Perspectives on preconception health among formerly incarcerated women with substance use disorders

• Published in: Journal of substance abuse treatment Vol. 131; p. 108545
• Main Authors: Bello, Jennifer K., Johnson, Alysia, Skiöld-Hanlin, Sarah
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2021; Elsevier Limited
• Subjects: Behavior change; Change agents; Criminal justice system; Decision making; Drug addiction; Drug use; Ex-convicts; Health services; Imprisonment; Incarceration; Interviews; Motivation; Preconception health; Pregnancy; Prisoners; Substance use disorder; Substance use disorder (SUD); Treatment needs; Unwanted pregnancy; Women; Womens health; Pregnancy; Preconception health; Behavior change; Incarceration; Substance use disorder (SUD)
• ISSN: 0740-5472; 1873-6483
• DOI: 10.1016/j.jsat.2021.108545

Women involved in the criminal justice system have high rates of substance use disorders (SUD) placing them at increased risk for unintended pregnancy and adverse pregnancy outcomes. Little is known about the factors that influence the decision-making of formerly incarcerated women with SUD prior to becoming pregnant, in the preconception period. The goal of this study is to understand formerly incarcerated women's perceptions of changing substance use behaviors before pregnancy. We analyzed 33 semi-structured interviews with formerly incarcerated women in Saint Louis, Missouri. We asked questions about factors that influenced decision-making related to substance use and pregnancy. Interviews were recorded and transcribed verbatim. Transcripts were coded and analyzed using a grounded theoretical approach with ATLAS.ti software. Four main themes emerged: (1) participants' understanding of preconception behavior change was influenced by their experiences with unplanned pregnancies and lack of control over outcomes; (2) substance use created challenges for women in considering their reproductive wishes; (3) while pregnant, participants weighed the medical and legal risks in their decision-making about their substance use; and (4) participants described how the internal motivation necessary to stop substance use during pregnancy was influenced by factors such as hitting rock bottom and witnessing negative outcomes experienced by others. Preconception health services must be provided to women with SUD during opportunistic times such as during incarceration or while in SUD treatment. Services need to be non-judgmental and supportive rather than penalizing and should increase internal motivation to adopt behavior change. •Addiction makes it difficult for women to consider future pregnancy.•Beliefs about preconception behavior change are influenced by prior experiences.•Women with SUD weigh the medical and legal risks of using during pregnancy.•Internal motivation is necessary stop substance use during pregnancy.