Research presenting outcomes for women who enter substance abuse treatment during pregnancy consistently shows benefits. While treatment has nearly universal benefits, there are many barriers to seeking substance abuse treatment for pregnant women. The purpose of this study is to explore barriers for rural pregnant women seeking substance abuse treatment. There were three eligibility criteria for study participation: (1) aged 18 and older, (2) pregnant, and (3) undergoing short-term inpatient detoxification at the University of Kentucky Chandler Medical Center. Eighty-five rural women (N = 85) were included in the analysis. Substance use history and previous treatment were assessed with measures adapted from the Addiction Severity Index. Treatment barriers were measured with three qualitative questions and were coded into four overarching categories: availability, accessibility, affordability, and acceptability barriers. This sample had an extensive substance use history. Almost all participants had used alcohol (98%), marijuana (98%), illicit opiates (99%), and cigarettes (97%). On average, participants reported about two barriers to receiving treatment (Mean = 1.8; SD = 1.3), with over 80% of the sample reporting having experienced any barrier to treatment. The majority experienced acceptability (51%) and accessibility (49%) barriers. Twenty-six percent (26%) of the sample reported availability barriers. A smaller percentage of participants reported affordability barriers (13%). Rural pregnant women seeking substance abuse treatment face many obstacles to receiving needed treatment. More studies on barriers to substance abuse treatment among rural pregnant women are needed. Identifying these barriers can help in improving treatment access and services.

Barriers to entering and motivations for substance abuse treatment were examined among rural and urban pregnant women. All pregnant women entering inpatient detoxification at the University of Kentucky Medical Center were approached about participating in a study on health and well-being. One hundred fourteen (N = 114) pregnant women voluntarily participated. Treatment barriers and motivators were measured with open-ended questions. The Treatment Attitude Profile quantitatively measured motivation. Both groups reported approximately two treatment barriers. Top treatment motivators were pregnancy (65.8%), needing help (23.7%), family (18.4%), and being tired of the lifestyle (16.7%). Overall, Treatment Attitude Profile scores were fairly high (Mean = 74.3, SD = 10.7), representing motivation for treatment. Multivariate analyses revealed a significant negative relationship between treatment motivation and gestational age (β = -0.233; p = 0.012), and a positive relationship between treatment motivation and reporting an acceptability barrier (e.g., denial, stigma) (β = 0.202; p = 0.024). Few between group differences existed in barriers and treatment motivation. Individuals residing in rural areas have unique beliefs, social ties, attitudes, and financial hardships. Research about the role of these factors in treatment access and motivation could be used to minimize treatment barriers.

Among pregnant women, intimate partner violence (IPV) is recognized as a critical risk factor in adverse health outcomes for the mother and newborn alike. This pilot study examined IPV and health for rural Appalachian pregnant women, a particularly vulnerable high-risk and high-needs group. Participants were 77 rural, Appalachian pregnant women entering a hospital-based inpatient detoxification unit primarily for Opiate Dependence. Study participants gave informed consent to a face-to-face interview and secondary data abstraction from hospital medical records. IPV was measured via questions from the National Violence Against Women Survey, the Revised Conflict Tactics Scale (CTS2), and the Psychological Maltreatment of Women Inventory (PMWI). The majority of the sample reported lifetime psychological (89.6%) and physical (64.9%) violence. A little over three fourths (75.3%) experienced IPV in the past year. Furthermore, over one third (39.0%) experienced stalking, physical, or sexual violence in the past year. Most participants (71.4%) experienced psychological abuse in the past year. IPV experiences, in conjunction with pervasive substance use, mental and physical health problems, and poverty present in rural Appalachia, culminate in a particularly high-risk and high-needs group of pregnant women. These women present unique opportunities and challenges for prevention, intervention, and treatment.

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