A Qualitative Study of Substance use during Pregnancy: Implications for Reproductive Healthcare in Western Kenya

Abstract

Women who use alcohol and drugs are often in their childbearing years, creating a need for integrated substance abuse and reproductive health services. However, our understanding of the social context and drivers of substance use during pregnancy, particularly in developing countries, is limited and largely unaddressed in clinical care. Our qualitative research explored the reproductive health of women of childbearing age who inject drugs and its implications for healthcare in Kisumu, Kenya. We used in-depth, semi-structured qualitative interviews with 17 women who inject drugs to explore reproductive health topics including knowledge, practices, and clinical interactions related to substance use during pregnancy. All but one woman had a prior pregnancy and two were pregnant during our study. Alcohol and drug use was prevalent throughout pregnancy, often described as a coping mechanism for stress. Women received mixed advice from family and social contacts regarding alcohol use during pregnancy, leading to differing perceptions of its health effects. Healthcare providers infrequently screened women for alcohol or drug use. Our analysis highlights the need for culturally appropriate alcohol and drug screening and counseling to be included in integrated reproductive health services in western Kenya.

Determinants of Women’s Drug Use During Pregnancy: Perspectives from a Qualitative Study

“…Overall, a clear majority of women continued to use drugs while pregnant, and none reported stopping using them due to pregnancy. This finding is generally consistent with that reported by Yotebieng et al ( 2016 ) showing that alcohol abuse was prevalent through-out pregnancy among Kenyan women. However, our study extends these findings by including women who use a wide variety of substances, including heroin and cocaine.…”

“…Drug-using women often encounter significant environmental and socioeconomic stressors (Forray 2016 ). These stressors have been reported as contributing to substance use during pregnancy (Latuskie et al 2019 ), including among Kenyan women (Yotebieng et al 2016 ).…”

“…Given the detrimental impact of drug use in pregnancy, scholars have explored reasons why women use illicit substances in pregnancy. Evidence from this research suggests that a combination of factors determine women’s drug use, ranging from personal reasons such as lack of self-efficacy and internal stressors (Latuskie et al 2019 ; Yotebieng et al 2016 ), social reasons such as identity (Meurk et al 2014 ), and structural reasons such as lack of information, or inability to understand risk because of the way that it is communicated (Latuskie et al 2019 ; Loxton et al 2013 ). In a rare study that explored the use of alcohol during pregnancy in Kenya, Yotebieng et al ( 2016 ) found that using it as coping mechanism, lack of screening from health care providers, and mixed advise from family and friends were all contributing factors.…”

“…The lack of research related to female drug use is problematic because it hinders the generation of appropriate policies and interventions (Ayon et al 2017 ). In Kenya, research related to female drug use generally is only starting to accumulate, and as Yotebieng et al ( 2016 ) assert, even less of it is concerned with the use of drugs during pregnancy.…”

“…For example, methamphetamine is commonly consumed in South Africa (Jones et al 2011 ), while in east Africa, where cannabis has been widely available, consumption of opiates such as heroin is being increasingly documented (Kurth et al 2015 ; Syvertsen et al 2015 ). In this paper, we build on previous work by Yotebieng et al ( 2016 ) who explored alcohol use in pregnancy, to report factors influencing women use of a wider variety of drugs during pregnancy.…”