Barriers and Enablers in Disclosing Substance Use by Pregnant Women in Australian prisons
Abstract
Background: Pregnant women with substance use histories face many challenges during incarceration, leading to potentially harmful outcomes for both maternal and infant health. However, research on how to address these challenges is limited. Early disclosure of substance use is crucial for engaging in and receiving timely and appropriate drug treatment. This is also important for maintaining continuous treatment that includes pre-release planning and post-release referral. Current evidence suggests women under-report their substance use when pregnant, due to stigma and fear of losing child custody. These factors may be exacerbated in the prison environment. The aim of study is to identify the enablers and barriers impacting pregnant women’s decisions to disclose their substance use in the context of incarceration in Australian prisons.
Methods: We conducted qualitative interviews to explore the viewpoint of currently or recently pregnant women (n = 31) with a history of substance use currently incarcerated in New South Wales, Australia. Thematic analysis was used with line-by-line coding.
Results: Several unique barriers and enablers for disclosing in prison settings were identified. Barriers included: frustration due to repeated substance use history taking during prison intake, lack of privacy, and fear of consequences following disclosure of substance use (e.g., being housed in a high-security cell with restricted conditions, potentially leading to extended incarceration or impact on child custody post-release). Enablers for disclosure within custodial settings included: knowledge of a shared experience with other women, less judgemental approach by healthcare providers, substance use history known by healthcare staff from previous incarcerations, and expressing concerns for unborn baby’s health.
Conclusions: Findings highlighted specific barriers and enablers that impact the decision of pregnant women to disclose their substance use history in a prison environment. Prisons can provide unique opportunities for engagement in drug and alcohol treatment, evidenced by prison being perceived as a less judgemental approach by healthcare providers and the realisation of common substance use experiences among women. Yet, the difficulty of the prison environment and current clinical practice of the intake screening process, which includes repeated steps for gathering substance use history and often lacks privacy, should be addressed. This would enhance more open disclosure of substance use history, leading to timely and appropriate drug and alcohol assessment and treatment, thereby minimising harm for both the mother and foetus during incarceration.
