Barriers to women's disclosure of and treatment for substance use during pregnancy: A qualitative study

Published:December 27, 2021DOI:



      The use of alcohol and or illicit drugs during pregnancy is a complex public health issue. There are many adverse short- and long-term health implications of substance use during pregnancy that can potentially affect the mother-foetal dyad. Although prevention and treatment options — such as counselling, pharmacotherapy, rehabilitation, support and case management and withdrawal management — are available, a range of barriers impedes women's ability to disclose their substance use, which limits access and engagement with available services.


      This research explored barriers women encountered in disclosing substance use and accessing substance use treatment in pregnancy.


      Participants were recruited from a longitudinal cohort study of people with a history of injecting drug use from metropolitan Melbourne. One-on-one in-depth interviews with 15 participants were conducted using a semi-structured interview guide. To be included in this study, participants must have reported a history of substance use during one or more of their pregnancies.


      The fear of losing child custody associated with the involvement of the child protection services was one of the main barriers to disclosing substance use during pregnancy and accessing treatment and rehabilitation services. Other barriers including stigma and perceived limited treatment options impacted women in various ways.


      Pregnancy is an important time for women and offers opportunities for service providers to support women who are using substances. While not all barriers can be removed, careful consideration of individual cases and circumstances may help service providers to tailor interventions that are likely to be more successful.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Women and Birth
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Sebastiani G.
        • Borrás-Novell C.
        • Alsina Casanova M.
        • Pascual Tutusaus M.
        • Ferrero Martínez S.
        • Gómez Roig M.D.
        • et al.
        The effects of alcohol and drugs of abuse on maternal nutritional profile during pregnancy.
        Nutrients. 2018; 10: 1008
        • Goel N.
        • Beasley D.
        • Rajkumar V.
        • Banerjee S.
        Perinatal outcome of illicit substance use in pregnancy—comparative and contemporary socio-clinical profile in the UK.
        Eur. J. Pediatr. 2011; 170: 199-205
        • Oni H.T.
        • Khan M.N.
        • Abdel-Latif M.
        • Buultjens M.
        • Islam M.M.
        Short-term health outcomes of newborn infants of substance-using mothers in Australia and New Zealand: a systematic review.
        J. Obstet. Gynaecol. Res. 2019; 45: 1783-1795
        • Oni H.T.
        • Buultjens M.
        • Abdel-Latif M.E.
        • Islam M.M.
        Barriers to screening pregnant women for alcohol or other drugs: a narrative synthesis.
        Women Birth. 2018; 32: 479-486
        • Burns L.
        • Mattick R.P.
        • Cooke M.
        Use of record linkage to examine alcohol use in pregnancy.
        Alcohol. Clin. Exp. Res. 2006; 30: 642-648
        • Kelly J.J.
        • Davis P.G.
        • Henschke P.N.
        The drug epidemic: effects on newborn infants and health resource consumption at a tertiary perinatal centre.
        J. Paediatr. Child Health. 2000; 36: 262-264
        • Abdel-Latif M.E.
        • Oei J.
        • Craig F.
        • Lui K.
        • NSW, ACT NAS Epidemiology Group
        Profile of infants born to drug-using mothers: a state-wide audit.
        J. Paediatr. Child Health. 2013; 49: E80-E86
        • Abdel-Latif M.E.
        • Bajuk B.
        • Lui K.
        • Oei J.
        Short-term outcomes of infants of substance-using mothers admitted to neonatal intensive care units in New South Wales and the Australian Capital Territory.
        J. Paediatr. Child Health. 2007; 43: 127-133
        • Forray A.
        Substance use during pregnancy.
        F1000Research. 2016; 5: 887
        • Ministry of Health NSW
        Clinical Guidelines: Substance Use During Pregnancy Birth and the Postnatal Period.
        2014 (Available from:
        • National Drug & Alcohol Research Centre
        Supporting Pregnant Women Who Use Alcohol Or Other Drugs: A Guide for Primary Health Care Professionals.
        2016 (Available from:
        • Frank L.E.
        • Nagel S.K.
        Addiction and moralization: the role of the underlying model of addiction.
        Neuroethics. 2017; 10: 129-139
        • Haber P.
        • Lintzeris N.
        • Proude E.
        • Lopatko O.
        Quick Reference Guide to the Treatment of Alcohol Problems: Companion Document to the Guidelines for the Treatment of Alcohol Problems.
        Australian Government Commonwealth Department of Health and Ageing, Canberra2009 (9)
        • Stone R.
        Pregnant women and substance use: fear, stigma, and barriers to care.
        Health Justice. 2015; 3: 1-15
        • Phillips D.
        • Thomas K.
        • Cox H.
        • Ricciardelli L.A.
        • Ogle J.
        • Love V.
        • et al.
        Factors that influence women's disclosures of substance use during pregnancy: a qualitative study of ten midwives and ten pregnant women.
        J. Drug Issues. 2007; 37: 357-376
        • Oni H.T.
        • Buultjens M.
        • Davis D.
        • Abdel-latif M.
        • Islam M.M.
        Barriers and facilitators in antenatal settings to screening and referral of pregnant women who use alcohol or other drugs: a qualitative study of midwives’ experience.
        Midwifery. 2020; 81: 102595
        • Victoria State Government Health and Human Services
        Alcohol and Other Drug Treatment Services.
        2019 (Available from:
        • Horyniak D.
        • Higgs P.
        • Jenkinson R.
        • Degenhardt L.
        • Stoové M.
        • Kerr T.
        • et al.
        Establishing the Melbourne injecting drug user cohort study (MIX): rationale, methods, and baseline and twelve-month follow-up results.
        Harm Reduct. J. 2013; 10: 1-14
        • Braun C.
        • Clarke V.
        • Hayfield T.
        Thematic analysis.
        Qual. Res. Clin. Health Psychol. 2015; : 95-113
        • Alcaraz S.
        • Viladrich C.
        • Trujols J.
        • Siñol N.
        • de Los Cobos J.P.
        Heroin-dependent patient satisfaction with methadone as a medication influences satisfaction with basic interventions delivered by staff to implement methadone maintenance treatment.
        Patient Prefer. Adher. 2018; 12: 1203
        • Taplin S.
        • Richmond G.
        • McArthur M.
        Identifying Alcohol and Other Drug Use During Pregnancy: Outcomes for Women, Their Partners and Their Children.
        Australian National Council on Drugs, Canberra2015 (Available from:
        • Taplin S.
        • Mattick R.P.
        The nature and extent of child protection involvement among heroin-using mothers in treatment: high rates of reports, removals at birth and children in care.
        Drug Alcohol Rev. 2015; 34: 31-37
        • Stone R.J.G.
        A Narrative Inquiry of Women's Substance Use in Pregnancy and Motherhood.
        Michigan State University, 2014
        • Lester B.M.
        • Andreozzi L.
        • Appiah L.
        Substance use during pregnancy: time for policy to catch up with research.
        Harm Reduct. J. 2004; 1: 1-44
        • Payne J.
        • France K.
        • Henley N.
        • D’Antoine H.
        • Bartu A.
        • O’Leary C.
        • et al.
        Changes in health professionals’ knowledge, attitudes and practice following provision of educational resources about prevention of prenatal alcohol exposure and fetal alcohol spectrum disorder.
        Paediatr. Perinat. Epidemiol. 2011; 25: 316-327
        • Metzl J.M.
        • Hansen H.
        Structural competency: theorizing a new medical engagement with stigma and inequality.
        Soc. Sci. Med. 2014; 103: 126-133
        • Fonti S.
        • Davis D.
        • Ferguson S.
        The attitudes of healthcare professionals towards women using illicit substances in pregnancy: a cross-sectional study.
        Women Birth: J. Aust. Coll. Midwives. 2016; 29: 330-335
        • Doleman G.
        • Geraghty S.
        • DeLeo A.
        Midwifery student's perceptions of caring for substance-using pregnant women.
        Nurse Educ. Today. 2019; 76: 26-30
        • Geraghty S.
        • Doleman G.
        • De Leo A.
        Midwives’ attitudes towards pregnant women using substances: informing a care pathway.
        Women Birth. 2019; 32: e477-e482
        • Wodak A.
        Drug Treatment for Opioid Dependence.
        • Zedler B.K.
        • Mann A.L.
        • Kim M.M.
        • Amick H.R.
        • Joyce A.R.
        • Murrelle E.L.
        • et al.
        Buprenorphine compared with methadone to treat pregnant women with opioid use disorder: a systematic review and meta-analysis of safety in the mother, fetus and child.
        Addiction. 2016; 111: 2115-2128
        • Gyarmathy V.
        • Giraudon I.
        • Hedrich D.
        • Montanari L.
        • Guarita B.
        • Wiessing L.
        Drug use and pregnancy – challenges for public health.
        Eurosurveillance. 2009; 14: 19142
        • Brown V.B.
        • Melchior L.A.
        • Panter A.
        • Slaughter R.
        • Huba G.
        Women's steps of change and entry into drug abuse treatment: a multidimensional stages of change model.
        J. Subst. Abuse Treat. 2000; 18: 231-240
        • Hayatbakhsh M.R.
        • Flenady V.J.
        • Gibbons K.S.
        • Kingsbury A.M.
        • Hurrion E.
        • Mamun A.A.
        • et al.
        Birth outcomes associated with cannabis use before and during pregnancy.
        Pediatr. Res. 2012; 71: 215-219
        • Abdolrahimi M.
        • Ghiyasvandian S.
        • Zakerimoghadam M.
        • Ebadi A.
        Therapeutic communication in nursing students: a Walker & Avant concept analysis.
        Electron. Phys. 2017; 9: 4968-4977