The Nexus of Gender Difference, Substance Use and Impending Challenges of Pregnant Women and Neonates in Sri Lanka

Abstract

This project concerns the needs of gender-responsive approaches to address the under recognized issue of substance use during pregnancy. In many societies including Sri Lankan society, substance use among women is highly stigmatized. Use of illicit substances (narcotics or psychotropic substances) during pregnancy can lead to multiple health consequences for both mother and child (fetus and growing child). Some of these effects include, intrauterine growth restriction, low birth weight, congenital abnormalities, pre mature rupture of membranes, neurodevelopment problems, premature labor and pre-term birth, sudden infant death syndrome (SIDS), Attention Deficit Hyperactive Disorder (ADHD), placental abruption, antepartum hemorrhage (APH), colic with uncontrollable crying, neonatal withdrawal, asthma and obesity in childhood. Not only does substance use during pregnancy lead to multiple family and social problems. Dependence on drugs severely impairs her functioning as a mother and this can lead to gender-based violence and domestic violence which significantly affect the physical, mental and emotional development of children.

Due to limited studies related to pregnant women’s substance use and its associated problems, it is difficult to identify barriers women face when seeking health care and treatment support. But some of the studies highlight systemic, structural, social, cultural and personal barriers when accessing treatment.

Pregnancy can be an opportunity for women and their family members to change their substance use behavior. Therefore, antenatal care (ANC) health workers have an important role in screening, diagnosis and prevention of disease and complications among these women understanding the complexity of the problem. However, this remains as a hidden problem within society due to criminalization, stigma, lack of awareness and limited screening within ANC.

Therefore, this project is planned with the overall goal of reducing the health risks and social consequences of substance use during pregnancy in Sri Lanka by establishing an evidence-based, gender-responsive national framework for early identification of pregnant women with substance use, strengthening their participation in antenatal care services through capacity building of healthcare providers and standardizing screening and referral guidelines, addressing structural and social barriers to treatment, and informing policy reforms that expand accessible treatment and rehabilitation services for women and newborn.

Three sites were planning to selected from high drug prevalence areas of the Western province of Sri Lanka and highly concern about the enhancing the early identification of pregnant women with substance use while strengthening the capacity of healthcare workers, pregnant mothers and community. Further, this project includes the collection of evidence on the prevalence and patterns of pregnant women substance use by analyzing 500 urine samples with consent. Ethical considerations, confidentiality and voluntary participation are encouraged during the project.

The targeted outcomes of this project include improved knowledge, attitudes, practices and awareness among healthcare workers and the community towards pregnant women who depend on substances, increased early identification of substance use during pregnancy and the generation of evidence for policy reforms and provide policy recommendations to implement a gender-sensitive treatment approach at national level. Finally, this project aims to improve maternal and child health outcomes while promoting gender equality and reproductive justice.