Complex Calculations: How Drug Use During Pregnancy Becomes a Barrier to Prenatal Care

Sarah C. M. Roberts; Cheri Pies


Matern Child Health J. 2011;15(3):333-341. 

In This Article

Abstract and Introduction


Pregnant women who use drugs are more likely to receive little or no prenatal care. This study sought to understand how drug use and factors associated with drug use influence women's prenatal care use. A total of 20 semi-structured interviews and 2 focus groups were conducted with a racially/ethnically diverse sample of low-income women using alcohol and drugs in a California county. Women using drugs attend and avoid prenatal care for reasons not connected to their drug use: concern for the health of their baby, social support, and extrinsic barriers such as health insurance and transportation. Drug use itself is a barrier for a few women. In addition to drug use, women experience multiple simultaneous risk factors. Both the drug use and the multiple simultaneous risk factors make resolving extrinsic barriers more difficult. Women also fear the effects of drug use on their baby's health and fear being reported to Child Protective Services, each of which influence women's prenatal care use. Increasing the number of pregnant women who use drugs who receive prenatal care requires systems-level rather than only individual-level changes. These changes require a paradigm shift to viewing drug use in context of the person and society and acceptance of responsibility for unintended consequences of public health bureaucratic procedures and messages about effects of drug use during pregnancy.


Pregnant women who use drugs are over-represented among women who receive late, limited, and no prenatal care.[1–5] Similar to pregnant women in general,[6] women who use drugs and receive adequate prenatal care generally have better pregnancy outcomes than women who use drugs and do not receive adequate care.[7–16] It is unclear whether these improvements are due to prenatal care or if lack of prenatal care is a proxy for other risk factors associated with poor outcomes.[13,17] Nevertheless, lack of prenatal care clearly limits opportunities for offering other health promoting interventions.

The limited research suggests that women who use drugs during pregnancy face the following barriers to prenatal care: difficulties with transportation and health insurance,[18] "drug lifestyle",[19] fear of having drug use identified by providers,[20] and fear of legal repercussions,[21] including Child Protective Services (CPS) reports.[22] In addition, a recent study examined whether drug use itself or factors associated with drug use are barriers.[23] The study found that both drug use and factors associated with drug use are barriers, although this differs depending on the specific drug.

The existing research primarily tests researchers' a priori hypotheses.[24] Thus, it may exclude some key barriers. In addition, it has focused on determining the most common barriers[18] and on determining which risk factors explain the most variance in limited prenatal care.[23] While each are important, they do not provide information on how drug use or factors associated with drug use become barriers to prenatal care. With the goal of informing interventions to reduce barriers to prenatal care for women who use drugs during pregnancy, this qualitative study identifies women's perspectives on barriers to prenatal care and seeks to understand the processes through which drug use and factors associated with drug use during pregnancy become barriers.


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