“Women Never Use Drugs Alone”: Assessing Stigma & Access to Care among Women who Use Drugs.


  • Amanda Essex Indiana University School of Medicine
  • Carrie Lawrence, Ph.D. CFLE CHES Indiana University School of Public Health
  • Brooklyn Sean Turner Indiana University School of Public Health





Substance misuse remains a significant health threat in communities across Indiana. Despite the 2015 HIV outbreak in Scott County, Indiana’s health systems continue to lack the capacity to reduce health harms associated with substance misuse. Unlike general patient populations, people who use drugs (PWUD) face various social and structural barriers that impede access to health care and result in poorer health outcomes. Such impediments are of more significant concern for pregnant women who use drugs (PWWUD) who experience greater stigma, complex health needs, and require more specialized care. The purpose of this study was to assess access to healthcare and related services among women of childbearing age with a history of substance misuse.


For this qualitative study, participants (n=20) completed a sociodemographic questionnaire and semi-structured interview. Interview questions included perceptions of their overall health, healthcare experiences, and how to improve access to and retention in these services.


The results reported reflect a thematic analysis of the interview transcripts. Two key care barriers identified were: (1) experiences of stigma related to professionals’ attitudes towards PWWUD and (2) fear of losing custody of their child as a result of physician mandated reporting to child welfare.

Conclusions and Recommendations

Addressing social and stigma related barriers experienced by PWWUD are key to increased linkage to and retention in care as well as improved health outcomes. Additionally, our findings call for mandated student and physician education on patients who use drugs as well as reform of mandated reporting laws to reduce barriers and increase care access among PWWUD.