“It Was Like a Baptism by Fire:” Sexual and Reproductive Healthcare Providers’ Training Experiences Related to the Provision of Care to Black and Latina Women Who Use Substances in the United States

Abstract

Black and Latina cisgender and transgender women who use substances face adverse sexual and reproductive health (SRH) outcomes due to intersecting forms of discrimination and limited access to high-quality SRH services. Insufficient research has explored healthcare providers’ views and experiences related to delivering SRH care to multiply marginalized women, especially the role of training in shaping their attitudes and practices. Using purposive sampling, we conducted online, in-depth interviews with 20 SRH care providers in Massachusetts and Rhode Island in August-November 2023 to elucidate how their training influenced their provision of SRH care to Black and Latina cisgender and transgender women who use drugs and identify the strategies they used to address the limitations of their formal training. Using intersectionality-informed thematic analysis, we found that most providers expressed dissatisfaction with their clinical education, which failed to address how racism, transphobia, and substance use stigma simultaneously influenced SRH outcomes and care. Further, many reported that the training needed to provide high-quality SRH care to Black and Latina cisgender and transgender women who use drugs largely occurred outside of their formal education, but that burnout, time constraints, and lack of reimbursement undermined their ability to obtain additional training and deliver tailored care. Providers also described how their professional and personal backgrounds influenced their practices and noted that specialized SRH education, working in person-centered care settings, and sharing social identities with patients facilitated their provision of high-quality SRH care to Back and Latina women who use drugs. Medical and nursing programs should incorporate training on intersectional discrimination and facilitate the enrollment of students with multiple minoritized social identities to advance SRH equity and justice.