Examining the impact of naming equity within perinatal substance use and mental health policy: a scoping review

The ways in which we understand and respond to perinatal substance use are explicitly and implicitly driven by policy. Perinatal substance use is a visible manifestation of intersecting systems of oppression, shaped by racist, colonial and sexist discourses surrounding mothering and drug use. Policies related to perinatal substance use and mental health have far-reaching impacts on families, communities and generations. This scoping review examined the conceptualization and operationalization of equity within foundational perinatal policies in one Canadian province, British Columbia (BC), between 2005 and 2025. Documents were included if they were: (1) provincial-level policy documents that either (a) guided perinatal service delivery generally or (b) focused on mental health promotion, prevention of mental disorders or harms of substance use; (2) publicly available; and (3) published within the study timeframe. Inductive content analysis and sensitizing questions were used to explore how equity concepts were conceptualized and integrated. In total, 30 documents met inclusion criteria. Equity was mentioned in 15, but only 4 provided explicit definitions. Often, implied proxy terms for equity were substituted to discuss equity considerations, such as risk, disadvantage, social determinants of health, vulnerable, marginalized and harm reduction, with limited direction on public health system roles or accountability in addressing root causes of inequities. Content analysis yielded the following missed opportunities in the results: an absence of clear definitions; focus on accessibility; inattention to structural conditions; and incoherent concepts of equity. Given BC's reputation as a leader in equity-oriented perinatal substance use policy, these gaps are notable. In the context of an expanding drug poisoning crisis and increasing global recognition of equity as foundational to public health, it is imperative to examine how equity is understood and actioned in policy to strengthen alignment between intentions and outcomes.