Multi-Service Programs for Pregnant and Parenting Women with Substance Use Concerns: Women’s Perspectives on Why They Seek Help and Their Significant Changes

Abstract

Within Canada, several specialized multi-service prevention programs work with highly vulnerable pregnant and early parenting women with substance use issues. Experiences of trauma, mental health, poverty, and other factors associated with the social determinants of health complete the picture. Program evaluations have demonstrated their value, but less has been said as to women’s reasons for choosing to seek help from these programs, what they were hoping to gain, or what difference they believe has occurred as a result. The Co-creating Evidence project is a multi-year (2017–2020) national evaluation of holistic programs serving women at high risk of having an infant with prenatal alcohol or substance exposure. The evaluation uses a mixed methods design involving quarterly program output and “snapshot” client data, as well as in-person, semi-structured interviews and questionnaires with clients, program staff, and program partners. This article presents findings from interviews with women regarding why they sought help, how they used the services, and what they perceived to be the most significant change in their lives as a result. Obtaining help with substance use was the top theme for what women hoped to get from their participation in their program; however, women’s reasons were often intertwined. Additional motivations included wanting information, support or assistance with: child welfare; pregnancy; housing; getting connected to health care or prenatal care; and opportunities for peer support. With respect to the most significant life change, themes included: reduced substance use; improved housing; stronger mother–child connection; and improved wellness and social connections. Findings demonstrated that vulnerable, marginalized pregnant and parenting women who are using substances will seek help when health and social care services are configured in such a way as to take into consideration and address their unique roles, responsibilities, and realities.

Missing in Action: Sex and Gender in Substance Use Research

“…Hubberstey et al [15] consider the gendered social determinants of substance use among disadvantaged women in order to analyze the nature of help required, focusing on the gendered roles, norms and relations affecting women with children who use substances. Andrews et al [21] offer an elegant description of the links between early intimate partner violence(IPV) and hypothalamic-pituitary-adrenal axis (HPA) dysfunction, relational deficits and pathways to substance use among women with substance use issues.…”

“…While the past twenty years has seen a rise in interest and application of sex and gender science in health, the substance use field has been slow to insist on the inclusion of these concepts. This special issue [5,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] is aimed at providing a remedy for this lack, and more importantly, to provide examples of the impact of sex and gender in a range of substances, cultures, populations and contexts.…”

“…These articles address concepts [5], different substances such as alcohol [12,19,23], cannabis [5,17,18], illegal drugs [13], nicotine [11,12], opioids [14], and multi drug use [10], populations such as gay and bisexual men [13], fathers [20], mothers [15], pregnant women [9,23], patients [9,17] and adolescents [14]. They address interactions with interpersonal violence [22], treatment responses [21], abortion policy [23], other harms [12] in a range of settings in countries including Spain, Scotland, Turkey, Canada, China, Taiwan, and the USA.…”

Multi-service prevention programs for pregnant and parenting women with substance use and multiple vulnerabilities: Program structure and clients’ perspectives on wraparound programming

“…Systemic barriers also exist: substance use services and child protection services typically have operated discretely with their own set of goals, policies, philosophies, expectations, and legislative regulations and timelines, resulting in high rates of child apprehensions and reluctance to positively sanction parenting by women who use substances [12][13][14]. Nevertheless, pregnancy has been shown to be a pivotal time when women are interested in contemplating or making a significant life change, partly as a result of their desire to keep their newborn in their care and to regain custody of older children, and thus they are receptive to engaging with services [5,[15][16][17][18][19].…”

“…In Canada, services designed to address the particular health needs of women who use substances and who are pregnant or parenting can operate in two different ways. Since the 1990s, several community-based, multi-service programs aimed at reaching vulnerable pregnant or parenting women with substance use and complex issues have emerged [4,17,18]. Offering a safe, single point of access, these programs rely on a range of formal and informal partnerships and community connections to reduce barriers and provide holistic care, including a variety of health, substance use and trauma-related services, children's health services, nutrition and basic needs supports, drop-in and outreach, and in some cases, housing and child care [18].…”