Cross-Cutting Narratives of Opioid Use Disorder Among Pregnant Women and Mothers: Implications for Humanistic Care

Opioid-related fatalities in the U.S. have increased drastically. Pregnant women and mothers with opioid use disorders (OUD) are a rapidly growing and vulnerable population. Using a critical narrative approach, this dissertation examines how the syndemic of trauma, substance use, and mental health conditions influences opioid use and treatment trajectories among pregnant women and mothers across the lifecourse. The goal of this dissertation was to examine three discursive resources that shape the social construction of perinatal and maternal opioid use across all strata of social life: macro-level (news media), meso-level (scientific), and micro-level (individual) narratives. Informed by 18-months of ethnographic observation, in-depth interviews, and mixed methods analysis of scientific research and news media coverage of perinatal and maternal OUD, this research brings together the voices of women in recovery, clinicians, social workers, policymakers, and the public. Building from what Sanders (2014) refers to as the “gendered double standard” faced by women with substance use disorders, in this dissertation I characterize the intersecting identities of female, pregnant/mother, and substance user as a gendered triple standard. Throughout this work I argue that being held to this gendered triple standard intensifies the stigma faced by pregnant women and mothers with OUD as they navigate the medical, legal, and social service institutions. Key findings from this research include: (1) a predominating focus on “fetal victimhood” (Knight, 2015), which overlooks the needs of pregnant women and mothers with OUD that run concurrent to ensuring a healthy pregnancy and birth; (2) approaches to addressing the opioid “crisis” that elide key at-risk populations (e.g. People of Color, active substance users, and polysubstance users); (3) “folk” pharmacokinetic knowledge and practices utilized by pregnant women and mothers that function as both facilitators and barriers to treatment engagement; and (4) the traumas associated with institutional policies and procedures specific to the management of opioid use (e.g., practices associated with civil commitment to treatment, loss of custody, and intergenerational family separation via the criminal justice and/or foster care systems). Informed by key findings, this dissertation concludes with five specific recommendations for research and practice

Working with Pregnant & Postpartum Women with Opioid Use Dependence: Digital Storytelling as an Innovative Qualitative Data Collection Tool and Intervention

As part of the mini-symposium entitled Pregnant and Parenting Mothers with History of Opiate Addiction, this presentation describes a qualitative study that will use digital storytelling with pregnant women in a medication assisted treatment (MAT) program as an intervention to promote self-efficacy as well as a patient-centered data collection tool

The Ethics and Practice of Digital Storytelling as a Methodology for Community-Based Participatory Research in Public Health

Moderator: Alice Fiddian-Green, PhD student, Department of Health Promotion and Practice, School of Public Health and Health Sciences, University of Massachusetts Amherst. Presenters and Session Titles: “An Ethics Framework for Digital Storytelling as a Multi-Purposed Public Health Method”: Aline Gubrium, PhD Applying the Ethics Framework in Two Projects: (1) Louis Graham, MPH, DrPH, and Sarah Lowe, MPW: “Stakeholder Engagement and Ethical Planning for Digital Storytelling: The MOCHA Moving Forward Project” (2) Mary Paterno, CNM, PhD: “Digital Storytelling as Health Promotion and Data: Ethical Considerations from a Peer-Mentor Based Project to Address Perinatal Substance Use Disorder in a Rural Community Session Description Public health often mislocates its lineage in the medical sciences. Being foremost about people and what happens when people live together, the field is equally rooted in the humanistic and social sciences. By providing a focus that is more open to the rich and variegated tapestry of health and wellbeing, participatory visual and digital approaches, such as digital storytelling, enhance understandings of health and well being. If carried out responsibly, digital storytelling has the potential to function both as a vehicle for community-based health promotion, and as a method for collecting culture-centered data that can assist researchers and practitioners in better serving local communities. Based on a Freirian model, which promotes active engagement as participants construct stories to promote change through a group process, the goal of our digital storytelling practice is to provide a creative forum for expressing the generative themes or collective issues of community members. Beyond being mere data points, digital stories enliven statistics, make research meaningful, and position research participants as experts in their own right by inviting them to define relevant issues, broaden the evidence base, and create an emotional product that attracts and influences policymakers and the public at large. Finally, digital stories can be re-purposed for use in health communication campaigns (on and offline) to effect broad reach. Published literature on the ethics of community-based participatory research methods grounded in personal storytelling and participatory media approaches is in short supply, as are advanced training opportunities for public health researchers interested in these approaches (Gubrium & Harper, 2013; Gubrium, Hill, and Flicker, 2014; Gubrium, Hill & Fiddian-Green, 2016). Based on their previous research and practice experiences with digital storytelling, Gubrium and colleagues (2014) discuss the “situated practice of ethics” for participatory visual and digital methods in public health research and practice. Specifically, they write about six common challenges faced by researchers, advocates, and health promotion practitioners alike: the fuzzy boundaries that arise when negotiating between research, advocacy/action, and health promotion practice when using these methods; tensions related to recruitment of participants and consent to participate; the complex considerations specific to the release of the digital materials produced in workshops; power issues as they relate to the shaping of both stories and digital media content; the potential for reproducing harm in visual/digital representation; and the promise of confidentiality/anonymity to research participants. The proposed breakout session will provide a brief overview of the digital storytelling process (including discussion of recruitment, informed consent and release of materials, standard activities in the digital storytelling process, follow-up semi-structured interviews with participants, pre/post measures used to evaluate the impact of the process on participants, data analysis, and strategic communications based on produced digital stories). The session will enable participants to understand the myriad ethical issues that can present when carrying out community-based participatory research that employs digital storytelling as a methodology. By the end of the session, participants will be able to demonstrate critically enhanced awareness of ethical issues surrounding participatory visual and digital methodologies and identify effective ways to address these issues

Gendered Triple Standard and Biomedical Management of Perinatal and Maternal Opioid Use Disorder in the United States: Investigating Bodily, Visceral, and Symbolic Violence

Despite trends towards treatment versus punitive-based approaches to addressing opioid use disorders (OUD) in the United States, pregnant and parenting women with OUD remain highly stigmatized, their maternal fitness routinely contested. Biomedical conceptions of OUD as a chronic, relapsing condition often run counter to the abstinence-based models enforced across the myriad institutions that manage OUD, particularly for women whose maternal status is contingent on treatment enrollment and adherence. Exposure to trauma is considered to be nearly universal among women with OUD; biomedical classifications of trauma primarily center on the interpersonal (i.e., adverse childhood [ACEs] and lifetime experiences). This work responds to a call to ‘gender addiction’ (Campbell and Ettorre 2011) and examine the ‘epistemologies of ignorance’ (Tuana 2006) around notions of ‘risk’ by advocating for a broadened definition of trauma that incorporates the institutional violence imbedded into policies and procedures specific to the biomedical management of OUD. Drawing from an 18-month ethnographic investigation of pregnant and parenting women with OUD living in the Northeastern United States., this article argues that the intertwined institutions (e.g. medical, legal, and social services) that manage OUD according to biomedical dictates enact a converging constellation of violence on women; this in turn becomes a form of embodied trauma, directly influencing perinatal and maternal opioid use trajectories. Key findings include: (1) civil commitment to treatment as a form of direct bodily violence, (2) loss of maternal status as visceral violence, and (3) institutional erasures (i.e., intergenerational family separation) as symbolic violence

Protecting pregnant people & infants against influenza: A landscape review of influenza vaccine hesitancy during pregnancy and strategies for vaccine promotion

Before COVID-19, influenza vaccines were the most widely recommended vaccine during pregnancy worldwide. In response to immunization during pregnancy, maternal antibodies offer protection against potentially life-threatening disease in both pregnant people and their infants up to six months of age. Despite this, influenza vaccine hesitancy is common, with few countries reporting immunization rates in pregnant people above 50%. In this review, we highlight individual, institutional, and social factors associated with influenza vaccine hesitancy during pregnancy. In addition, we present an overview of the evidence evaluating interventions to address influenza vaccine hesitancy during pregnancy. While some studies have indicated promising results, no single intervention has consistently effectively increased influenza vaccine uptake during pregnancy. Using a social-ecological model of health framework, future strategies addressing multiple levels of vaccine hesitancy will be needed to realize the potential health benefits of prenatal immunization programs

Women-Reported Barriers and Facilitators of Adherence to Medications for Opioid Use Disorder

AIM: A poorly understood challenge is why many women with opioid use disorder do not remain engaged with medications for opioid use disorder (MOUD; e.g., methadone, buprenorphine, naltrexone) long enough to achieve sustained benefits. We aimed to identify barriers and facilitators that impact women\u27s MOUD adherence. METHODS: We conducted in-person interviews and focus groups with 20 women who had received MOUD for at least 90 days in Springfield and Holyoke, Massachusetts in 2018. Using grounded theory, we inductively identified major themes and selected illustrative quotations. FINDINGS: Gender-specific barriers to treatment are shaped by MOUD-related stigma stemming from multiple sources: (1) the internalization of messaging from social networks that equate pharmacotherapies to substituting one drug for another; (2) pharmacotherapy side effects related to weight gain, tooth decay, and interactions with anti-anxiety medications; (3) negative consequences from being discovered as a MOUD client, including loss of custody, children being bullied in school, workplace-related stigma, and being associated with sex-work. Women identified the following key facilitators of MOUD adherence: avoiding pain, sickness, and death; feeling safe in treatment settings, particularly for those with histories of interpersonal and sexual trauma; developing positive routines that replace opioid seeking behaviors and build self-esteem; maintaining healthy boundaries with friends, family, and partners who actively use opioids; and offering relatable peer support to other women as a source of recovery hope. CONCLUSION: Women encounter gendered stigma and support from individual, interpersonal, and community level sources that if addressed collectively, can inform improvements to MOUD engagement and adherence efforts