title: "Like a lots happened with my whole childhood": violence, trauma, and addiction in pregnant and postpartum women from Vancouver's Downtown Eastside.
abstract: BACKGROUND
  Women living in poor and vulnerable neighbourhoods like Vancouver's Downtown Eastside (DTES) face multiple burdens related to the social determinants of health. Many of them struggle with addiction, are involved in the sex trade and experience homelessness and gender-based violence. Such evidence suggests that psychological trauma is also a common experience for these women.
  
  
  METHODS
  The purpose of this qualitative study was to explore themes and subjective perspectives of trauma and gender-based violence in women who lived in an impoverished neighbourhood and struggled with substance use during pregnancy and early motherhood. We interviewed 27 individuals accessing harm reduction services for pregnant and postpartum women in Vancouver, Canada.
  
  
  RESULTS
  Key themes that emerged from these women's narratives highlighted the ubiquity of multiple and continuing forms of adversities and trauma from childhood to adulthood, in a variety of contexts, through a variety of offenders and on multiple levels. Both individual and environmental/structural conditions mutually intensified each other, interfering with a natural resolution of trauma-related symptoms and substance use. Women were also concerned that trauma could be passed on from one generation to the next, yet expressed hesitation when asked about their interest in trauma-specific counselling.
  
  
  CONCLUSIONS
  In offering harm reduction services for poor and marginalized women, it is clear that an understanding of trauma must be integrated. It is recommended that service providers integrate trauma-informed care into their programme in order to offer this service in a trusted environment. However, it is also necessary to shift the focus from the individual to include environmental, social, economic and policy interventions on multiple levels and from issues of drug use and reduction of drug-related harms to include issues of gendered vulnerabilities and human rights.
authors.affiliation: Centre for Health Evaluation and Outcome Sciences (CHÉOS), St. Paul's Hospital, 588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. itorchalla@cheos.ubc.ca.|Department of Psychiatry, University of British Columbia, Detwiller Pavilion, 2255 Westbrook Mall, Vancouver, BC, V6T 2A1, Canada. itorchalla@cheos.ubc.ca.
authors.forename: Iris
authors.initials: I
authors.lastname: Torchalla
authors.affiliation: Centre for Health Evaluation and Outcome Sciences (CHÉOS), St. Paul's Hospital, 588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
authors.forename: Isabelle Aube
authors.initials: IA
authors.lastname: Linden
authors.affiliation: Centre for Health Evaluation and Outcome Sciences (CHÉOS), St. Paul's Hospital, 588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.|Department of Psychiatry, University of British Columbia, Detwiller Pavilion, 2255 Westbrook Mall, Vancouver, BC, V6T 2A1, Canada.
authors.forename: Verena
authors.initials: V
authors.lastname: Strehlau
authors.affiliation: Centre for Health Evaluation and Outcome Sciences (CHÉOS), St. Paul's Hospital, 588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
authors.forename: Erika K
authors.initials: EK
authors.lastname: Neilson
authors.affiliation: Centre for Health Evaluation and Outcome Sciences (CHÉOS), St. Paul's Hospital, 588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.|Department of Psychiatry, University of British Columbia, Detwiller Pavilion, 2255 Westbrook Mall, Vancouver, BC, V6T 2A1, Canada.|School of Population and Public Health, University of British Columbia, James Mather Building; 5804 Fairview Avenue, Vancouver, BC, V6T 1Z3, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Krausz
mesh_terms: D000328:Adult; D002170:Canada / Q000453:epidemiology; D005260:Female; D006801:Humans; D049590:Postpartum Period / Q000523:psychology*; D011203:Poverty / Q000523:psychology / Q000706:statistics & numerical data; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D013315:Stress, Psychological / Q000453:epidemiology / Q000523:psychology*; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology*; D014505:Urban Population / Q000706:statistics & numerical data; D014754:Violence / Q000523:psychology* / Q000706:statistics & numerical data