ID: 387

Type of submission: Oral

Conference track: Research

Topics: Human Rights and Harm Reduction; Women, Drug Use and Harm Reduction

Presenting author: Natalia Sidorenko

Presenting author biography:

I"m started my journey in AIDS services in 2002: peer-to-peer classes in schools and at universities. Later I did outreach work with various groups: drug users, migrants, sex workers, ex-convicts… I"m work from an outreach worker to a project manager, trainer, and counselor to Russian and international organizations.

“A Nobody’s Patient”: Healthcare for pregnant drug-using women in Russia through the eyes of physicians and patients

Natalia Sidorenko, Janna Ataiants

Background: Up to 11% pregnant women in Russia have history of illicit drug use. Drug-dependent pregnant women frequently receive late or no prenatal care and underutilize other healthcare services. Little is known about barriers to accessing healthcare for pregnant drug-using women in Russia.

Methodology: Semi-structured in-depth interviews were conducted with 27 key informants (drug-dependent women, physicians, and staff of harm reduction agencies) in three Russian cities in 2013-2014.

Results: The study identified three particular barriers in accessing healthcare services for pregnant drug-dependent women. First, the lack of clear guidelines on managing opioid dependency during pregnancy and ban on medication-assisted treatment in Russia severely limits options for pregnant patients. Women have to choose between self-tapering, hiding pregnancy to enroll to abstinence-based addiction treatment, or continuing using street drugs. Second, access to prenatal care was compromised by women’s fear of the authoritative figure of the OB/GYN provider and low self-esteem(‘unfit for the role of mother’). Third, Russia’s fragmented healthcare system has a particularly detrimental effect on healthcare access for pregnant drug-dependent women.. Physicians with their highly specialized training and lack of guidance/protocols were uncertain on providing proper care for pregnant patients with addiction and comorbidities and often referred them to the next specialist. With the lack of externalsupport, women often were unable to overcome transportation barriers and long waiting lines and eventually they were have been lost tomedical observation in principal – turning into the ‘nobody’s patient.’

Conclusions: Findings suggest that drug-dependent women unable to overcome structural barriers without external support. Russia should modify its policies to offer evidence-based, interdisciplinary and integrated healthcare services for drug-dependent pregnant women to ensure the best possible state of health for mothers and their babies.