Sociocultural aspects of drug dependency during early pregnancy and considerations for screening: Case studies of social networks and structural violence

Objective: To contribute in closing the current gap in literature that holistically examines sociocultural influences on perinatal drug dependency. This article draws from social network theory and structural violence to qualitatively consider the contextual components of addiction and substance use during pregnancy, which purposefully moves away from situating this issue from solely being within the contexts of pathologized disorders or products of social inequalities. Design: Face-to-face semi-structured interviews with drug-dependent pregnant women identified during a reproductive environmental health consultation. Setting: Interviews were conducted at a university hospital in southeastern Spain between October 2015 and June 2016. Participants: 10 pregnant women with confirmed perinatal substance use and/or drug dependency. Findings: The sociocultural perspective offers a useful lens by which providers can understand the reasons for initial substance use and progress of multi-drug dependency as way of individually tailoring intervention strategies for expecting mothers. This perspective draws from the frameworks of social network analysis (SNA) and structural violence to dialectically examine drug dependency in this unique patient population not to be solely an individual occurrence, but rather a combination of macro and microlevel factors at play. Key Conclusions: The sociocultural approach in examining maternal health allows for the holistic exploration of the already taboo and symbolically paradoxical phenomenon of drug dependency in pregnant women. Implications for Practice: The Hoja Verde and similar perinatal screening methods that comprehensively assess for the potential of environmental risks can be a key instrument in the practice of preventing developmental issues of children as early as pregnancy and into adolescence. (C) 2019 Elsevier Ltd. All rights reserved.