Addiction and pregnancy intentions: Understanding the why behind the what.

摘要

Addiction and fertility are complex, multifaceted phenomena, which affect individuals, families and societies. They are biological and cultural and have huge economic and political influences and impacts. This dissertation explores addiction and fertility through a review of the literature and original qualitative and quantitative research in a population of women in residential treatment for Substance Use Disorders (SUDs). The purpose of this dissertation is to describe and explain women's experiences of addiction through life history interviews and to explore and analyze demographic, reproductive, contraceptive and substance use characteristics in this population. Results are then compared to national substance use and reproduction surveys.;Women with SUDs have often been victims of child abuse and domestic violence. Many have co-occurring psychiatric, medical and socioeconomic problems. Substance abuse is related to a number of reproductive health risks including rape, risky sexual behavior, sexually transmitted infections and unintended pregnancies. Substance use during pregnancy can cause numerous adverse pregnancy outcomes. Drug and alcohol use are commonly associated with cases of child abuse and neglect. Total fertility rates among women with SUDs are much higher than rates in developed countries around the world. But addiction conflicts with and interferes with reproduction and parenting.;Addiction and fertility are discussed and examined through the lens of several theories and frameworks including a human behavioral ecology perspective, life history theory and life history narratives. While there is a great need to reduce the number of children adversely affected by substance abuse and addiction, coerced abortions, sterilizations, termination of parental rights and incarceration are not solutions to this problem. When addiction prevention and delayed or protected sexual activity have failed, early interventions, education and treatment are required to reduce current harm and possibly break the cycle for future generations.