Contextos de exclusão social e vulnerabilidade de mulheres usuárias de drogas no ciclo gravídico puerperal

Abstract

The production, trafficking and use of drugs are a threat to safety and health of individuals, families, and communities. An increased use of drugs among women of childbearing age has been observed in recent years, causing challenges for intervention in respect of damages resulting from the relationship between abused drug and maternal and child health. The urgency for the drug and the lack of financial conditions lead them to engage in illicit activities, such as drug trafficking, theft and prostitution, in exchange for drugs or money to purchase them, and under the influence of drugs, they have difficulty negotiating the practice of safe sex, submitting to the risk of unwanted or unplanned pregnancy. This study aimed to evaluate contexts of vulnerability of women bearing abused drugs during the puerperal cycle. By using the analytical reference of the vulnerability, it was performed a descriptive and retrospective study of a case series of 12 women bearing abused drugs in the puerperal cycle, from three municipalities of Northwestern Paraná State, whose cases were reported to the Center for Intoxication Control of the University Hospital of Maringá, in the years from 2008 to 2010. As a data source, it was used the epidemiological records of Toxicological Occurrence and the hospital charts of the women. The tools used to collect the data were a script for a semi-structured interview, applied during home visits, and a field diary. The data were categorized according to the three analytical levels of vulnerability - Individual, Social, and Programmatic, and analyzed by thematic content. Most women said belonged to the race/color mulatto (58.3%), at childbearing age - between 17 and 33 years; lived in a common-law marriage (58.3%), had education incompatible with their age and had no fixed income (75%); survived with the alimony of children or government support of the Family Grant Program. The number of pregnancy/woman ranged between two and 11, but 66.7% reported more than three pregnancies. All of them started using drugs during the adolescence and had an addictive behavior. They used multiple abused drugs during pregnancy, crack being the most frequent (10 - 83.3%), followed by alcohol (5 - 41.7%), and marijuana (3 - 25%). Throughout their lives, tobacco and alcohol were the drugs of initiation, followed by marijuana, the first illicit drug used by ten women (83.3%). As triggering factors for the use of drugs, stood out the influence of friends (10), relatives (9), companions (8), and the presence of drugs in their community. At individual level, the elements of vulnerability found refer to gender, age, marital status, education, occupation, income, and race/color of the woman. At social level, refer to situations experienced by women in the family - the addictive behavior, psychiatric disorders, conflicts, physical violence, psychological and sexual abuse; and conflict with the law - drug trafficking, other crimes, prison, prostitution and murder. At programmatic level, it was found the low access to health services to carry out the prenatal care and treatments for chemical dependency; the lack of bond with professionals; and low resolution and autonomy in matters of reproductive planning and harm reduction in the use of drugs.