Abstract
Kelly Ray Knight set out to disentangle the incredibly complex realities of unstably housed, drug-addicted pregnant women—and prevailed. Addicted. Pregnant. Poor. is a product of 4 years of participant observation in daily rent hotels throughout San Francisco’s Mission District, wherein Knight presents a skillfully written ethnographic study of 19 women and the drug–sex economy, housing instability, comorbidity, and the service and policy environments that encompass their lives. The study is inclusive of multiple perspectives, including medical professionals, case managers, child protective service workers, and other stakeholders, to fully illuminate the predicaments and conflicts of addicted pregnancy. Nonetheless, in true feminist fashion, Knight keeps the women’s stories central and allows for their voices and self-definition to inform the work (e.g., choosing to use the term “addict” as opposed to “drug user” because that’s how the women defined themselves).
Addicted. Pregnant. Poor. shows just how paradoxical systems and the actors within them can be when it comes to dealing with addicted pregnant women. Inadvertently or not, addicted pregnant women may be seen as victims or perpetrators, interventions may rehabilitate or criminalize, or an at-risk fetus’ rights may be valued over the mother’s rights, just to name a few. The concept of time is also paradoxical in this study, as Knight clearly explains the many temporal demands that drive every facet of these women’s lives. Knight describes “addict time,” for example, as the constant pursuit of securing drugs of addiction, which may conflict with the biomedical demands of “pregnancy time.” These temporalities must be balanced with the necessity of sex work to meet the daily rent demands of “hotel time” and so on. These paradoxes allow the reader to walk away with a nuanced understanding of these women’s everyday struggles, and the conditions that are, at times, exacerbated by some of the very policies and programs that are meant to ameliorate them.
Knight’s capacity for storytelling is a significant strength of this book. Through a combination of ethno-photography and strategic integration of strikingly vivid verbatim field notes, she adds colorful context to her analysis. The field notes really allow the women’s voices to be heard in a way that enables the reader to vicariously experience the pain of child loss, eviction from the daily rent hotel rooms, public benefit denial, arrests, and the literal highs and lows of cyclical drug use.
One of the most impressive aspects of this book is Knight’s vulnerability and keen awareness of her various social positions as a medical anthropologist, “outreach worker, confidant, friend, chauffeur, and sometime ‘doctor’” (p. 25). In the opening field note, she highlights the ongoing ethical dilemmas of ethnographic work and walking the tightrope of building and maintaining the trust of women who have many reasons not to trust outsiders. Knight is transparent in her writing about her emotional positioning and ethical conflicts and is poignantly honest about the complexities of researching such a marginalized population while still maintaining her own humanity.
Although this is an ethnographic text, it takes on a social work framework in that Knight paints a picture of these women in environment. Knight is not cheap on detailing the ways in which gentrification; criminalization; economic exploitation; the complexities of comorbidity, policy changes, and processes; and temporal demands impact women’s lives. As social work is a field that squarely focuses on society’s most oppressed and marginalized people, those working in the domains of direct practice, policy, and research have something to gain from this work because it presents difficult but essential questions for the profession to grapple with. For example, jail has become the site for much of these women’s social service coordination; how can we change that? Or, how can we ensure safe shelter for addicted women if sobriety remains an eligibility criterion for many shelters and other forms of housing?
This book clearly highlights the discrepancies between intent and impact so that social workers, as well as other professionals, can reflect on where they have been going wrong and identify new approaches for intervention with women at risk for addiction, poverty, and the lack of good health care when pregnant.