BackgroundSubstance use during pregnancy and motherhood is both a public health and criminal justice concern. Negative health consequences associated with substance use impact both the mother and the developing fetus, and there are ongoing attempts to criminalize substance use during pregnancy that put pregnant substance-using women at risk of detection, arrest, and punishment. This study explored the experiences of substance-using mothers as they navigated health and criminal justice consequences and accessed needed resources in the community.MethodsIn-depth life history interviews were conducted with 30 recently-pregnant women who had used alcohol or other drugs during their pregnancies. The three-part interview schedule included questions about past and current substance use, life history, and experiences with criminal justice authorities, child protective services, and health professionals.ResultsWomen’s stories highlighted their strategies for managing their risk of detection by health or criminal justice authorities, including isolating themselves from others, skipping treatment appointments, or avoiding treatment altogether. Women described multiple barriers to treatment and healthcare, including a lack of suitable treatment options and difficulty finding and enrolling in treatment.ConclusionThe findings suggest that policies that substance-using women find threatening discourage them from seeking comprehensive medical treatment during their pregnancies. The implications of the findings are discussed, particularly the need for further expansion of treatment programs and social services to meet the needs of substance-using women.

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The current study employs a prospective mixed-methods design to examine women parolees’ identities early in their supervision and the association of their identity development at that point to their record of subsequent arrests. Guided by narrative identity theory, we first conduct quantitative analysis of the relationship between redemption and contamination narratives and subsequent arrests. We then return to the qualitative interview data to search for additional explanatory themes that shed further light on women’s identity and desistance from crime. Results indicate that identity verification from parole officers and others increases women’s self-esteem and assists them in overcoming barriers to desistance.

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