Abstract
BackgroundWomen 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.MethodsThe 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.ResultsKey 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.ConclusionsIn 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.
Highlights
Women living in poor and vulnerable neighbourhoods like Vancouver’s Downtown Eastside (DTES) face multiple burdens related to the social determinants of health
Such evidence suggests that people residing in the DTES face multiple burdens related to social determinants of health and that psychological trauma is likely a common experience
This study explored themes of trauma, violence and mental health in pregnant and postpartum women who struggled with substance use and accessed harm reduction services, in order to offer insight into the complexities of the target group and elucidate potential points for improvement of and access to services
Summary
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 a common experience for these women. Researchers have identified the significance of traumatic experiences such as childhood maltreatment, sexual assault and family and partner violence for individuals with substance use problems [7,8]. Such evidence suggests that people residing in the DTES face multiple burdens related to social determinants of health and that psychological trauma is likely a common experience
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