Summary Black women who use substances face significant barriers to accessing resources and parenting their children, largely as a result of interactions with the criminal legal, child welfare, and healthcare systems. While extensive literature has demonstrated how structural racism and punitive policy approaches underpin the operation and impact of these systems, minimal attention has been paid to how social workers approach child, maternal, and family well-being when interacting with clients who use substances and have been incarcerated. To address this gap, we conducted semi-structured qualitative interviews with 19 social workers practicing in jail/prison, community, and hospital settings across the United States. Findings Interviews identified the cyclical and intergenerational nature of harms perpetuated through criminal legal, child welfare, and healthcare systems. Participants described structural racism, inadequate resources (i.e., housing), and previous criminal legal and child welfare involvement as compounding barriers to an individual’s ability to parent and maintain recovery, particularly among Black families. Participants described the pervasiveness of structural racism but did not perceive themselves as active participants in perpetuating racist and oppressive structures. Applications Social workers engage with Black pregnant women who use substances across diverse practice settings and as such have the potential to both contribute to systemic harms and to champion interventions that target the root causes of inequity. Study findings support structural interventions that dismantle punitive systems and re-center the needs of Black communities, thereby supporting Black mothers in their fundamental right to parent their children.