PSICOLOGIA: TEORIA E PESQUISA DOI: https://dx.doi.org/10.1590/0102.3772e34425 2018, V.34, e34425 CLINIC PSYCHOLOGY AND CULTURE Women Crack Users, Pregnancy and Motherhood: Potential Periods for Health Care Fernanda de Souza Ramiro, Ricardo da Costa Padovani, Thiago Marques Fidalgo, & Adriana Marcassa Tucci* Universidade Federal de São Paulo, São Paulo, SP, Brasil ABSTRACT – This study aimed to understand how women report their behaviors concerning drug use during pregnancy and breastfeeding. This is a qualitative study, conducted in the metropolitan area of Santos. Twelve women who have used crack were interviewed through a semistructured interview. The interviews were analyzed from the perspective of content analysis. Our data indicate that pregnancy is a critical time to sensitize these women and try to lessen the damage and the risks associated with the use of crack among them. KEYWORDS: crack cocaine, women, pregnancy, motherhood Mulheres Usuárias de Crack, Gravidez e Maternidade: Períodos Potenciais para Cuidados em Saúde RESUMO – Este estudo objetivou compreender como as mulheres reportam seus comportamentos em relação ao uso de drogas durante a gravidez e a amamentação. Trata-se de um estudo qualitativo, realizado na região metropolitana de Santos. Doze mulheres usuárias de crack foram entrevistadas por meio de entrevista semiestruturada. As entrevistas foram analisadas a partir da análise de conteúdo. Os dados indicam que a gravidez é um momento crítico para sensibilizar essas mulheres e tentar diminuir danos e riscos associados ao consumo de crack entre elas. PALAVRAS-CHAVE: crack, mulheres, gravidez, maternidade. Cocaine addiction is one of the most challenging Precarious social policies, low level of education, low diseases worldwide. The World Drug Report, compiled by participation in the labor market, poor family relationships the United Nations Office for Drugs and Crime (UNODC) and conflicts in one’s family are risk factors for drug use. in 2013, indicated that 17 million people used cocaine Physical and mental health problems are also common at least once during the past year (UNODC, 2013). among drug users. Mood swings, anxiety and depression However, the Americas present the most problematic use of symptoms, respiratory diseases and sexually transmitted cocaine, considering cocaine use and trafficking are more diseases are some of the common physical and mental prominent in South America, particularly in Brazil, due diseases among this part of the population (Costa et al, 2012; to its geographical location and its large urban population Marangoni & Oliveira, 2013). (UNODC, 2014). In Brazil, according to the most recent survey, 4% of According to the World Drug Report, despite the use of the population has consumed cocaine at least once in their illicit drugs being more common among men than women, lives and around 1.5% has used crack cocaine (Gigliotti, the non-medical use of pharmaceutical drugs is almost Ribeiro, Aguilera, Rezende, & Perrenoud, 2014). Women equivalent, if not higher, among women (UNODC, 2014). account for 21.3% of crack users in drug use areas (Bastos, Besides that, there has been reports of a major increase of Bertoni, Salganik, & Feehan, 2013). crack cocaine use among women (Fertig, 2016). * E-mail: [email protected] 1 FS Ramiro, RC Padovani, TM Fidalgo, & AM Tucci Women who use crack cocaine have specific needs, affect women’s health, interfering with their ability to such as the use pattern of crack cocaine, pregnancy, take care of themselves and, therefore, impairing prenatal responsabilities of child care, prostitution and/or the development (Botelho, Rocha, & Melo, 2013; Narcowicz, exchange of sex for money or drugs, traumas and history Plotka, Polkowska, Bizwik, & Namiesnik, 2013; Silva, Pires, of violence, mental health problems, low self-esteem and Guerreiro, & Cardoso, 2012). stigma for “being a woman” and a drug user. Therefore, it Moreover, fetal injuries can happen due to the use of is important to identify and take into consideration their crack cocaine. Injuries are especially likely during the needs and characteristics when planning treatments (Cruz, perinatal period, ranging from the twenty-second week of Oliveira, Coimbra, Kantorski, Pinho, & Oliveira, 2014). gestation to the seventh day of birth. During this period, Although changes have slowly been introduced along there is an increased risk of placental abruption, presence with new social roles for women, they are still judged by of meconium in the fetus, premature rupture of the amniotic moral beacons established in past times (Pinsky, 2012) sac, short stature, low birth weight, preterm birth (Araújo, and women drug users are still perceived through a gender 2012; Botelho, Rocha & Melo, 2013; Gouin, Murphy & bias. Women drug users are stigmatized by the general Shah, 2011; Narcowicz et al., 2013), and genitourinary and population and also by professionals when seeking health abdominal abnormalities (Botelho, Rocha & Melo, 2013; care. Professionals perceive them as irresponsible, criminals Moreira, Mitsuhiro, & Ribeiro, 2012; Narcowicz et al., and sex workers (Cruz et al. 2014). 2013). Furthermore, the regular use of cocaine during this From the developmental perspective, the specialized period increases the likelihood that the child will develop literature shows some aspects of familial relationships hypertension later in life and will have difficulties both in associated with drug use. Parent-child relationships and concentration and in psychomotor movement throughout parenting style have been consistently found as important their development (Araújo, 2012; Botelho, Rocha, & Melo, factors. Pettenon et al (2014) found that women crack users 2013; Narcowicz et al., 2013). had a different perception of the bond they had with their Parental drug use has been consistently associated with parents when compared to non-drug users; they were more drug use by the offspring (Basu & Ghosh, 2014; Biederman, likely to perceive their mothers as negligent and their fathers Faraone, Monuteaux, & Feighner, 2000; Merikangas et as affectionless and controlling. The authors also suggest al, 1998). Moreover, women who use drugs have been that such findings might be associated with less resilience characterized by some faults in their motherhood which among children when facing stressful life events, what in have been associated with a greater risk of drug use by turn increases their risk to use crack. the offspring, such as: negligence, practice of physical or Systematic review of Brazilian women crack users emotional abuse, punishment to control child-like behavior, shows that the use of crack by this group is related to a lack of emotional involvement and inconsistent discipline history of childhood maltreatment (neglect, physical and (Basu & Ghosh, 2014; Suchman & Luthar, 2000; Tucci, sexual abuse), lack of education, risky sexual behavior, Kerr-Corrêa, & Souza-Formigoni, 2010). prostitution and unplanned pregnancy; the study shows that A recent study has found that prenatal cocaine exposure the use of crack cocaine is high among them (Limberger et alters responses to environmental stress and that it may al, 2016). Additionally, a “binge” use pattern of crack has increase sensitivity in relation to childhood maltreatment been identified among women (Cruz et al, 2014). (CM). Moreover, prenatal exposure was associated with Risky sexual behavior and unplanned pregnancies have poorer coping strategies only among adolescents with CM been associated with the use of crack cocaine (Bastos et al., (Min, 2017). Eventual consequences of addiction on the 2013; Costa, Soibelman, Zanchet, Costa, & Salgado, 2012; child, after birth or during infancy, such as prematurity, Duffet al., 2013). The statistics of cocaine and crack cocaine abstinence syndrome, breathing disorders, feeding disorders, use during pregnancy are difficult to estimate, given that sleep disorders, hyperactivity, malformations, make these pregnant women generally omit this information (Botelho, women feel guilty, given that pregnancy and motherhood are Rocha, & Melo, 2013). Nevertheless, it has been pointed experienced with a strong feeling of ambivalence between out that the estimate is getting higher (Yamaguchi, Cardoso, addiction and parenting (Silva et al., 2012). Torres, & Andrade, 2008). In addition to that, it is desirable that mothers should be Costa et al (2012) found among pregnant crack addicts encouraged to breastfeed. It is believed that the promotion admitted for detoxification in a psychiatric inpatient unit that of this practice might even prevent or delay postpartum the main reasons given for crack cocaine use were sadness relapse (Forray, 2016). However, a research points out or stress relief, the influence of a friend or a partner who that crack cocaine use is absolutely contraindicated during uses crack and the easy access to/availability of the drug. lactation because the drug is present in the milk at high Studies show that pregnancy may not work as a turning concentrations, causing irritability, vomiting, diarrhea and point in stopping drug use, reflecting the vulnerability of seizures in babies (Araújo, 2012). On the other hand, studies women crack users (Marangoni & Oliveira, 2013; Limberger indicate that breastfeeding should be avoided by women with et al, 2016). However, drug abuse during pregnancy can heavy drug use within the first 24 hours after the last use of 2 Psic.: Teor. e Pesq., Brasília, 2018, v. 34, e34425 Women Crack Users, Pregnancy