The risk of being ‘too honest’: drug use, stigma and pregnancy

Abstract

In this article, I examine the ways in which risk is constructed and managed by those involved in the pregnancy and childbirth of women who use drugs, including the women themselves. I discuss how constructions of risk influence maternal care outcomes and the understanding of choice, often in the form of stigmatisation. In this article, I draw on data from a qualitative research study that I conducted in 2011 in a western Canada city in which I interviewed 13 pregnant and parenting women who had used drugs during their pregnancy. In this article, I show how the everyday risk construction of pregnancy, labour and delivery is compounded significantly by drug use and the stigmatisation associated with this perceived risk-taking behaviour. The participants in the study often internalised this understanding of risk and this manifested itself in delays in accessing maternal health and social care services. The women in the study had different understandings of risk and these were structured by the women’s own understanding of general risk factors during their pregnancy, as well as their experiences of the constructions of risk and risk management by health and social care professionals. While structural life chances can constrain women’s feelings of self-efficacy, services that promote clients’ ability to make choices can facilitate reduced stigmatisation and facilitate the development of more compassionate and autonomous approaches to risk management.

Keywords:

• risk
• drug use
• pregnancy
• maternal health and social care
• stigma
• risk management

Acknowledgements

I would like to thank the individuals at the Centre for Addictions Research British Columbia, the University of Victoria, and the women who participated in this research project.

Notes

1. The author of this article was sole interviewer for this research, as the fieldwork and data analysis were part of the academic requirements for obtaining a Master of Arts degree in Sociology. The researchers who were involved with the larger research project were comprised of nurses, academics, medical doctors and community representatives who worked together with the HerWay Home Programme planning team and main funders to develop the programme from the initial conception, design and eventual delivery. Professor Cecilia Benoit supervised this Masters research and was the principal investigator of the larger research project.

2. This research was funded by the Banting and Charles Best Canada Graduate Scholarship, granted by the Canadian Institute for Health Research, and through a fellowship from the Sarah Spencer Foundation.