Pregnant women and substance use: fear, stigma, and barriers to care

Abstract

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.

Screening Pregnant Women and Their Neonates for Illicit Drug Use: Consideration of the Integrated Technical, Medical, Ethical, Legal, and Social Issues

“…As mentioned, respect for persons requires that informed consent be obtained when screening for drug use, given the multitude of legal and social implications of a positive screen. Consuming drugs in pregnancy is considered child abuse in at least 19 states in the United States, and women can lose custody of their children based on a positive screening test, even without confirmation (Stone, 2015). Because women know of these legal consequences, many will engage in behavior to avoid detection, including not presenting for prenatal care and attempting to deliver outside of the hospital environment (Stone, 2015).…”

“…Consuming drugs in pregnancy is considered child abuse in at least 19 states in the United States, and women can lose custody of their children based on a positive screening test, even without confirmation (Stone, 2015). Because women know of these legal consequences, many will engage in behavior to avoid detection, including not presenting for prenatal care and attempting to deliver outside of the hospital environment (Stone, 2015). Therefore, screening women without adequate protection for their legal and social rights can have negative effects on both maternal health and the health of their children.…”

“…Approximately 5% of women will admit to taking illicit drugs while pregnant (Substance Abuse and Mental Health Services Administration, 2014). However, self-reported studies regarding maternal substance use disorders have a high incidence of underreporting, due to fear and associated stigma (Stone, 2015). Many women fear the consequences of using drugs in pregnancy, even if they cannot stop.…”

“…Many women fear the consequences of using drugs in pregnancy, even if they cannot stop. Certain US States including Alabama, South Carolina, and Tennessee have charged women who have taken drugs in pregnancy with child abuse and mothers who use illicit drugs are at high risk of losing custody of their newborns (Young et al, 2007; Stone, 2015). While these laws were originally designed to protect the fetus, the fear instilled in women can prevent them from enrolling in treatment programs and accessing medical care throughout pregnancy.…”

Criminalizing substance use in pregnancy: misplaced priorities

“…Y.N.). Currently, 17 states hold that substance abuse during pregnancy qualifies as child abuse under civil child welfare statutes [5].…”