Anna Millington, founder of Harm Reduction Mother 2 Mother, accessed drug treatment at an NHS-led service in the UK for her drug use and her key worker suggested, “why don’t you just drink a bottle of wine every night instead? That’s what I do.”
Women who use drugs and alcohol experience particular forms of gendered social stigmas due to historic and pervasive connections between women, femininity and morality. This is exacerbated when women are mums and especially if they also have other marginalized identities. There is a further differential to this regarding criminalized versus non-criminalized substance use which may inform how mothers are treated by public health and social services institutions.
In this post, I will explore some of the issues faced by mums who use drugs in the UK and some of the solutions that have been suggested to support mums who use drugs internationally.
UK drug policy fails to meet the needs of women who use drugs - especially mothers. The criminalization of drugs means that mums risk having their children taken away if they are known to use illegal drugs. For this reason, mums face several risks:
In trying to hide their drug use to avoid the removal of children, mums often cannot use them around other people and have to use them hurriedly for safety. Using drugs alone and in a rush are both factors associated with an increased risk of fatal overdose. Using drugs in a rush can also lead to an increased risk of injection-related infections.
At the same time, UK harm reduction services like needle exchanges are often embedded in drug and alcohol treatment services. mums who want to access harm reduction supplies like unused needles, naloxone, and sharps boxes, must go to these services, potentially with their children if they do not have childcare, and risk having their children removed from them. Without access to these supplies and fear of the educators in these services means that mothers may be forced to engage in riskier drug use habits such as needle sharing (increased risk of infectious disease like HIV or Hepatitis C and skin and soft tissue infections) and using opioids without naloxone availability.
At the same time, mums who use drugs share critical harm reduction knowledge with each other to keep one another safe while using drugs. This is a form of knowledge that comes from communities and is frequently ignored by healthcare services in favor of evidence that is considered to be more credible, such as clinical trials.
While it is important to note that the majority of people who use drugs never struggle with a problematic relationship with substances, some people do, and some mums may wish to access drug and alcohol treatment services.
In the UK, some service users accessing opioid substitution treatment for opioid dependence are required to visit the pharmacy and consume their medication under the supervision of a pharmacist. April Wareham, a member of Working with Everyone, shared an anecdote at the Drink and Drugs New Conference 2023 about a mum accessing opioid substitution treatment:
"During [the COVID-19 lockdowns] there was a woman who got referred to social services by her pharmacist for putting [her kids] at risk of covid, but she couldn’t get unsupervised because the service thought that put her kids at risk of [overdose]. You’re damned if you do and damned if you don’t."
The first UK government drugs strategy from 1998 failed to mention the specific issues faced by parents in accessing treatment. Later drugs strategies from the UK government, including the most recent drugs strategy published in 2021, have largely failed to address this issue other than a brief reference to “family-based services” (Chapter 3). UK drugs strategies largely treat parental drug dependency as a gender-neutral issue. This ignores the fact that while drug and alcohol treatment services were originally designed to meet the needs of men in the UK, the majority of caregiving of children in the UK is done by women, who have specific needs within treatment services.
A scoping review from Scotland on parental drug dependence did not list the needs of female caregivers of children as a part of their aims and objectives. They have a section on mothers and pregnancy in the report in which they note, “this was not a specific area listed in the original objectives for the scoping review, yet it emerged as an important area in which a lot of work had been undertaken.” Mothers in UK drug treatment policy and research are frequently treated as just that: an afterthought.
Prospective mums can be fearful of accessing healthcare for prenatal care and sometimes even birth because of fear of having their child taken away. When they do access services, sometimes they feel like they cannot be honest with the providers. For example, Polly Radcliffe, a researcher of people who use drugs during pregnancy states in a paper:
"One strategy…is to under-represent the amount of heroin being used to treatment providers. This means that the initial dose of methadone determined by a doctor to be safe (i.e.. that will not result in overdose) is unlikely to ‘hold’ the patient, resulting in the symptoms of opiate withdrawal and the probable use of heroin ‘on top’ of the methadone."
Mums who use drugs are told by healthcare providers that the best thing they can do for the safety of mum and baby is to be honest with their providers. At the same time, healthcare providers can and do assess child welfare risks and carry out child protection procedures. This creates a dilemma for the mum who uses drugs on which information to choose to disclose.
Existing health issues or health issues related to drug use are also exacerbated by the fact that mums fear going to the doctor in general because of the stigma that they face as people who use drugs.
All of these risks are compounded by the fact that tabloid coverage of the criminalization of mothers who use drugs in the UK is deeply stigmatizing – normalizing a narrative that mums who use drugs are bad mums which pushes them deeper into the closet.
In order to counter this narrative, the Narcofeminism Storyshare Model is a short documentary from the US by Drugreporter created in collaboration with the International Network of People who use Drugs and the North Carolina Survivors Union. The documentary tells the story of womxn’s experiences of parenting and drug use. Louise Vincent, Executive Director of the North Carolina Survivors Union speaks of the aims behind the documentary:
"I hope that as you watch, you’ll be able to think of these stories as disrupting a narrative…that has taught you to believe that people and especially womxn who use drugs who are pregnant and parenting…that we don’t love our children or we’re unable in some ways to be honest or connect."
Taking another approach, Metzineres, a non-profit in Barcelona, offers tangible solutions to problems that mothers who use drugs face. They have safe consumption services with childcare, legal services, listening circles, and much more crucial services to mothers in Barcelona. These work to “promote communities that guarantee full access to the rights, well-being, and pleasure of womxn who are surviving violence, intersectional vulnerabilities, and that are affected by the war on drugs”.
In the UK, Anna Millington is one of very few people offering culturally-competent services to women and mums who use drugs. She is one of the UK’s most prominent activists for mums who use drugs and founder of Harm Reduction Mother 2 Mother, an organization that provides crucial harm reduction tools and advocacy for mums who use drugs.
UK drug policy has a far way to go on meeting the needs of mothers who use drugs. Crucially, mothers who use drugs lack access to dignified and non-judgmental healthcare services, among other rights afforded to other citizens in the UK. Activists like Anna Millington are starting to put the spotlight on this issue and offer pathways forward, and hopefully the next few years will see some positive changes.
Acknowledgements
Thank you to Anna Millington for her input on this piece and April Wareham for sharing the script to her powerful speech at the Drug and Drink Network National Conference 2023 with me.
Photo credit: Anna Millington