Women's perspectives on screening for alcohol and drug use in prenatal care.
BACKGROUND
Screening for alcohol and drug use in prenatal care is widely promoted in the United States as a public health strategy for reducing alcohol and drug use during pregnancy. However, the published literature does not consider women's perspectives or the potential negative ramifications of screening.


METHODS
Twenty semistructured interviews and two focus groups (n = 38) were conducted with a racially/ethnically diverse sample of low-income pregnant and parenting women using alcohol and/or drugs in a northern California county.


RESULTS
Most women were averse to having drug but not alcohol use identified and were mistrustful of providers' often inconspicuous efforts to discover drug use. Women expected psychological, social, and legal consequences from being identified, including feelings of maternal failure, judgment by providers, and reports to Child Protective Services. Women did not trust providers to protect them from these consequences. Rather, they took steps to protect themselves. They avoided and emotionally disengaged from prenatal care, attempted to stop using substances that could be detected by urine tests before prenatal care visits, and shared strategies within social networks for gaining the benefits of prenatal care while avoiding its negative consequences.


CONCLUSIONS
Considerations of the public health impact of screening for drug use in prenatal care should account for the implications of women's physical avoidance of and emotional disengagement from prenatal care, specifically the direct effects of late, limited, and no prenatal care on pregnancy outcomes and missed opportunities for health promoting interventions.
Roberts
Sarah C M
SC
Alcohol Research Group, Emeryville, California 94608, USA. sroberts@arg.org
Nuru-Jeter
Amani
A
D000328:Adult; D000428:Alcohol Drinking; D001294:Attitude to Health; D002140:California; D002648:Child; D005260:Female; D017144:Focus Groups; D015438:Health Behavior; D006293:Health Promotion; D006801:Humans; D007407:Interviews as Topic; D008403:Mass Screening / Q000523:psychology*; D008875:Middle Aged; D011203:Poverty; D011247:Pregnancy; D011295:Prenatal Care / Q000523:psychology*; D012648:Self Care; D019966:Substance-Related Disorders / Q000175:diagnosis; D055815:Young Adult
Matern Child Health J. 2004 Sep;8(3):137-47
15503394
AIDS Public Policy J. 2005 Fall-Winter;20(3-4):74-91
17624031
Alcohol Clin Exp Res. 2000 Aug;24(8):1276-86
10968668
Am J Obstet Gynecol. 1992 Jun;166(6 Pt 1):1747-54; discussion 1754-6
1615983
BMJ. 2002 Aug 10;325(7359):314
12169509
Psychiatr Serv. 1999 Dec;50(12):1584-90
10577877
J Psychoactive Drugs. 1997 Jan-Mar;29(1):55-66
9110266
Obstet Gynecol. 2006 Feb;107(2 Pt 1):348-54
16449123
J Fam Pract. 1991 Mar;32(3):283-8
2002319
J Matern Fetal Neonatal Med. 2004 Jul;16(1):45-50
15370082
Pediatrics. 1999 Aug;104(2):e18
10429136
Semin Perinatol. 1995 Aug;19(4):293-300
8560295
BMC Public Health. 2002 Nov 6;2:25
12421466
Am J Drug Alcohol Abuse. 1979;6(4):413-29
549470
Obstet Gynecol. 1989 Dec;74(6):882-5
2586952
Fam Plann Perspect. 2000 Mar-Apr;32(2):56-64
10779236
Obstet Gynecol. 2008 Dec;112(6):1449-1460
19037056
J Perinatol. 2003 Jul-Aug;23(5):354-60
12847528
J Trauma. 2003 Apr;54(4):701-6
12707531
Subst Use Misuse. 1996 Jun;31(8):1063-76
8806168
Obstet Gynecol. 1998 Aug;92(2):193-200
9699750
JAMA. 1993 Oct 6;270(13):1581-6
8371469
J Subst Abuse. 1997;9:63-76
9494939
J Am Dent Assoc. 2006 Dec;137(12):1692-8; quiz 1730-1
17138714