Assumptions of Womanhood: A Critical Discourse Analysis of the Minnesota 1115 Substance Use Disorder System Reform Demonstration

Background and Purpose: Substance use disorder (SUD) is a critical issue in Minnesota. From 2020 to 2021, opioid-involved overdose deaths rose in Minnesota by 43% (Minnesota Department of Human Services, 2023). In response to the ongoing opioid epidemic, the Minnesota Department of Human Services (DHS) launched the 1115 Substance Use Disorder System Reform Demonstration (“The Demonstration”) in 2022. Policymakers have demonstrated an ambitious commitment to treating SUD in Minnesota with the Demonstration, yet this policy may reveal shortcomings, such as the medicalization of women’s bodies and racial disparities in women’s construction. These essentializing elements have consequences for women with SUD, such as internalizing stigma and shame (Smith et al., 2022). This study addresses the following research question: “Using state and federal documents pertaining to Minnesota’s 1115 Substance Use Disorder System Reform Demonstration, what assumptions are evident in the construction of womanhood?”

Methods: This study uses Goodkind et al.’s (2021) epistemological principle of “reframe questions, problems, dilemmas, and goals” to answer its research question (Goodkind et al., 2021). The primary data for this study are 15 state and federal documents that were written by DHS and the Centers for Medicare and Medicaid Services (CMS) dating from March 28, 2018 to February 14, 2022. The author used content analysis to quantify the themes of womanhood and pregnancy. In addition, critical discourse analysis (Fairclough, 2012) was used to explore the relationship between policymakers’ language in the primary data in relation to assumptions evident in the construction of womanhood. This was conducted using the qualitative software package Nvivo, maintaining a codebook, and memo-writing.

Results: The results of the content analysis revealed that, throughout 986 pages, women were mentioned 21 times, and pregnancy was mentioned 98 times. All but one of the sentences about women were written in the context of pregnancy or motherhood. This laid the groundwork for the critical discourse analysis, which revealed several unexamined assumptions regarding womanhood. Specifically, analysis of the data showed an assumption that men and women need the same approach to SUD treatment, and the only noted difference is if a woman is pregnant. The data were explicit in the need to “target” a woman if she is pregnant, which contributes to the medicalization of a woman’s body, rather than the perception of a woman as a complete human being. Furthermore, the data expressed an assumption of BIPOC women’s deviance from societal expectations when pregnant, as demonstrated by the policymakers’ overemphasis on BIPOC women being at increased risk of SUD during pregnancy.

Conclusions and Implications: This critical discourse analysis reveals how policymakers maintain assumptions evident in the construction of womanhood, such as the medicalization of women’s bodies and the racialization of BIPOC women. These findings demonstrate the need for policymakers to consider gender differences in SUD that transcend the assumption of pregnancy and motherhood. Social workers should advocate for further policy considerations in the treatment of SUD that include transgender women, gender non-conforming individuals, and those who cannot or choose to not have children.