Research Update

Alcohol Use and Pregnancy: An Important Canadian Public Health and Social Issue

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8.2 Barriers to Identifying Pregnant Women with Significant Substance Use Issues

Insight: Unplanned and Unwelcomed...

Many women with substance use issues report that their pregnancies were unplanned and unwelcome, sometimes occurring as a result of sexual assault.²¹⁴ Pregnant women in these circumstances tend not to seek early prenatal care or substance abuse services (in the US, it has been estimated that only about 5% to 10% of pregnant women with substance use problems receive professional treatment).²¹⁵ Major reasons given by women for not seeking medical assistance or treatment are feelings of shame and fear of loss of custody of their child.^216,217 Many women in this situation are so overwhelmed with a sense of the inevitability of harm and child custody issues that they have difficulty taking concerted action. Ironically, punitive interventions that aim to protect the fetus have the opposite effect, pushing the woman further from needed supports. Research clearly indicates that fetal protection is best achieved through maternal protection in the form of therapeutic, non-punitive interventions.^218,219

When women seek help from services other than prenatal or substance abuse services, their substance use problems often go unrecognized by professionals, many of whom lack knowledge and harbor negative attitudes toward women with substance use problems, particularly pregnant women. Lack of routine professional training on substance abuse screening and advice for the prevention of women's alcohol use during pregnancy continues to be a barrier. Other barriers that have been variously cited are long waiting lists, limited access to low-threshold services, lack of access to women-centred treatment for pregnant women with substance use problems, lack of designated staff, insufficient staff, insufficient referral protocols, weak referral linkages (staff reluctant to identify unless they can readily provide help), poor coordination of services, and lack of transportation and child care for clients.^220-223

Barriers are also compounded in "distressed" communities. A qualitative study by Kowalsky and Verhoef demonstrated the difficulties inherent in living in an isolated Aboriginal community. They described an unnamed Déné community in northern Canada, citing a number of barriers for people who have substance use issues, including fear of stigmatization, lack of awareness of the issues and other social problems in their community. They noted that substance use problems are embedded in the fabric of these other social problems and must be addressed within the context of these issues.²²⁴

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