An Examination of Reproductive Health-care Barriers in a Sample of Appalachian Women With a History of Drug Use

Abstract

Summary: Closing the health gap is a priority of the Grand Challenges for Social Work, yet reproductive healthcare disparities remain a significant concern in the Appalachian region of the United States, particularly for women who use drugs. To better understand reproductive healthcare access in this context, we examined associations between past-year illicit substance use and reproductive healthcare access and barriers among Appalachian women. Guided by stigma theory (including anticipated, enacted, and structurally produced stigma related to substance use and pregnancy) and a place-based health equity/social determinants of health lens, we conducted a secondary analysis of anonymous, electronic survey data from 357 reproductive-aged women residing in Appalachia. Bivariate tests and logistic regression models were conducted to compare participants who did and did not report past-year substance use. Findings: Appalachian women with a history of drug use reported more barriers to reproductive healthcare, lower engagement in care, and higher rates of unintended pregnancy. Barriers included affordability of care, perceived stigma, discomfort obtaining appointments, and fear of legal consequences. Applications: These findings underscore the potential role for social workers in addressing reproductive health and drug treatment disparities among Appalachian women who use drugs. Applications for regional social workers include building trust between clients and providers, strengthening connections between substance use disorder treatment and reproductive healthcare, and advocating for policies such as Medicaid expansion and restoration of Title X funding. By integrating micro-level support with macro-level advocacy, social workers can help reduce unintended pregnancies, improve access to care, and advance health equity in this historically underserved region.