Background: According to the CDC, almost one in four pregnancy-related deaths are attributed to preventable mental health conditions, including substance use disorder (SUD), making it the leading cause of pregnancy-related deaths in the U.S. The opioid and COVID-19 pandemics have exacerbated the concern of perinatal SUD, disparately impacting Black and Indigenous birthing people. Expanding access to mental and behavioral health services is imperative to improving U.S. maternal health.

Methods: Through a partnership, the Association of Maternal & Child Health Programs (AMCHP) and the Association of State and Territorial Health Officials (ASTHO) are experts on state approaches to addressing perinatal SUD. With support from the Maternal and Child Health Bureau in HRSA, AMCHP and ASTHO sponsored a special issue of the Maternal and Child Health Journal on public health approaches to prevent and mitigate the harms of perinatal SUD.

Results: The special issue features 20+ articles, authored by public health practitioners, that aim to improve maternal health by addressing perinatal SUD. Five strategic directions emerged from the special issue: (1) assess and understand perinatal SUD, (2) develop a diverse and competent perinatal behavioral health workforce, (3) integrate and co-locate perinatal and behavioral health services, (4) advance non-punitive and harm reduction approaches, and (5) strengthen systems support for perinatal people with SUD.

Conclusions: The strategic directions featured in the special issue are linked to program and policy approaches with actionable steps at the local, state, and federal levels to prevent and reduce the harms of perinatal SUD and improve U.S. maternal health.