B. Substance Use Among Women

Substance use disorders in women tend to be multifaceted and highly correlated with comorbid mental health conditions such as depression and anxiety. Additionally, substance use disorders are strongly correlated to childhood personal violence and trauma. Women who inject drugs have significantly higher mortality rates, increased likelihood of injection-related problems, faster progression from first drug use to a disorder, higher rates of communicable diseases, higher levels of risky injecting and/or sexual risk behaviors, greater overlap between sexual and injecting social networks, and more commonly report interpersonal violence than the general population.

According to a 2009 Substance Abuse and Mental Health Services Administration (SAMHSA) publication, pregnant women may be reluctant to seek prenatal care due to fear of losing custody of the infant or other children. Most mothers who are in substance use disorder treatment feel a strong connection with their children and want to be good mothers. Most of these mothers want to maintain or regain custody of their children and become “caring and competent parents.” Women who believe they have not cared for their children adequately or who believe that they are perceived as having neglected their children carry enormous guilt. Therefore, for many women, maintaining caring relationships with their children is sufficient motivation to keep them in treatment. Unfortunately, they often have inadequate role models in their own lives or lack the information, skills, or economic resources that could make motherhood less difficult.[195]

In its 2018 biennial report, the Texas Maternal Mortality and Morbidity Task Force found that drug overdose (typically opioids) was the leading cause of maternal mortality for women typically occurring after 60 days postpartum.[196]