Shame, Stigma, and Maternal Concern: Understanding Motivation for Treatment in Substance Abusing Pregnant and Postpartum Women

Background and Purpose: The nature of substance misuse for women who are pregnant and/or early parenting is profoundly complex. Understanding this complexity is crucial as the population of mother-infant dyads affected by substance use is growing in the U.S. (Patrick et al., 2012) and parental substance abuse is a major contributing factor for up to 2/3 of children involved in child welfare. In recent years, the link between women’s substance use and parenting has understandably been examined primarily through a child-focused lens. However, few in-depth studies of the experiences and needs of pregnant substance using women have been undertaken (Kuo, et al., 2013). These women are among the most stigmatized in society. Thus, gaining knowledge of their experiences and motivations for treatment is essential for the development of evidence-based parent-child interventions aimed at maintaining recovery and optimizing parenting practices.

Methods: This qualitative needs assessment was conducted as the first step in the development of a multi-service perinatal intervention for mothers and infants. Semi-structured retrospective interviews were conducted with 21 mothers (M age= 29) of children 4 years old or younger who used opiates (e.g., heroin, methadone, painkillers) or cocaine during pregnancy. Participants were predominantly Caucasian, approximately 1/2 were single, 1/3 had some college education and most were receiving methadone at the time. The interviews had three aims: to detail the mothers’ social/emotional experiences during pregnancy and postpartum; to review contact with systems of care such as, health care/hospital staff and child welfare; and to reflect on their needs during pregnancy and postpartum. Interviews were recorded and transcribed verbatim. Thematic coding using Grounded Theory techniques was conducted by two RAs in consultation with the PI. It was anticipated that women’s experiences with pregnancy, substance use and systems of care would provide clues to understanding motivation for treatment and subsequent program development.

Results: Findings show that participants were often secretive about their substance use during pregnancy due to shame and fear of judgment by family and health care providers, as well as fear of losing their child. Hiding drug use led to isolation and restricted use of services. Many women shared experiences of being stigmatized and witnessing misinformation once their drug use was exposed. Conversely, concern about the health of their unborn infant motivated many participants to seek treatment and to reveal their substance use. Once they were honest some participants had helpful experiences with providers and subsequently were able to initiate treatment. Numerous suggestions were offered regarding engaging substance using pregnant women in services.

Implications: This study provides initial findings to aid understanding of substance using pregnant women’s use of treatment services. Shame, stigma, fear and misrepresentations all served to limit these women’s use of treatment despite frequent concern for their unborn child and the desire to be a good parent. Findings from this study are being used to develop a new community-based intervention for pregnant and postpartum women and infants in recovery from substance abuse and can be used to inform overall social work practice in child welfare.