Background: Following national trends, Rhode Island has observed an increase in congenital syphilis births in recent years among women who use drugs and/or are homeless. After a decade of seeing no cases, there have been nine cases reported from 2020 through 2023. The majority of these cases were individuals who accessed prenatal care late in their pregnancies. Rhode Island's reponse was to learn from community members how to develop a public health response grounded in health equity.
Methods: Bilingual Rhode Island Department of Health (RIDOH) staff conducted focus groups with twenty-five women who accessed care at Parent Support Network, a social service agency for mothers experiencing substance use disorders. The purpose of the focus groups was to identify barriers to pre-natal care among this group. The focus groups were also used for consumer input for campaign materials and street outreach activities.
Results: The top three barriers to accessing prenatal were: 1) Fear of losing their children to DCYF by confiding in doctors that they have a current/past drug use history; 2) Stigma and shame encountered in clinical settings; 3) Lack of knowledge of pregnancy due to irregular menstrual cycles related to drug use. The focus group members strongly endorsed harm reduction street outreach efforts that included education and referral to prenatal care and family planning, distribution of pregnancy kits, and access to emergency contraception.
Conclusion: On Februray 1, 2024, a social media marketing campaign was launched called "Healthy Beginnings." The messaging focused on accessing prenatal care, and intentionally did not include the term "congenital syhilis" in order to avoid stigmatization. Early pregnancy test kits are being distributed through street outreach and harm reduction vending machines in various settings, including probation offices, SUD treatment sites, and FQHC's. In the first six weeks of the campaign 350 individuals clicked on the social media ads.
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