Risk Environments for Pregnant/Postpartum Women who Use Drugs: a longitudinal qualitative study

For women who use drugs (WWUD) in the US, the months they are pregnant and postpartum are among the most hazardous of their lives: the US has the highest maternal mortality rate of all industrialized nations, and up to 26% of maternal deaths in multiple states are attributed to drug use. Public health scientists have largely neglected this crisis. Since 2010, just 1.6% of articles in major addiction journals have addressed pregnancy or the postpartum period; a parallel silence exists in maternal health research. The proposed 4- year longitudinal qualitative study is thus designed to help lay the foundations for a new arena of multilevel epidemiologic research and interventions to help WWUD survive while pregnant and postpartum. Three pillars of the Risk Environment Model (REM) guide this novel inquiry: harm reduction, risk environments, and resilience. Harm reduction principles invite us to recognize that pregnant/postpartum WWUD have vital insights into the drug and sexual/reproductive (SR) harms that drugs can create for them, and may have crafted effective practices to prevent these harms (e.g., altering drug use frequency). REM suggests that features of WWUD’s social, economic, physical, and healthcare/criminal legal intervention risk environments create these variations, as can resilience practices that unfold within individuals and communities. Guided by REM and Advisory Boards of WWUD, we will use Constructivist Grounded Theory and Qualitative Longitudinal Research methods to “walk alongside” a cohort of WWUD living in 4 regions of Georgia while they are pregnant and postpartum, gathering 5 waves of data, to: Aim 1. Explore pregnant WWUDs’ (a) drug- and SR-related health concerns and practices, and how they vary across pregnancy; and (b) perceptions of their risk environments, how they evolve during pregnancy, and how these evolving environments shape WWUD’s concerns and practices. Aim 2. Analyze postpartum WWUD’s (a) drug- and SR-related concerns and practices, and how they vary across the postpartum months; and (b) perceptions of their risk environments, how they evolve postpartum, and how these evolving environments shape WWUD’s concerns and practices.