that describes how emotions, stress, habits, coping mechanisms, and mental wellbeing influence health and daily functioning. It includes mental health conditions, substance use and the way people respond to life pressures. Behavioral health is not only about illness; it is also about how people cope, adapt and seek support when facing challenges.
Substance use during pregnancy is sometimes framed as a moral failing or a purely medical concern. However, health systems research increasingly shows that it is better understood as a behavioral health issue shaped by social and economic conditions.
During pregnancy and the postpartum period; the hormonal changes, emotional stress, and social expectations can intensify vulnerability. Many women who use substances during pregnancy or after childbirth are responding to stress, anxiety, depression, trauma, or social pressure.
When behavioral health services are weak or poorly integrated into maternal care, women are more likely to seek help late, often through emergency units rather than preventive services.
What health systems data are showing
A study, conducted by a research team at the University of Nevada, Las Vegas, a U.S. research university, analyzed trends in perinatal substance-related emergency department visits before and during the COVID-19 pandemic.
The findings, published in the Journal of Women’s Health, a reputable women’s health journal affiliated with an R1 research ecosystem (DOI: https://doi.org/10.1177/15409996251370887), showed that women from lower socioeconomic backgrounds were disproportionately represented in emergency care for substance-related conditions, both before the pandemic and throughout its disruptions.
Researchers note that these visits often reflect gaps in access to preventive and community-based behavioral health services, rather than isolated individual behavior.
These patterns were observed both before and during the COVID-19 pandemic, suggesting long-standing gaps in care rather than short-term shocks.
Emergency departments are designed for urgent medical situations, not ongoing behavioral health support. When they become the main point of care, it often signals missed opportunities for early identification, counseling, and follow-up within routine maternal health services.
Why this matters for Ghana
Even though much research comes from high-income countries, the implications are highly relevant to Ghana. In many parts of the country, maternal health care focuses mainly on antenatal visits, childbirth, and physical problems. Mental health and substance use during pregnancy are often not talked about unless the situation becomes very serious.
Perinatal substance use is often discussed only in extreme cases, yet the underlying drivers are more common than many assume. Economic hardship, unemployment, housing problems, relationship stress, and untreated mental health challenges can make pregnancy and life after childbirth very difficult.
When women do not have access to proper emotional or behavioral health support, some may turn to alcohol, unregulated medicines, or other substances to cope.
Ghana has made strong progress in encouraging women to attend antenatal care and deliver in health facilities. However, routine screening for mental health or substance use during pregnancy and after childbirth is still limited. Because of this, problems are often missed at the early stages.
Many women only visit health facilities when the situation gets worse and requires emergency or hospital care. Behavioral health professionals are few, referral pathways are fragmented, and stigma around substance use during pregnancy discourages women from seeking help early.
As a result, district hospitals and emergency units may encounter women only when problems have escalated, reinforcing a cycle of reactive rather than preventive care. This mirrors patterns seen globally, even though the health system contexts differ.
A global pattern, not a local problem
While health systems differ across countries, the patterns observed in perinatal substance use are strikingly similar worldwide. Research from high-income countries, including the United States, shows that pregnant and postpartum women from lower socioeconomic backgrounds are more likely to rely on emergency care for substance-related issues. This is not because emergencies are more common among these women, but because preventive and community-based services are less accessible.
In lower- and middle-income countries, including Ghana, the same dynamic appears in different forms. Limited behavioral health infrastructure, shortages of trained professionals, and fragmented referral systems often mean that support is unavailable until problems become severe. In both settings, emergency services end up absorbing cases that could have been prevented through early screening, counseling, and follow-up.
The COVID-19 pandemic exposed these vulnerabilities globally. Disruptions to routine health services, increased economic stress, and reduced social support intensified risks for pregnant and postpartum women. The pandemic did not create perinatal substance use challenges; it revealed how fragile existing support systems were across countries and income levels.
What can be done
Addressing perinatal substance use requires clearer pathways for care. Pregnant and postpartum women need safe, non-judgmental spaces within antenatal and postnatal services where substance use and mental health can be discussed openly.
Community health workers and midwives can be trained to recognize early warning signs and provide basic psychosocial support or referrals. Public education is also critical to reduce stigma and encourage families to support women in seeking help early.
For individuals and families, the key step is early engagement. If a pregnant or postpartum woman is struggling with alcohol, drugs, or medication misuse, seeking help from a health facility, trusted health worker, or community support service as early as possible can prevent complications. Substance use during the perinatal period is a health issue, not a moral failure.
Perinatal substance-related emergencies are often the visible outcome of invisible system gaps. Strengthening behavioral health support within maternal care, before crises occur is essential for protecting mothers, infants, and communities in Ghana and around the world.
Ghanaian researcher sheds light on hidden health risks for pregnant women
By Abena Gyawu Owusu-Ansah
