Abstract
BackgroundIndigenous women in Canada have been hyper-visible in research, policy and intervention related to substance use during pregnancy; however, little is known about how the social determinants of health and substance use prior to, during, and after pregnancy intersect. The objectives of this study were to describe the social contexts of pregnant-involved young Indigenous women who use substances and to explore if an Indigenous-Specific Determinants of Health Model can predict substance use among this population.MethodsUsing descriptive statistics and hierarchical logistic regression guided by mediation analysis, the social contexts of pregnant-involved young Indigenous women who use illicit drugs’ lives were explored and the Integrated Life Course and Social Determinants Model of Aboriginal Health’s ability to predict heavy versus light substance use in this group was tested (N = 291).ResultsImportant distal determinants of substance use were identified including residential school histories, as well as protective factors, such as sex abuse reporting and empirical evidence for including Indigenous-specific determinants of health as important considerations in understanding young Indigenous women’s experiences with pregnancy and substance use was provided.ConclusionsThis analysis provided important insight into the social contexts of women who have experiences with pregnancy as well as drug and/or alcohol use and highlighted the need to include Indigenous-specific determinants of health when examining young Indigenous women’s social, political and historical contexts in relation to their experiences with pregnancy and substance use.
Highlights
Indigenous women in Canada have been hyper-visible in research, policy and intervention related to substance use during pregnancy; little is known about how the social determinants of health and substance use prior to, during, and after pregnancy intersect
In Canada, Aboriginal1, 2 mothers have been hyper-visible in research, policy and intervention related to alcohol and drug use during pregnancy, while the social contexts underlying Aboriginal women’s substance use have often been ignored [17, 22] as they relate to experiences with pregnancy
Due to imposed legislative and social conditions, beginning with colonization, many young Aboriginal mothers are located at the intersections of multiple dimensions of social inequality that shape their experiences with substance use and parenting in complex ways
Summary
Indigenous women in Canada have been hyper-visible in research, policy and intervention related to substance use during pregnancy; little is known about how the social determinants of health and substance use prior to, during, and after pregnancy intersect. In Canada, Aboriginal mothers have been hyper-visible in research, policy and intervention related to alcohol and drug use during pregnancy, while the social contexts underlying Aboriginal women’s substance use have often been ignored [17, 22] as they relate to experiences with pregnancy. There is a dearth of epidemiological data that explores these contextual factors related to substance use before, during and after pregnancy, and quantitative data which necessarily and explicitly attends to understanding these broader determinants of substance use is needed [22] To understand these determinants across women’s lives in a more nuanced and contextualized way, the typical research focus on substance use only during pregnancy must be broadened to include pregnant-involved women’s life experiences with alcohol and drug use before, during and after pregnancy. Women who use alcohol or drugs problematically are often living in high risk environments characterized by poverty, unstable housing, food insecurity and unemployment, and often have histories of abuse and psychological issues [17]
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