“What's the point of telling them?”: Unspoken struggles of pregnant women with substance use history in Australian prisons

Introduction

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, appropriate intervention and follow-up care post-release. Current evidence suggests women under-report their substance use when pregnant due to stigma and fear of losing child custody. Whilst these factors are likely exacerbated in the prison environment, specific underlying factors that influence women's decisions to withhold disclosure of their substance use in the context of prison reception are unknown.

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 two adult women's prisons in New South Wales, Australia, between April and October 2022. Thematic analysis was used with line-by-line coding. Goffman's theory of total institution, mortification, and stigma was used to examine the experiences and underlying factors influencing pregnant women to disclose their substance use during the prison reception process.

Findings

Several unique barriers to disclosing in prison settings were identified. Barriers included tension surrounds the reception process itself (e.g. long waits, hunger, fatigue, and lack of privacy), frustration due to repeated requests for recounting substance use history, fear of negative consequences following disclosure (e.g., possible extension of incarceration or impacting on child custody post-release), and perceived a lack of benefit of disclosing, including insufficient treatment options, particularly for methamphetamine use disorder, or being housed longer in a restricted high-security cell.

Conclusions

Findings highlighted the underlying dynamics and contextual factors that influence the decision of pregnant women to disclose their substance use at prison reception. Understanding these factors and addressing gaps in clinical practice is crucial to enhancing open disclosure of substance use, leading to timely and appropriate intervention, thereby reducing potential harm for both mother and foetus.