Legacies of prohibition in Canada: calling for a reproductive justice approach to cannabis use during pregnancy

While the 2018 Cannabis Act adopted in Canada signaled a non-prohibitionist approach to cannabis use, governments have not yet reached consensus on how to tackle it, especially amongst groups deemed vulnerable like pregnant persons. Focusing on healthcare interventions, this article investigates institutional approaches to cannabis use implemented in Canada since legalization, as well as the experiences, responses, and coping mechanisms pregnant persons employ to navigate the system, to unveil whether historical social inequalities and norms grounded in prohibitionism have transformed. Adopting a feminist approach, we conducted 36 semi-structured interviews with healthcare professionals and cisgender women who used cannabis while pregnant in the Province of Quebec (Canada). We argue that current institutional practices and discourses in healthcare still reflect some of the gendered, classed, and raced patterns embedded in the previous prohibitionist paradigm. Indeed, we coin three “legacies of prohibition” by which social inequities pervade: i) social representations around “problematic use,” ii) practices of punitive care, and iii) pregnant persons’ coping strategies that are reminiscent of the era of criminalization. We call for a reproductive justice approach to cannabis use during pregnancy in Canada, through healthcare practices that account for and effectively address the structural and institutional barriers affecting the capacity of pregnant persons who use cannabis to make informed reproductive health decisions.