Secrecy Versus Disclosure: Women with Substance Use Disorders Share Experiences in Help Seeking During Pregnancy
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Secrecy Versus Disclosure: Women with Substance Use Disorders Share Experiences in Help Seeking During Pregnancy Ruth Paris1 · Anna L. Herriott2 · Mihoko Maru1 · Sarah E. Hacking3 · Amy R. Sommer4 Accepted: 31 August 2020 / Published online: 6 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Objectives Substance misuse during pregnancy can be harmful to the health of both mothers and infants. Existing recovery services or prenatal care for pregnant women with substance use disorders (SUD) in the U.S. and other countries typically fall short in providing the necessary specialized care women with SUDs need. Disclosure of substance misuse is one key factor in gaining access to specialized prenatal care; yet, barriers such as social stigma and internal shame and guilt lead many women to under-report any substance misuse during their pregnancy. This study sought to understand the process of how and why pregnant women with SUDs choose to disclose or not disclose their substance misuse to their providers when seeking prenatal care. Methods Data were collected through interviews with N = 21 women with SUDs in the northeast U.S. whose young children had been exposed to opioids, cocaine, or MAT in utero. Thematic, inductive analysis using line-by-line coding was conducted to understand the perspectives of the women. Results The women’s narratives suggested a clear tension regarding whether to disclose their substance misuse to any providers during their pregnancy. Four themes describing the process of disclosure or non-disclosure were found, including reasons for and ways of being secret or choosing to disclose their substance misuse during pregnancy. Conclusions for Practice The centrality of shame, guilt, and stigma regarding substance misuse must be addressed by medical and mental health providers in order to increase disclosure and improve access to care for women with SUDs. Keywords Maternal substance use disorders · Prenatal substance misuse · Maternal-child health · Stigma · Disclosure * Ruth Paris [email protected]
Significance
Anna L. Herriott [email protected]
Pregnant women with SUDs encounter stigma and feel shame and guilt regarding their substance misuse, resulting in secrecy and difficulties in accessing prenatal care. Disclosure of substance misuse eliminates a barrier to care, yet little is known about why and how pregnant women with SUDs maintain their secrecy and choose to disclose or not to disclose to their provider or family. This qualitative study elucidates the tension regarding secrecy and disclosure of SUDs during pregnancy. Findings offer useful guidance for providers during the perinatal period in order to engage women with SUDs in essential health care and treatment.
Mihoko Maru [email protected] Sarah E. Hacking [email protected] Amy R. Sommer [email protected] 1
Boston University School of Social Work, 264 Bay State Road, Boston, MA 02215, USA
2
School of Social Service Administration, University of Chicago, Chapin Hall, Hyde Par
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