Background: Substance use during the perinatal period poses significant physical and mental health risks for parents and children. The harm reduction model of perinatal substance use responds to the reality that while it may not be possible for all pregnant people who use drugs (PPWUD) to become abstinent, individuals can enhance their well-being through safer use, reduced use, or constructive changes unrelated to substances. At the same time, emerging research suggests that service providers experience conflicts and ethical dilemmas when implementing harm reduction approaches with PPWUD. To our knowledge, no research has described these challenges or investigated how providers negotiate them.

Objectives: This study aims to (1) describe harm reduction practices that clinicians mobilize in the perinatal context (2) describe the tensions arising from applying a perinatal harm reduction framework and (3) examine how service providers negotiate these challenges.

Methods: The study is being conducted in collaboration with a perinatal substance use clinic in Montreal (Canada) that operates from a harm reduction framework. We have conducted 10 semi-structured interviews with perinatal service providers including nurses, social workers, and physicians. Interview audio is being recorded, transcribed, and analysed using NVivo. Data analysis is following a reflexive thematic analysis approach. Data remain in the original language (French) during analysis and are being coded by a bilingual researcher.

Results: Preliminary analysis suggests that clinicians mobilize harm reduction practices such as parenting safety plans, home visits, and adapting to clients’ individualized paces. Initial results indicate that providers experience tensions in the following four domains: 1) health and social systems, including hospitals and child protective services; 2) relationships between professionals; 3) relationships with clients; 4) internal conflicts within themselves. To manage these tensions, initial results suggest that providers foster team cohesion, anchor their practice in empathy, prioritize therapeutic alliances and transparency with clients, and cultivate interagency collaboration.

Conclusions: This project bridges the gap between perinatal harm reduction as a concept and perinatal harm reduction as an on-the-ground praxis that operates within interpersonal, organizational, and systems-level dynamics. Once finalized, the results of this study will be used to inform a perinatal harm reduction clinical guidance document to be released in the province of Quebec (Canada), in March 2027.