In Virginia, there have been laws created recently regarding Neonatal Substance Abuse. These laws are important since substance abuse in pregnant women can cause premature birth, low birth weight, increased risk of infant mortality, and neurobehavioral and developmental complications (Forray, 2016).The main way of detecting drug use in mothers is when a child is born with neonatal abstinence syndrome (NAS). NAS describes conditions that present when a baby withdraws from drugs it is exposed to in the womb (Virginia Department of Health, 2020). In Virginia, the rate of NAS among newborns has almost quadrupled from 2009-2017 (HCUP Fast Stats, 2019). Virginia has created laws to address this growing public health concern. These laws require mandatory substance use screening in pregnant women and referrals to Child Protective Services for any children who show evidence of exposure to illegal substances even if the mother tries to receive treatment (CSB Guidelines, 2017).
While these laws are well intended, they also have negative consequences. They can be critiqued with the Theory of Justice. Although there is limited data on how many treatment facilities accept pregnant women in Virginia, nationwide, only 19% of treatment facilities offer to program for pregnant women (“Treating Pregnant Women...”, 2015). Even if a pregnant woman wants to seek treatment, lack of childcare and insurance can prevent her from following through. We can also use the theory of spatial mismatch to critique these laws. In theory, the healthcare system should help pregnant women with a history of substance abuse, but many women have described multiple environmental barriers to treatment. First, there is the matter of affording healthcare. Additionally, some women struggle to deal with wait times or having to rely on public transit/bartered transportation due to not having their own reliable car. Often, their jobs do not offer flexibility, and missing work can lead to being fired or otherwise penalized. This may help explain why, in Virginia, the rate of NAS is approximately five times greater in the lowest income quartile than in the highest (HCUP Fast Stats, 2019).
Social suffering is present as well: a nationwide study showed that women strategize to manage their risk of detection by health or criminal justice authorities by isolating themselves or avoiding treatment (Boyd, 1999). Pregnant women with substance abuse issues are often stigmatized and treated punitively rather than getting supportive care. Many pregnant women often feel unwelcome and judged at clinics or emergency departments when they want to receive help with their addictions(Eggertson, 2013). Studies have shown that pregnant women drop out of treatment when they are confronted harshly or when a medical provider attempts to scare them into stopping their drug use (Corse, McHugh, & Gordon, 1995 cited in “Treating Pregnant Women...,” 2015).
One factor that can help contextualize the economic and social inequities described above is the fact that mothers-to-be may not have access to affordable healthcare and medical insurance through their service jobs and it is becoming harder to attain employment that provides those benefits without a college education. This pattern is stereotypically associated with rural areas that offer few opportunities, and data show that NAS rates are indeed higher in rural Virginia than other parts of the state (HCUP Fast Stats, 2019). Obviously, this is not an ideal situation for most pregnant women and these factors lead to emotional stress. This emotional stress can lead them to seek opioid prescriptions, which puts them at a higher risk for addiction (Eggertson, 2013).
We need to resocialize the stigma associated with being a substance-abusing mother and address the inaccurate fear that substance abuse will lead to mothers’ criminalization--in Virginia, it does not--and children being taken away (CSB Guidelines, 2017). To reduce these barriers, health care providers must educate themselves and then advocate and support these women so that they can derive the greatest benefit from substance abuse treatment (“Treating Pregnant Women...,” 2015) . By putting mothers-to-be in a collaborative setting and making treatment more accessible for them, the healthcare system can work more effectively to help prevent substance abuse among pregnant women.
A local pilot program would be a good start to creating an intervention. The program would have two stages: First, it would conduct interviews with local women in the area who had struggled with substance abuse during pregnancy and use the interview to learn about their experiences and how their treatment could have been made better. In order to protect the identities of these women, we would keep their identities anonymous but consciously make sure to use women from a variety of different racial and ethnic backgrounds. The second part of the pilot program will use the feedback to create specific, targeted interventions. Possible examples would be the interventions listed on the Vanderbilt graphic, such as training OB’s and other providers to prescribe buprenorphine or enhancing reimbursement rates to improve insurance acceptance or simply helping provide transportation for these women. Finally, these interviews can be used to help lawmakers create more effective laws that will not create impossible situations or unrealistic expectations for women struggling with substance abuse.
References Boyd, S. C. (1999). Mothers and Illicit Drugs: Transcending the Myths. University of Toronto Press. Community Service Board (CSB) Guidelines... (2017, March 7). Retrieved July 20, 2020, from https://ncsacw.samhsa.gov/files/va_community_service_board_guidlines_on_maternal_substance_use _and_508.pdf.. Data Use Agreement for HCUP Fast Stats. (2019, December 12). Retrieved July 22, 2020, from https://www.hcup-us.ahrq.gov/faststats/NASServlet?radio-2=on&location1=VA&characteristic1=01 C15&location2=&characteristic2=01C11&expansionInfoState=hide&dataTablesState=hide&definitio nsState=hide&exportState=hide Drug Addiction And Babies: Long Term Effects. (2020, May 06). Retrieved July 22, 2020, from https://www.addictioncampuses.com/blog/drug-addiction-and-babies/ Eggertson, L. (2013, December 10). Stigma a major barrier to treatment for pregnant women with addictions. Retrieved July 22, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3855110/ Forray, A. (2016, May 13). Substance use during pregnancy. Retrieved July 22, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4870985/ National Institute on Drug Abuse. (2020, May 02). Virginia: Opioid-Involved Deaths and Related Harms. Retrieved July 22, 2020, from https://www.drugabuse.gov/drug-topics/opioids/opioid-summaries-by-state/virginia-opioid-involved- deaths-related-harms Neonatal Abstinence Syndrome (NAS) Among Newborn Hospitalizations. (2019, September). Retrieved July 22, 2020, from https://www.hcup-us.ahrq.gov/faststats/NASMap?setting=IP Roozbeh, N., Nahidi, F., & Hajiyan, S. (2016, December). Barriers related to prenatal care utilization among women. Retrieved July 22, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5303769/ Treating Pregnant Women With Substance Abuse Issues in an ... (2015). Retrieved July 22, 2020, from https://www.counseling.org/docs/default-source/vistas/treating-pregnant-women-with-substance-abus e-issues-in-an-obgyn-clinic-barriers-to-treatment.pdf?sfvrsn=8 Virginia Department of Health. (2020). NEONATAL ABSTINENCE SYNDROME (NAS). Retrieved from https://www.vdh.virginia.gov/opioid-data/neonatal-abstinence-syndrome-nas/ Virginia Department of Social Services. (2017, July). Perinatal Substance Use: Promoting Healthy Outcomes. Retrieved July 23, 2020, from https://www.dss.virginia.gov/files/division/dfs/mandated_reporters/cps/resources_guidance/Perinatal_ Substance_Use_Promoting_Healthy_Outcomes.pdf Virginia’s Gender Specific Substance Abuse Treatment ... (2011, August 17). Retrieved July 22, 2020, from http://www.dbhds.virginia.gov/library/mental health services/scrn-pw-satreatment-svcs-va.pdf Vucinovic, M., Roje, D., Vucinovic, Z., Capkun, V., Bucat, M., & Banovic, I. (2008, October 31). Maternal and neonatal effects of substance abuse during pregnancy: Our ten-year experience. Retrieved July 22, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2615365/
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