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.
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.
Drug Alcohol Depend. 2021 May 1;222:108677. doi: 10.1016/j.drugalcdep.2021.108677. Epub 2021 Mar 18.
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.
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.
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.
We recommend harm reduction approaches to address the multiplicity of stigmas that women navigate in opioid misuse and pregnancy to improve healthcare experiences.
有阿片类药物滥用史的女性面临与毒品相关的污名，而这种污名在怀孕期间可能会加剧。尽管女性经常因为吸毒而受到指责，并被敦促改变，但造成和强化污名的社会环境在很大程度上没有受到挑战。我们借鉴污名的多维模型，研究了污名如何在女性怀孕过程中表现出来，从而影响她们获得医疗保健的机会和质量。
我们对俄亥俄州 28 名有阿片类药物滥用史且怀孕或刚分娩的女性和 18 名医疗保健提供者进行了深入访谈。我们采用主题分析方法，考察了污名在不同的医疗保健环境中是如何表现的。
提供者包括医生、护士、社会工作者、顾问和医疗保健管理人员。在 28 名女性中，平均年龄为 30 岁（范围：22-41 岁），79%为白人。大多数女性使用产前药物辅助治疗（MAT），包括丁丙诺啡（n=19）或美沙酮（n=8），15 人怀孕。在医疗保健环境中都出现了污名的证据。结构性污名体现在保险实践和惩罚性药物治疗中的障碍，而表现性污名则表现为提供者的虐待和评判。即使女性通过使用 MAT 做到了“一切正确”，新生儿戒断综合征（NAS）的诊断也具有不可预测性，这导致了对失去监护权的预期污名，并使一些女性感到内疚，从而加剧了内心的污名。提供者认识到这些污名的有害影响，许多人积极地加以解决。
我们建议采取减少伤害的方法来解决女性在阿片类药物滥用和怀孕过程中所面临的多种污名，以改善医疗保健体验。
