Providers’ constructions of pregnant and early parenting women who use substances

Abstract

The research literature indicates that problematic substance use as a form of health behaviour is poorly understood, being sometimes viewed as deviance, at other times as a disease, and most often as a combination of these states. The use of substances by women who are pregnant or new parents is often conceptualised within an individualised framework. Yet drinking alcohol and using other drugs during pregnancy and early parenthood cuts across social divisions and is shaped by socio-structural contexts including health care. There is a growing body of literature that critically examines public health interventions that are aimed at implementing harm reduction and health promotion techniques in service delivery to help pregnant and early parenting women who are identified as problem substance users. We examine qualitative data from representatives of a recent harm reduction intervention, focusing, in particular, on providers' individual conceptualisations of the problematic behaviour. Our results show that most study participants regard any substance use during pregnancy, birth and the postpartum period as fundamentally unacceptable. This framing of problematic substance use is accomplished via gendered responsibilisation of women as foetal incubators and primary caregivers of infants. We discuss our results in light of the current literature and suggest policy implications.

Complicating the dominant morality discourse: mothers and fathers’ constructions of substance use during pregnancy and early parenthood

“…In contrast to the near universal view of abstinence as the ideal among the service providers we interviewed in an earlier stage of this study, parents were divided on the issue and were also less likely to view abstinence as the ideal and to frame mothers as fetal-vessels [ 27 ]. Instead, parents were more likely to place the mother as the centre of the discussion and as the subject of her reproductive experience and to describe her needs as inseparable from the needs of her child(ren).…”

“…Most of the service providers associated with HerWay Home that we interviewed regarded any substance use by women during the reproductive period as morally wrong and essentially insupportable. This notion of problematic substance use was framed within an individualized gendered responsibilisation perspective that depicts women as foetal incubators and primary caregivers [ 27 ].…”

Drug and alcohol treatment providers’ views about the disease model of addiction and its impact on clinical practice: A systematic review

“…Physicians' concern for social and family problems of clients indicated a much stronger desire to perceive alcoholism as a social or psychological problem rather than as a medical problem. In a Canadian study of family and infant health providers, substance use among pregnant women was seen as so deviant that practitioners did not use the disease concept to explain maternal substance abuse [69].…”

Between stigma and mother‐blame: blind mothers' experiences in USA hospital postnatal care

“…Surveillance medicine, particularly as it has targeted ‘bad mothers’, has led to the criminalisation of pregnant women in the USA as medical institutions and the criminal justice system cooperate to exact optimum compliance from women (Benoit et al . , Flavin ). As Flavin argues, ‘The climate has become one of surveillance, regulation, and enforcement rather than one of support and collaboration’ (2010: 23).…”