Top

Maternal and Child Health Journal

Published in:

Open Access 01-09-2020

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

Authors: Gitau Mburu, Sylvia Ayon, Samantha Mahinda, Khoshnood Kaveh

Published in: Maternal and Child Health Journal | Issue 9/2020

Abstract

Introduction

Drug use during pregnancy can have negative effects on maternal and child health. However, there is a dearth of data regarding drug use among pregnant women in Kenya, where illicit drug use is on the rise. In this paper, we report factors influencing women’s decisions to use drugs during pregnancy.

Methods

In 2015, we conducted in-depth interviews and focus group discussions with 45 women who inject drugs and five key stakeholders involved in provision of services to people who use drugs in coastal Kenya. Inductive thematic analysis was conducted to draw out themes related to key determinants of drug use during pregnancy.

Results

Four key themes emerged outlining determinants of drug use during pregnancy: (i) the use of drugs to cope with the stress of unexpected pregnancy, (ii) the continued drug use during pregnancy to manage withdrawal, (iii) the dual effect of pregnancy on drug use either as a facilitator or as a moderator of drug use, and (iv) the role of male intimate partner in influencing women’s drug use during pregnancy.

Conclusion

Our paper reports women’s drug use during pregnancy and the factors influencing this phenomenon. To safeguard the health and well-being of pregnant women and their unborn children, there is a need for education and awareness raising, implementing couple-based harm reduction approaches to leverage on positive male influences, improving availability of drug treatment, and provision of family planning interventions for women who use drugs.

Ashley, O. S., Marsden, M. E., & Brady, T. M. (2003). Effectiveness of substance abuse treatment programming for women: a review. American Journal of Drug and Alcohol Abuse, 29(1), 19–53.CrossRef

Ayon, S., Ndimbii, J., Jeneby, F., Abdulrahman, T., Mlewa, O., Wang, B., et al. (2017). Barriers and facilitators of access to HIV, harm reduction and sexual and reproductive health services by women who inject drugs: role of community-based outreach and drop-in centers. AIDS Care. https://doi.org/10.1080/09540121.09542017.01394965.CrossRefPubMed

Bazeley, P. (2007). Qualitative data analysis with NVIVO. London: Sage.

Black, K. I., Stephens, C., Haber, P. S., & Lintzeris, N. (2012). Unplanned pregnancy and contraceptive use in women attending drug treatment services. Australian and New Zealand Journal of Obstetrics and Gynaecology, 52(2), 146–150.CrossRef

Bryman, A. (2012). Social research methods. Oxford: Oxford University Press.

Charmaz, K. (2000). Grounded theory: Objectivist and constructivist methods. In N. K. Denzin & Y. S. Lincoln (Eds.), Handbook of Qualitative Research (pp. 509–535). Thousand Oaks, CA: Sage.

Coyle, S. L., Needle, R. H., & Normand, J. (1998). Outreach-based HIV prevention for injecting drug users: A review of published outcome data. Public Health Reports, 113(Suppl 1), 19–30.PubMedPubMedCentral

Esterberg, K. (2002). Qualitative methods in social research. Boston: USA McGraw-Hill.

Forray, A. (2016). Substance use during pregnancy. F1000Research. https://doi.org/10.12688/f1000research.7645.1.CrossRefPubMedPubMedCentral

Guise, A., Rhodes, T., Ndimbii, J., Ayon, S., & Nnaji, O. (2016). Access to HIV treatment and care for people who inject drugs in Kenya: A short report. AIDS Care, 28(12), 1595–1599. https://doi.org/10.1080/09540121.2016.1191606.CrossRefPubMed

Hammer, R. (2019). ‘I can tell when you’re staring at my glass…’: Self-or co-surveillance? Couples’ management of risks related to alcohol use during pregnancy. Health, Risk & Society, 21(7–8), 335–351.CrossRef

Higgins, P. G., Clough, D. H., Frank, B., & Wallerstedt, C. (1995). Changes in health behaviors made by pregnant substance users. International Journal of Addiction, 30(10), 1323–1333.CrossRef

Howell, E. M., Heiser, N., & Harrington, M. (1999). A review of recent findings on substance abuse treatment for pregnant women. Journal of Substance Abuse Treatment, 16(3), 195–219.CrossRef

Jones, H. E., Browne, F. A., Myers, B. J., Carney, T., Ellerson, R. M., Kline, T. L., et al. (2011). Pregnant and nonpregnant women in cape town, South Africa: Drug use, sexual behavior, and the need for comprehensive services. International Journal of Pediatrics, 2011, 353410. https://doi.org/10.1155/2011/353410.CrossRefPubMedPubMedCentral

Jones, H. E., Heil, S. H., Tuten, M., Chisolm, M. S., Foster, J. M., O'Grady, K. E., et al. (2013). Cigarette smoking in opioid-dependent pregnant women: Neonatal and maternal outcomes. Drug and Alcohol Dependence, 131(3), 271–277. https://doi.org/10.1016/j.drugalcdep.2012.11.019.CrossRefPubMed

Kurth, A. E., Cleland, C. M., Des Jarlais, D. C., Musyoki, H., Lizcano, J. A., Chhun, N., et al. (2015). HIV prevalence, estimated incidence, and risk behaviors among people who inject drugs in Kenya. Journal of Acquired Immune Deficiency Syndromes, 70(4), 420–427. https://doi.org/10.1097/qai.0000000000000769.CrossRefPubMed

Larney, S., Mathers, B., Poteat, T., Kamarulzaman, A., & Degenhardt, L. (2015). Global epidemiology of HIV among women and girls who use or inject drugs: Current knowledge and limitations of existing data. Journal of Acquired Immune Deficiency Syndromes, 69(Suppl 2), S100–109. https://doi.org/10.1097/qai.0000000000000623.CrossRefPubMed

Latuskie, K. A., Andrews, N. C., Motz, M., Leibson, T., Austin, Z., Ito, S., et al. (2019). Reasons for substance use continuation and discontinuation during pregnancy: A qualitative study. Women and Birth, 32(1), e57–e64.CrossRef

Loxton, D., Chojenta, C., Anderson, A. E., Powers, J. R., Shakeshaft, A., & Burns, L. (2013). Acquisition and utilization of information about alcohol use in pregnancy among Australian pregnant women and service providers. Journal of Midwifery & Women's Health, 58(5), 523–530.CrossRef

Mburu, G. (2019). Determinants of drug use trajectories and HIV risks among women who inject drugs in coastal Kenya. (Doctoral thesis), Lancaster University, UK.

Mburu, G., Ayon, S., Tsai, A., Ndimbii, J., Wang, B., Strathdee, S., et al. (2018a). “Who has ever loved a drug addict? It’s a lie. They think a ‘teja’ is as bad person”: Multiple stigmas faced by women who inject drugs in coastal Kenya. Harm Reduction Journal, 15(1), 29.CrossRef

Mburu, G., Ndimbii, J., Ayon, S., Mlewa, O., Mbizvo, M., Kihara, C., et al. (2018b). Contraceptive use among women who inject drugs: Motivators, barriers and unmet needs. Women's Reproductive Health, 5(2), 99–116. https://doi.org/10.1080/23293691.2018.1463737.CrossRef

Meurk, C. S., Broom, A., Adams, J., Hall, W., & Lucke, J. (2014). Factors influencing women’s decisions to drink alcohol during pregnancy: Findings of a qualitative study with implications for health communication. BMC Pregnancy and Childbirth, 14(1), 246.CrossRef

Minozzi, S., Amato, L., Bellisario, C., Ferri, M., & Davoli, M. (2013). Maintenance agonist treatments for opiate-dependent pregnant women. Cochrane Database Syststematic Review. https://doi.org/10.1002/14651858.CD006318.pub3.CrossRef

NASCOP. (2013). Kenya National Guidelines for the Comprehensive Management of the Health Risks and Consequences of Drug Use. Nairobi: National AIDS and STI Control Programme (NASCOP). Ministry of Health, Government of Kenya.

Ndimbii, J., Ayon, S., Abdulrahman, T., Mahinda, S., Jeneby, F., Armstrong, G., et al. (2018). Access and utilisation of reproductive, maternal, neonatal and child health services among women who inject drugs in Coastal Kenya: Findings from a qualitative study. Sexual & Reproductive Healthcare, 18, 48–55.CrossRef

O’Connor, M. J., Rotheram-Borus, M. J., Tomlinson, M., Bill, C., LeRoux, I. M., & Stewart, J. (2014). Screening for fetal alcohol spectrum disorders by nonmedical community workers. Journal of Population Therapeutics and Clinical Pharmacology, 21(3), e442.PubMedPubMedCentral

Patrick, S. W., Schumacher, R. E., Benneyworth, B. D., Krans, E. E., McAllister, J. M., & Davis, M. M. (2012). Neonatal abstinence syndrome and associated health care expenditures: United States, 2000–2009. JAMA, 307(18), 1934–1940. https://doi.org/10.1001/jama.2012.3951.CrossRefPubMed

Peters, V., Liu, K. L., Dominguez, K., Frederick, T., Melville, S., Hsu, H. W., et al. (2003). Missed opportunities for perinatal HIV prevention among HIV-exposed infants born 1996–2000, pediatric spectrum of HIV disease cohort. Pediatrics, 111(5 Pt 2), 1186–1191.PubMed

Rhodes, T., Closson, E. F., Paparini, S., Guise, A., & Strathdee, S. (2016). Towards "evidence-making intervention" approaches in the social science of implementation science: The making of methadone in East Africa. International Journal of Drug Policy, 30, 17–26. https://doi.org/10.1016/j.drugpo.2016.01.002.CrossRefPubMed

Rhodes, T., Ndimbii, J., Guise, A., Cullen, L., & Ayon, S. (2015). Navigating the poverty of heroin addiction treatment and recovery opportunity in Kenya: Access work, self-care and rationed expectations. Global Public Health, 10(7), 867–880. https://doi.org/10.1080/17441692.2015.1046385.CrossRefPubMed

Simpson, M., & McNulty, J. (2008). Different needs: women's drug use and treatment in the UK. International Journal of Drug Policy, 19(2), 169–175. https://doi.org/10.1016/j.drugpo.2007.11.021.CrossRefPubMed

Syvertsen, J. L., Agot, K., Ohaga, S., Strathdee, S. A., Camlin, C. S., Omanga, E., et al. (2015). Evidence of injection drug use in Kisumu, Kenya: Implications for HIV prevention. Drug and Alcohol Dependence, 151, 262–266.CrossRef

Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349–357.CrossRef

Weber, A., Tyndall, M., Spittal, P., Li, K., Coulter, S., O'Shaughnessy, M., et al. (2003). High pregnancy rates and reproductive health indicators among female injection-drug users in Vancouver, Canada. The European Journal of Contraception & Reproductive Health Care, 8(1), 52–58.CrossRef

Wong, S., Ordean, A., Kahan, M., Gagnon, R., Hudon, L., Basso, M., et al. (2011). Substance use in pregnancy. Journal of Obstetrics and Gynaecology Canada, 33(4), 367–384.CrossRef

Yotebieng, K. A., Agot, K., Rota, G., Cohen, C. R., & Syvertsen, J. L. (2016). A qualitative study of substance use during pregnancy: Implications for reproductive healthcare in western Kenya. African Journal of Reproductive hHealth, 20(4), 51.CrossRef

Title: Determinants of Women’s Drug Use During Pregnancy: Perspectives from a Qualitative Study
Authors: Gitau Mburu
Sylvia Ayon
Samantha Mahinda
Khoshnood Kaveh
Publication date: 01-09-2020
Publisher: Springer US
Published in: Maternal and Child Health Journal / Issue 9/2020
Print ISSN: 1092-7875
Electronic ISSN: 1573-6628
DOI: https://doi.org/10.1007/s10995-020-02910-w

At a glance: The STEP trials

Springer Medicine

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

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 9/2020

Antenatal Admissions Among Women with Opioid-Affected and Non-Opioid-Affected Deliveries

Maternal Decision-Making Input and Health-Seeking Behaviors Between Pregnancy and the Child’s Second Birthday: A Cross-Sectional Study in Nepal

An Overlooked and More Complicated Association of Social Support with Infant Birth Size: Commentary on Appleton and Colleagues (2019)

Variation in Postpartum Use of Most and Moderately Effective Contraceptive Methods Among Louisiana Women

Syndemic Perspectives to Guide Black Maternal Health Research and Prevention During the COVID-19 Pandemic

Pilot Randomized Controlled Trial of an Interconception Intervention Provided by Public Health Nurses