Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)


Applied Health Research and Evaluation

Committee Chair/Advisor

Rachel Mayo

Committee Member

Lior Rennert

Committee Member

Kathleen Cartmell

Committee Member

Lori Dickes

Committee Member

Jennifer Barkin


Substance use disorders (SUD) impact millions of pregnant and postpartum people in the United States. With the increasing rates of perinatal substance use and the risk of overdose and death during the postpartum period, understanding overall functioning and the needs of postpartum persons is critical for informing interventions to reduce the impact of substance use within the perinatal period. The goal of this research is to explore the needs of postpartum people navigating SUD recovery.

This dissertation investigates postpartum maternal functioning within the context of early SUD recovery, as well as the comfort of reproductive healthcare providers (RHPs) to care for postpartum persons with SUDs effectively. Three chapters make up this dissertation; each chapter is focused on a different perspective of functioning during the postpartum period.

The first chapter describes the psychometric evaluation of the Barkin Index of Maternal Functioning (BIMF) as a tool for evaluating maternal functioning in a population of postpartum people receiving residential treatment for SUD. Maternal functioning was significantly lower in a sample of postpartum people with SUD compared to a similar non-SUD group. Exploratory factor analysis and reliability and validity assessment indicated that the BIMF showed reliability within a sample of postpartum people with SUD. Additional multi-variable modeling studies are needed to explore influences on maternal functioning while navigating SUD recovery.

The second chapter explores the experiences, practices, and needs regarding maternal functioning while also navigating SUD recovery. Semi-structured qualitative interviews were conducted with postpartum people enrolled in residential addiction treatment services. Most participants emphasized pregnancy as a significant catalyst for initiating treatment. They also described the importance of their peer-support network in maintaining their recovery.

The third chapter investigates reproductive healthcare professionals’ self-reported comfort with screening, educating, and referring postpartum people with SUD. A mixed-methods survey was distributed to a nationally representative sample of reproductive healthcare professionals. Most RHPs reported higher comfort in screening for SUD while being less comfortable with providing education about the risks and impacts of substance use during the postpartum period. Most RHPs described a need for comprehensive, perinatal-specific SUD training that is affordable and accessible for providers. Additionally, they expressed a need for improved referrals and increased collaboration across disciplines to improve care delivery for peripartum people with SUD.

Available for download on Saturday, May 31, 2025