By: Sheigla Murphy and Paloma Sales
In this paper we present analyses of two National Institute on Drug Abuse-funded studies entitled, "An Ethnographic Study of Pregnancy and Drug Use" (Rosenbaum and Murphy 1991-94) and "An Ethnography of Victimization, Pregnancy and Drug Use," (Murphy 1995-98). Our goal is to explicate the ways in which pregnant drug users in the San Francisco Bay Area experienced, coped with and protected themselves from increasing stigmatization, abuse and punishment while enduring a period of fiscal retrenchment of government assistance programs.
Beginning in the 1980s, there has been a trend toward social welfare programs changing from the federally mandated and funded programs developed in the 1960s, to the state-by-state directed programs funded through federal block grant mechanisms. These policies were advanced during the Reagan/Bush administrations and continued during the Clinton era. As a result of shrinking budgets at the state level, numerous social service programs shifted to public subsidization supervised by local governments and finally, to privatization or the purchase of privately produced services. Historically, human service program provision tends to be downsized as programs move from federal to state to local supervision (Feldstein 1988).
For pregnant drug users with limited means, these funding decisions created barriers and denied access to cost effective services that would enable them to improve their lives. As a result, they were forced to find alternative resources and to construct survival strategies. The women we interviewed reported drug use helped them overcome some of the adversities in their daily lives. It was sometimes a source of income and usually a source of solace and recreation. Although drug use helped interviewees survive on a day-to-day basis, in the long term, women faced severe consequences. In a political context of social welfare reform, our interviewees' ability to care for themselves and their children was extremely compromised. Our collection of data over an seven-year period enabled us to chart interviewees perspectives and experiences within changing social and policy climates. In the following, we detail the ways in which pregnant drug users served as ideological offensives in the United States war on drugs. Pernicious images of drug using mothers having babies for the sole purpose of qualifying for government handouts in order to buy drugs and then neglecting and abusing these children were promulgated by the media and politicians (Campbell 2000; Humphries 1999).
These images contributed to the passage of legislation and funding allocations that resulted in the wholesale reduction of social welfare services to all poor women and children. The war on drugs has always been a war on the poor, particularly people of color (Maher 1992; Murphy and Rosenbaum 1999). In 2001, it is clear that drug use and drug users have played a very important role in defining women's and children's poverty as an individual behavioral problem rather than the result of systematic, structural economic inequities.
An Ethnographic Study of Pregnancy and Drugs
"An Ethnographic Study of Pregnancy and Drugs" conducted between 1991-1994 was a study of drug use during pregnancy in the San Francisco Bay Area (Rosenbaum and Murphy 1991-94). We employed fieldwork, depth-interviewing and closed-ended questions as the primary data gathering tools. We interviewed a total of 120 pregnant or postpartum adult women who were using heroin, methamphetamine or cocaine singly or in combination for a minimum of 25 days during their current or most recent pregnancy. Women who were enrolled in drug treatment more than five days within a four-week period were not included in the study. Those women who were in treatment for less than five days had to have returned to drug use for five or more days since their last day of treatment. These criteria allowed us to interview women who had brief encounters with drug treatment and had subsequently returned to drug use. Therefore, we were able to explore women's reasons for leaving treatment.
In order to fully explore AIDS risks, attitudes and behaviors, half (twenty) of the women interviewed in each of the three stages of pregnancy (discovery, five months to delivery and six months postpartum) were intravenous drug users (IDUs). IDUs were defined as those women who had injected heroin, cocaine, or methamphetamine at least once a week during the six months prior to discovering their pregnancy. These inclusion criteria permitted us to examine the changes in drug administration before and after the onset of pregnancy. Non-injection drug users were defined as any woman who had not injected drugs in the previous two years. Each of our subgroups, IDU and non-IDU in each stage of pregnancy consisted of twenty subjects. Our past research demonstrated that a minimum of 20 interviews is necessary to discover meaningful patterns and to produce a robust theoretical framework.
In the course of the life history interviews the interviewer and study participant explored 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. The other areas of inquiry included methods of ingesting drugs; violence; involvement in criminal activities; and high-risk AIDS behavior (including needle sharing and sexual practices); level of involvement in prenatal care; living arrangements and sources of income.
The ethnic breakdown of the sample was 53% African American (n=64), 34% white (n=41), 7% Latinas (n=9), and the remaining 6% were Asian, Native American or Pacific Islander. Eighty-eight percent of the women relied on public assistance to support themselves and their children. Approximately 40% were homeless at the time of interview and another 20% lived in publicly subsidized housing projects in neighborhoods characterized by high levels of drug sales, drug use and violent crime.
An Ethnography of Victimization, Pregnancy and Drug Use
Our second study entitled "An Ethnography of Victimization Pregnancy and Drug Use" conducted between 1995 - 1998 was an exploratory depth-interview study of pregnant drug users who experienced one or more victimizations (physical, sexual and/or emotional) while pregnant (Murphy 1995-98). This project was developed as a result of findings from the previous study of pregnancy and drug use which indicated pregnant drug users experienced an extremely high incidence of violence. Of the 120 women we had interviewed in the previous study, 78 (65%) were or had been in abusive relationships. We began this project by using ethnographic field work methods to locate and recruit women who were pregnant or recently pregnant and had used marijuana, crack/cocaine, heroin/opiates and/or methamphetamine singly or in combination. During the first phase of the study we collected information concerning demographics, family, drug use, relationship and reproductive histories employing a structured questionnaire. This instrument was designed to measure levels of drug use and victimization. Those who had experienced violence while pregnant were asked to participate in the second phase, a qualitative depth interview focusing on their drug use and victimization histories with an emphasis on victimizations experienced during pregnancy. Originally we estimated that we would have to recruit approximately 300 women in order to enroll 100 who had experienced victimizations and agreed to participate in the second phase. As it turned out, we only had to recruit 126 women, since 79% (n=100) of the women we surveyed had experienced physical and emotional violence during their most recent pregnancy. Violence was much more prevalent than we had estimated.
The mean age for this sample was 29. Only 9% were married, 63% were in a relationship and 28% were single. Fifty-two percent were African-Americans, 27% white, 15% Latina, 6% Native American or Asian/Pacific Islanders. Forty-one percent were primarily crack users, 28% marijuana users, 19% heroin users, 7% used powder cocaine, and 5% used methamphetamine. They had inadequate financial resources, lived in substandard housing, lacked marketable job skills and adequate support systems. They had one-fourth the income and more children (2.2 versus 1.6) than the general population of women in the San Francisco Bay Area (U.S. Census Bureau, 1990). They were three times as likely to have dropped out of high school and far less likely to have been in college. Fifty-seven percent of the sample had no permanent housing. Of those, 27 (37%) were temporarily living in a friend's or relative's home, 23 (32%) were homeless, 15 (21%) lived in SRO (single room only) hotels, and 7 (10%) lived in residential treatment facilities or group homes. Over two-fifths of the sample (42.9%) reported they had been homeless for three or more days in the six months prior to the interview.
Throughout this paper when we quote directly from interviewee's transcribed narratives we will indicate in which of the two studies (PAD for the first study, PAV for the second study) the interviewee participated. Participants in both projects were predominantly women of color, unemployed and living close to if not below the poverty level. They were directly impacted by cuts in social spending during the Reagan, Bush and Clinton administrations.