The stories behind the numbers: Purdue nursing researcher confronts stigma in treating maternal substance use disorders

Written By: Rebecca Hoffa, rhoffa@purdue.edu

In Indiana, 31.4 mothers die for every 100,000 births, according to the March of Dimes’ 2025 report card. Nationwide, according to the same data, 23.5 mothers die for every 100,000 births, which puts Indiana among the highest maternal mortality rates in the country. Through both research and nurse education, Kalyn Renbarger, assistant professor in the Purdue University School of Nursing, is hoping to help shape maternal health in a positive trajectory, both in Indiana and beyond.

“The data gives us the numbers, but there’s a story behind each one of those numbers, and it’s important to hear the stories themselves,” said Renbarger, whose work often focuses on qualitative data to gather how the participants feel. “I am motivated to get their voices out.”

A bulk of Renbarger’s work centers around maternal substance use disorder and how nurses respond to treating pregnant women who are using substances.

“These women face stigma and are fearful, and it keeps them out of the care they need,” Renbarger said. “Stigma keeps them from seeking treatment for their substance use disorder during pregnancy. It also prevents them from engaging fully with their infants. There are also these cliffs in postpartum care where women may be seen during their pregnancy, but then the resources kind of drop off. Postpartum is when they’re experiencing a lot physical and hormonal changes, and now they have a new infant to care for. So, a lot of the maternal deaths are preventable, and they happen in that postpartum period when women are really vulnerable.”

In studying healthcare providers’ attitudes toward maternal substance use, Renbarger has put her focus on nursing students to see where the biases begin.

“I’m a nurse, and I have experienced stigma toward the women with other nurses,” Renbarger said. “The stigma is real. I’ve been a nurse educator now for roughly 17 years, and taking students into the clinical setting, that stigma is very prevalent in nursing students as well. My thinking was that if we could target nurses earlier, when they’re just starting their careers, and tackle that stigma, we can eventually influence the care setting.”

In a series of studies looking at nursing students’ knowledge and attitudes toward substance use in pregnant women, with the most recent published earlier this year, Renbarger found these stigmas are already prevalent when students enter college. To combat or reverse the stigma, Renbarger is looking to develop a virtual reality simulation to expand their worldview.

“What we found is the rates of stigma are similar to what the rates are in nurses who are currently practicing as a nurse,” Renbarger said. “We’re wanting to create a virtual reality simulation to target stigma from nurses based on the mothers’ stories themselves. We have these stigmas, but a lot of the interventions don’t really include the mom’s voice in all of it.”

Renbarger has also spent a significant portion of her work looking at health disparities, both in her research and outreach. Some of Renbarger’s colleagues connected her with a nursing school in Uganda to help improve maternal outcomes there, which informs her work improving health disparities across groups of women. Locally, Renbarger is collaborating with the College of Engineering to improve health outcomes for Black mothers.

“I’m working to develop an AI-enhanced mHealth (mobile health) app for Black mothers who experience higher (maternal death) rates — three to four times higher — than white mothers in Indiana, but also across the United States,” Renbarger said. “I conducted a couple of studies listening to their stories about their perinatal care and talking about their knowledge around maternal mortality.”

Ultimately, Renbarger noted the central undertone across the issues she studies is that many women often feel unheard — a phenomenon she hopes to change through her research in the College of Health and Human Sciences.

“When I look across different populations, the big finding is that women feel dismissed in their care and feel unheard,” Renbarger said. “So, whether I’m working in Uganda or I’m working with women here, it’s a common theme.”