Secrecy Versus Disclosure: Women with Substance Use Disorders Share Experiences in Help Seeking During Pregnancy

Objectives Substance misuse during pregnancy can be harmful to the health of both mothers and infants. Existing recovery services or prenatal care for pregnant women with substance use disorders (SUD) in the U.S. and other countries typically fall short in providing the necessary specialized care women with SUDs need. Disclosure of substance misuse is one key factor in gaining access to specialized prenatal care; yet, barriers such as social stigma and internal shame and guilt lead many women to under-report any substance misuse during their pregnancy. This study sought to understand the process of how and why pregnant women with SUDs choose to disclose or not disclose their substance misuse to their providers when seeking prenatal care. Methods Data were collected through interviews with N = 21 women with SUDs in the northeast U.S. whose young children had been exposed to opioids, cocaine, or MAT in utero. Thematic, inductive analysis using line-by-line coding was conducted to understand the perspectives of the women. Results The women’s narratives suggested a clear tension regarding whether to disclose their substance misuse to any providers during their pregnancy. Four themes describing the process of disclosure or non-disclosure were found, including reasons for and ways of being secret or choosing to disclose their substance misuse during pregnancy. Conclusions for Practice The centrality of shame, guilt, and stigma regarding substance misuse must be addressed by medical and mental health providers in order to increase disclosure and improve access to care for women with SUDs.