“They Gave Me Life”: Motherhood and Recovery in a Tribal Community

Background: Many tribal communities strive to develop effective programs addressing substance abuse among pregnant women, but there are limited data on substance use during and after pregnancy among Native women. While Native women have high rates of abstinence, they are more likely than other women to meet criteria for past year need for substance abuse treatment. Unfortunately, few Native women are referred or enrolled in treatment programs and available treatment programs are usually not culturally specific. Few studies examine women’s recovery in tribal communities. This study explored tribally-specific factors related to lower substance use among Native mothers.

Method: Using a community-based participatory research model, this research developed in response to a tribal health board request to explore maternal health, substance use, and recovery. This mixed-methods project included 20 in-depth interviews, one focus group, and a cross-sectional, community-based sample of 101 American Indian, Alaska Native, and First Nations women of childbearing age (18-44 years). Eighty-three percent had primary responsibility for 1-3 children and 75% had a partner. Because we were interested in the experiences of Native mothers, quantitative analysis included women who reported ever having been pregnant (N=87). Frequency of substance use before and during pregnancy and lifetime trauma (i.e., childhood trauma and domestic violence) were analyzed using descriptive statistics. We also conducted bivariate analysis to examine the effects of lifetime trauma on substance use. Transcripts were analyzed using an inductive thematic approach to identify narratives of substance abuse and recovery in the lives of Native women of childbearing age. Findings were reviewed with tribal members. 

Results: Mothers in this community experienced high rates of lifetime trauma – 69% reported childhood abuse and 46% had been physically assaulted by a partner in the past year. Among those who reported childhood abuse, 36% experienced childhood physical abuse which is positively associated with alcohol abuse (t=2.67, p<.01). Regarding substance use 3 months before pregnancy, 46% smoked 5 or more cigarettes per day, 15% reported ever having binge drank, and 20% ever used marijuana. Importantly, substance use decreased during pregnancy – 24% smoked, 6% binge drank, and 9% used marijuana. Qualitative findings provide in-depth knowledge about motivations and strategies for getting and staying sober. Three themes related to substance abuse and recovery emerged: the relationship between lifetime trauma and substance abuse, the role of spirituality and traditional healing and the importance of motherhood in recovery.

Implications: Substance abuse during pregnancy is associated with multiple neurological and physical impairments and substance use in parents after pregnancy has been associated with challenges for family health and wellness. Identification of successful strategies for becoming or staying sober for Native mothers in tribal communities is an important step in the creation of sustainable, culturally-relevant interventions supporting maternal health. Because so many Native women experience lifetime trauma, it is imperative that women are provided trauma-informed care in maternal health and treatment services. Findings also suggest that family-oriented treatment services integrating families in recovery are critical and that services integrating culture and traditional healing may be more successful in Native communities.