Exploring the reproductive health and social care needs of women who use drugs : a qualitative study.

Abstract

Background and Aim Women who use illicit drugs are at higher risk of contracting sexual transmitted infection or disease, have poor contraceptive use, higher rates of unplanned pregnancy and are more likely to experience child removal. This research aims to explore the experiences and understanding women who use drugs have in relation to their reproductive health and sexual wellbeing. Methodology and Methods A systematic review of qualitative literature explored the lived experience of pregnancy among women who use drugs. Semi-structured, one to one interviews were conducted with women who use drugs and professionals who support them to explore their perspectives on reproductive health and sexual wellbeing. Findings Women who use drugs regard sexual and reproductive health as protection from disease and prevention of pregnancy. Findings from the qualitative systematic review indicate that pregnancy is often considered to be a window of opportunity for women who use drugs to incite change, however, this is nuanced and challenging for both them and services providing support. Findings from qualitative research demonstrate the lack of autonomy and body sovereignty experienced by women who use drugs have over their sexual and reproductive wellbeing. This was often exacerbated by sexual and physical abuse in their childhood and adult life. Accounts from women involved in my qualitative research suggest that they do attempt to exert agency surrounding their reproductive health, by exercising their right as women, to have children or not. Findings from both the qualitative systematic review and the qualitative research indicate that women who use drugs and experience pregnancy or have children are fearful of child removal which impacts on their access to care. Discussion Women are cognisant that access to care will increase their visibility and often results in intensive monitoring and surveillance from health and social care agencies. For this reason, and in order to pursue anonymity, women and mothers who use drugs avoid treatment and care and instead 2 implement discursive and covert strategies to manage their health and wellbeing. Punitive and adversarial approaches (including drug testing) are a barrier to women’s access to care. Trauma informed care across all health and social care services should be implemented to support them better. Women who use drugs have limited autonomy and agency over their reproductive health and wellbeing, which further marginalises and compounds their ability to meet societal expectations. Reproductive health and wellbeing interventions designed specifically for women who use drugs may improve their autonomy and access to care. These interventions should include family planning, informing women of the impact of drug use on their fertility and the promotion of healthy intimate partner relationships. Further research is necessary to support the implementation of these interventions and should be undertaken alongside women who use drugs so they can inform the development of interventions that will best meet their needs.