Implicit Bias and Breastfeeding Among Women With Opioid Use Disorder on Medication-Assisted Treatment

BACKGROUND: Breastfeeding enhances maternal-newborn bonding, supports newborn nutritional requirements, and is recommended in mothers undergoing medication-assisted treatment (MAT) for opioid use disorder (OUD). Breastfeeding decision-making is complex and may be influenced by implicit biases among healthcare providers, negatively impacting maternal quality of care and breastfeeding outcomes in mothers with OUD. PURPOSE: This integrative review aimed to synthesize current evidence on how healthcare professionals' implicit bias affects breastfeeding initiation, support, and continuation among women with OUD. STUDY SELECTION: Included studies focused on women with OUD, specifically those on MAT, and examined bias in relation to breastfeeding. Studies were excluded if they did not involve pregnant or postpartum women on MAT, focused solely on polysubstance use, or addressed only racial bias. A total of 117 articles underwent title and abstract review. DATA EXTRACTION AND ANALYSIS: Of the 117 articles initially identified through the database search, only 28 met the preestablished inclusion and exclusion criteria and were ultimately included in this integrative review. RESULTS: Key themes emerged: stigma and discrimination, lack of social and institutional support, provider knowledge gaps, and maternal fears related to recovery. Studies included qualitative, quantitative, and mixed methods research. IMPLICATIONS FOR PRACTICE AND RESEARCH: Educating healthcare providers with accurate, evidence-based information can reduce bias and better support women with OUD in achieving their breastfeeding goals. Future studies should examine how implicit bias impacts breastfeeding in this population to inform provider training and resource development.