Reducing Maternal Substance Use Through Behavioral Change: Q&A with Yukiko Washio

Addressing maternal health is a multifaceted challenge, especially during the critical period of a baby’s development. Pregnant and lactating people may be unable or reluctant to take certain medications, making it essential to prioritize behavioral interventions that support their health. 

Yukiko Washio, a senior research psychologist in the RTI Global Gender Center’s Substance use, Gender, and Applied Research Program, brings over 20 years of expertise in designing and evaluating behavioral interventions to reduce maternal substance and alcohol use, while promoting health behaviors such as breastfeeding. In this conversation, Dr. Washio shares her insights and experiences from her postdoctoral fellowship with the National Institute on Drug Abuse (NIDA) and her work with diverse communities in the U.S. and South Africa.

What inspired you to focus on maternal health behaviors?

During my postdoctoral position, I was involved in maternal smoking cessation trials that used behavioral interventions. In secondary outcome analyses, we found compelling links between these interventions and positive birth outcomes. Specifically, average birth weight increased and incidence of low birth weight decreased for those in the intervention group compared to the control group. These findings reflect the positive impact of behavioral interventions on maternal smoking cessation.

Seeing the positive impact that quitting smoking had on both these women and their babies’ health was deeply moving. I was especially touched by the determination of the women, who remained committed to making healthier decisions while caring for their babies. Realizing that our research was making tangible differences in the lives of women and their children solidified my passion for advancing maternal health. 

What kind of evidence-based interventions do you develop and test?

I’ve found that behavioral approaches are often more suitable and well-received by pregnant and breastfeeding women, who are understandably cautious about using medications during such a critical period in their baby’s development. However, addressing maternal health requires more than focusing solely on cessation or substance use. A holistic approach is essential—considering broader, contextual factors such as intimate partner relationships, sexual health, mental health, stigma, and family dynamic. 

In my work, I’ve designed and tested a range of interventions rooted in behavioral science and behavior analysis. One key approach is contingency management, where participants receive financial incentives for achieving specific health behavior goals. Recently, I’ve explored integrating this method with screening and brief interventions, both of which are behavioral strategies aimed at supporting individuals with addiction. I’m also interested in examining the effectiveness of combining behavioral interventions with pharmacotherapy.

What communities and locations have you worked in?

I’ve conducted behavioral research with perinatal populations in various regions across the United States, including New England and the mid-Atlantic. This work has taken place in both outpatient clinical settings and community-based programs like Women, Infants, and Children (WIC) centers. Internationally, my work has focused on reducing maternal alcohol use in South African communities, which have some of the highest prevalence estimates of fetal alcohol spectrum disorders (FASD) globally.

Working in both domestic and international settings has underscored the importance of tailoring interventions to specific cultural and community contexts. At the same time, it has reaffirmed that evidence-based behavioral approaches can be highly effective across diverse populations when adapted thoughtfully.

What commonalities have you found across different populations, communities, and cultures?

Evidence-based behavioral interventions can effectively reduce maternal alcohol, smoking, and substance use across diverse populations if they are tailored to the unique needs of the community. Conducting focus groups and in-depth individual interviews is invaluable for adapting these interventions to fit different cultural contexts. Strategies that have been successful in the United States have also shown promise in international settings, and vice versa, with the right adaptation.

Some of the contextual factors that influence maternal substance use—such as stigma, family dynamics, and social support—are often consistent across domestic and international settings. Research from colleagues in the field has further demonstrated that many challenges faced by maternal populations are universal, reinforcing the importance of adaptable, culturally-sensitive interventions.

What issues do you consider important in addressing maternal health behaviors in the near future?

Looking ahead, I believe it’s essential to develop and test comprehensive, evidence-based behavioral interventions that address not only specific behaviors but also the broader context of a person’s life. Addressing maternal alcohol and substance use should occur in tandem with other critical health behaviors, such as breastfeeding, and consider key contextual factors, such as intimate relationships, mental health, and socioeconomic status. By adopting a holistic approach, we can better address the complex needs of pregnant and breastfeeding individuals and create lasting change.