Jennifer L Syvertsen1, Hannah Toneff2, Heather Howard3, Christine Spadola4, Danielle Madden5, John Clapp6. 1. The Ohio State University, Department of Anthropology, 4034 Smith Lab, 174 W 18(th) Avenue, Columbus, OH, 43210, United States; University of California, Riverside, Department of Anthropology, 900 University Ave, 1320B Watkins Hall, Riverside, CA, 92521, United States. Electronic address: jsyverts@ucr.edu. 2. The Ohio State University, Department of Anthropology, 4034 Smith Lab, 174 W 18(th) Avenue, Columbus, OH, 43210, United States; University of Pennsylvania School of Social Policy and Practice, 3701 Locust Walk, Philadelphia, PA, 19104, United States. Electronic address: htoneff@upenn.edu. 3. Phyllis & Harvey Sandler School of Social Work, Florida Atlantic University College of Social Work & Criminal Justice, 777 Glades Road, SO 308, Boca Raton, FL, 33431, United States. Electronic address: howardh@fau.edu. 4. Phyllis & Harvey Sandler School of Social Work, Florida Atlantic University College of Social Work & Criminal Justice, 777 Glades Road, SO 308, Boca Raton, FL, 33431, United States. Electronic address: cspadola@fau.edu. 5. The Ohio State University, College of Social Work, 1947 North College Road, Columbus, OH, 43210, United States; University of Southern California Suzanne Dworak-Peck School of Social Work, Montgomery Ross Fisher Building, 669 West 34th Street, Los Angeles, CA, 90089-0411, United States. Electronic address: dmadden@usc.edu. 6. The Ohio State University, College of Social Work, 1947 North College Road, Columbus, OH, 43210, United States; University of Southern California Suzanne Dworak-Peck School of Social Work, Montgomery Ross Fisher Building, 669 West 34th Street, Los Angeles, CA, 90089-0411, United States. Electronic address: johnclap@usc.edu.
Abstract
BACKGROUND: Women with histories of opioid misuse face drug-related stigma, which can be amplified during pregnancy. While women are often blamed for their drug use and urged to change, the social contexts that create and reinforce stigma are largely unchallenged. Drawing on a multidimensional model of stigma, we examine how stigma manifested across women's pregnancy journeys to shape access and quality of care. METHODS: We triangulate in-depth interviews with 28 women with histories of opioid misuse who were pregnant or recently gave birth and 18 healthcare providers in Ohio. Thematic analysis examined how stigma operates across contexts of care. RESULTS: Providers represented physicians, nurses, social workers, counselors, and healthcare administrators. Among 28 women, average age was 30 (range: 22-41) and 79 % were White. Most women used prenatal medication-assisted treatment (MAT), including Suboxone (n = 19) or methadone (n = 8), and 15 were pregnant. Evidence of stigma emerged across healthcare contexts. Structural stigma encoded barriers to care in insurance practices and punitive drug treatment, while enacted stigma manifested as mistreatment and judgment from providers. Unpredictability of an infant diagnosis of neonatal abstinence syndrome (NAS), even when women were "doing everything right" by using MAT, perpetuated anticipated stigma from fear of loss of custody and internalized stigma among women who felt guilty about the diagnosis. Providers recognized the harmful effects of these stigmas and many actively addressed it. CONCLUSIONS: We recommend harm reduction approaches to address the multiplicity of stigmas that women navigate in opioid misuse and pregnancy to improve healthcare experiences.
BACKGROUND:Women with histories of opioid misuse face drug-related stigma, which can be amplified during pregnancy. While women are often blamed for their drug use and urged to change, the social contexts that create and reinforce stigma are largely unchallenged. Drawing on a multidimensional model of stigma, we examine how stigma manifested across women's pregnancy journeys to shape access and quality of care. METHODS: We triangulate in-depth interviews with 28 women with histories of opioid misuse who were pregnant or recently gave birth and 18 healthcare providers in Ohio. Thematic analysis examined how stigma operates across contexts of care. RESULTS: Providers represented physicians, nurses, social workers, counselors, and healthcare administrators. Among 28 women, average age was 30 (range: 22-41) and 79 % were White. Most women used prenatal medication-assisted treatment (MAT), including Suboxone (n = 19) or methadone (n = 8), and 15 were pregnant. Evidence of stigma emerged across healthcare contexts. Structural stigma encoded barriers to care in insurance practices and punitive drug treatment, while enacted stigma manifested as mistreatment and judgment from providers. Unpredictability of an infant diagnosis of neonatal abstinence syndrome (NAS), even when women were "doing everything right" by using MAT, perpetuated anticipated stigma from fear of loss of custody and internalized stigma among women who felt guilty about the diagnosis. Providers recognized the harmful effects of these stigmas and many actively addressed it. CONCLUSIONS: We recommend harm reduction approaches to address the multiplicity of stigmas that women navigate in opioid misuse and pregnancy to improve healthcare experiences.