Drug abuse during pregnancy is currently recognized as as prevalent and most serious problem. The literature indicates that while extensive information bas been gathered about fetal outcomes in drug-involved pregnancies, very little is known about the pregnant drug abuser herself. The widest gap in our knowledge pertains to pregnant drug abusers who are not in treatment. Our intent is to conduct a three-year ethnographic-type study of drug use during pregnancy in the San Francisco Bay Area. We will employ depth-interviewing, fieldwork and close-ended questions as the primary data gathering tools. The operative theoretical perspective guiding the proposed research is a combination of reference group and differential identification, role theoretic, and stigmatization theories. The project staff will interview a total of 120 pregnant or postpartum adult women who are using heroin, methamphetamine or cocaine singly or in combination and who are not in treatment. To gain a fuller understanding of the entire experience of drug-involved pregnancy, 40 women (20 of them will be injection drug users) will be interviewed from each of the three stages: the first five months of pregnancy; five months to full-term; and delivery to six months postpartum. Our qualitative interview guide will be a semi-structured instrument aimed at exploring the introduction and initiation to each drug used; social environments of use; pressures to use or not to use; the relationship of pregnancy to patterns of use; and barriers to treatment; methods of ingesting drugs; violence; involvement in criminal activities; and high-risk AIDS behavior (including needle-sharing and sexual practices). Cessation of drug use early in pregnancy has been shown to decrease the damaging effects on both the mother and her unborn child. Cessation or reduction of drug use at any stage in tbe pregnancy or postpartum period may attenuate negative outcomes. Findings from tbe proposed research will assist health care providers in developing outreach strategies, early interventions and effective treatments targeted to this hard-to-reach and hard-to-treat population.
