Reprinted from "Women" issue of Visions Journal, 2004, 2 (4), pp. 22-23
A story of Hope
Hope is a 28-year-old Aboriginal woman, pregnant, in her first trimester. She spent her youth in and out of foster care and group homes. A boyfriend introduced her to drugs and she became addicted to heroin in her early 20s. She subsequently worked in the sex trade to support both of their drug habits. When the boyfriend became increasingly violent, Hope south out supports in the community and moved into a women’s shelter. She has been started on methadone, a legal heroin substitute prescribed by a physician. This has given her more stability in her life—enabling her to begin making plans for herself and her baby.
for more background on substance use issues during pregnancy, see the Visions article by Dr. Shimi Kang (only available online) at www.heretohelp.bc.ca/publications/visions
Hope very much wants to parent her child and prevent a repeat of her own sad, dysfunctional childhood. She is currently on a waiting list for supported housing and is seeing a counsellor to address her addiction and past trauma issues. She is now receiving health care and nutritional support, as well as financial advocacy to enroll in the provincial income assistance program.
Nowadays, her afternoons are spent at a drop-in centre where she gets a hot lunch and socializes with other pregnant women. Hope is beginning to develop friendships with other women who share some of her circumstances.
Sheway exists for women like Hope
Hope is fictitious, but her profile characterizes the lives of many women at Sheway. These women are fortunate that the Sheway program exists and provides a range of services for pregnant and parenting women who are dealing with drug and/or alcohol issues.
When women first come to Sheway, most have inadequate housing, poor nutrition, and a fear and mistrust of health and social services. Many of the women come to Vancouver from other regions and provinces, so have little or no family support here. Many of them have experienced multiple losses such as the removal of a child and the death of family members.
These women typically lack positive parenting experiences, both during their own childhood and with their own children. A majority of them have been victims of violence and childhood abuse, and as a result, are struggling with illicit and licit substance use. Most have very limited financial resources, poor education and few job skills. Lacking alternatives, they become workers in the sex trade to survive.
Despite the overwhelming odds these women face, the staff at Sheway believe—and the program has proven—that given the appropriate supports, many of these women can successfully parent.
What is faced when seeking help
Motherhood is difficult for even the most well prepared, supported middle-class woman. For women who live in poverty struggling with addiction, the challenges of parenthood can seem insurmountable.
Pregnancy is a time when women become more introspective about their lives and their futures, and they are often motivated to make positive changes. But they find there are insufficient support services and they face many obstacles, including racism and cultural, geographic and attitudinal barriers.
Notably, the women encounter service providers who treat them judgmentally and disrespectfully, and so the women avoid seeking health care and other services. Understandably, these women are reluctant to disclose information about themselves to service providers whom they fear may bring legal action or punitive treatment. Pregnant women are even less likely to seek health care if they fear the removal of their children.
Social stigma is another barrier to seeking health care and social services, particularly for women who turn to the sex trade. Society views drug-using pregnant women as evil, unfit and the cause of family breakdown. But with a lack of adequate food, housing education and skills, these women are unlikely to be able to address their addiction issues.
Interestingly, as one authority, Dr. Mary Hepburn, has noted, “Poor women who use illegal drugs have drugs have a higher rate of perinatal death, pre-term deliveries, low birth weight babies, and sudden infant death syndrome (SIDS). However, the same incidence is found for women who smoke cigarettes and for those who are poor and non-drug users.”1
Attaining good maternal-child health is an appropriate goal for society, and poor obstetrical outcomes are costly in many ways. Vilifying pregnant women for drug use in pregnancy and consequent poor infant health, however, distracts society from addressing what the women and their families need most: social housing, adequate welfare funds for food and rent, and culturally appropriate, family-centred treatment programs.
How Sheway helps
The women who come to Sheway are welcomed by non-judgemental staff and invited to access the services. Some women come for health care during and after their pregnancies. Those who feel they are not able to care for their child may seek support to arrange an adoption. For the women who hope to parent their children, Sheway supports them in their efforts to prepare for parenting.
For these women, even the basic necessities are difficult to obtain. Diapers, formula and baby clothing must be purchased out of the meagre income assistance cheque. Sheway attempts to provide these items when welfare funds run out.
Isolation adds to the stresses of poverty. Food banks are helpful; however, a woman must wait in line alone with a new baby and no convenient way to transport her parcels home. Sheway provides weekly food bags, and limited bus tickets and transportation to appointment when possible.
Many women lack basic life and parenting skills. For women motivated by pregnancy and a live for their children, those skills and knowledge they already have are easily supplemented and supported. For a woman to nurture her baby, she, too, must be ‘mothered.’ Sheway first makes sure her basic needs—shelter, food, clothing, emotional support—are met, and secondly, helps her realize she can be a capable mother.
There is a great need for services that address the complexity of the circumstances of these women. Sheway is one such program, but is limited to Vancouver residents and by financial constraints.
What can be done now?
For more women like the fictitious Hope to succeed in parenting—and to break the costly cycle of child removal and foster placement—our communities need to increase the number of services that target the unique needs of this population. More of the following services are needed”
- non-judgemental health care that addresses perinatal addictions
- methadone programs that focus on the needs of pregnant women
- hospital-community partnerships (such as Fir Square (see p. 41))
- housing that is safe, affordable, and supportive for isolated women striving to paren (see Crabtree article, p. 40)
- programs that provide nutrition and food services to young families and pregnant women
- treatment centres that accommodate women and their children, and accept women on methadone
- detox beds for women
About the authorLaraine is a community health nurse. She has worked for the Sheway program for six years
Hepburn, M. cited in Boyd, S.C. (2004). From witches to crack moms: Women, drug law, and policy. (pp. 95-96). Durham, NC: Carolina Academic Press