A Bio-Ecological Perspective on Risk Awareness and Factors Associated with Substance Use during Pregnancy in Communities of the Western Cape Province, South Africa
Substance use among pregnant women is a perennial problem in the Western Cape Province of South Africa. There are many influential elements related with substance use among women of childbearing-age. Factors associated with substance use during pregnancy were explored using qualitative research approach and bio-ecological theoretical framework was utilised to guide the study. Participants were selected using purposive sampling. Participants accessed from the Department of Social Development who met the inclusion criteria of the study were interviewed using semi structured interviews. Participants were referred for psychological intervention during the interview if deemed necessary. Braun and Clarke’s six phases of thematic analysis were used to analyse the data. The study adhered to ethical measures for the participants’ protection. Participants had been knowledgeable about the study earlier than the initiation of the interviews and the important points of their voluntary participation had been explained. The key findings from this study illustrate that social factors, individual area and romantic relationship are the major contributing factors to substance use among pregnant ladies in this sample. Recommendations arising from the study encompass that the stakeholders, rehabilitation centers, Department of Health and future researchers ought to act proactively against substance use all through pregnancy.
 Briggs, G. G., Freeman, R. K., & Yaffe, S. J. (2012). Drugs in pregnancy and lactation: a reference guide to fetal and neonatal risk. Lippincott Williams & Wilkins.
 Zabaneh, R., Smith, L. M., LaGasse, L. L., Derauf, C., Newman, E., Shah, R., Arria, A., Huestis, M., Haning, W., Strauss, A. & Della Grotta, S. (2012). The effects of prenatal methamphetamine exposure on childhood growth patterns from birth to 3 years of age. American Journal of Perinatology, 29(03), 203-210.
 Howell, S., & Couzyn, K. (2015). The South African National Drug Master Plan 2013-2017: a critical review. South African Journal of Criminal Justice, 28(1), 1-23
 Olivier, L., Urban, M., Chersich, M., Temmerman, M., & Viljoen, D. (2013).The burden of fetal alcohol syndrome in a rural West Coast area of South Africa. SAMJ: South African Medical Journal, 103(6), 402-405.
 Dada, R., Kumar, S. B., Chawla, B., Bisht, S., & Khan, S. (2016). Oxidative stress induced damage to paternal genome and impact of meditation and yoga-can it reduce incidence of childhood cancer? Asian Pacific Journal of Cancer Prevention, 17(9), 4517-4525.
 Vythilingum, B., Roos, A., Faure, S. C., Geerts, L., & Stein, D. J. (2012). Risk factors for substance use in pregnant women in South Africa. SAMJ: South African Medical Journal, 102(11), 853-854.
 Forray, A. (2016). Substance use during pregnancy. F1000Research, 5, F1000 Faculty Rev–887.http://doi.org/10.12688/f1000research.7645.1
 McLellan, A. T., Lewis, D. C., & O'Brien, C. P. (2002). Drug Dependence, a Chronic Medical Illness: Implications for Treatment, Insurance, and Outcomes Evaluation. Year Book of Psychiatry and Applied Mental Health, 2002(1), 125-126.
 Amaro, H., & Black, D. S. (2017). Moment-by-Moment in Women's Recovery: Randomized controlled trial protocol to test the efficacy of a mindfulness-based intervention on treatment retention and relapse prevention among women in residential treatment for substance use disorder. Contemporary clinical trials, 62, 146-152.
 Petersen Williams, P., Jordaan, E., Mathews, C., Lombard, C., & Parry, C. D. (2014). Alcohol and other drug use during pregnancy among women attending midwife obstetric units in the Cape Metropole, South Africa. Advances in Preventive Medicine, 2014.
 Geldenhuys, K. (2015). Substance abuse in workplace. Sevamus Community-based safety and magazine 108, (6), 25-27.
 Dada, S., Burnhams, N.H., Erasmus, J., Parry, C., Bhana, A., Timol, F., & Fourie, D. (2015). South Africa Community Epidemiology Network on Drug Use (SACENDU): update: acohol and drug abuse trends; November 2015: January – June 2015 (Phase 38).
 Croxford, J., & Viljoen, D. (1999). Alcohol consumption by pregnant women in the Western Cape. South African Medical Journal, 89(9).
 Jones, H. E., Browne, F. A., Myers, B. J., Carney, T., Ellerson, R. M., Kline, T. L & Wechsberg, W. M. (2011). Pregnant and no pregnant women in Cape Town, South Africa: drug use, sexual behaviour, and the need for comprehensive services.International Journal of Paediatrics, 2011.
 Van Dyk, J. G. (2011). Maternal methamphetamine uses during pregnancy and subsequent neurodevelopmental and psychological subsequent in the child-a Cape Town experience (Doctoral dissertation, University of Cape Town).
 Peltzer, K., & Ramlagan, S. (2009). Alcohol use trends in South Africa. Journal of Social Sciences, 18(1), 1-12.
 Caswell, D. Experiences of coloured heroin users in Metro South ares of Cape Town: A social work perspective
 Basford, L., & Slevin, O. (Eds.). (2003). Theory and practice of nursing: An integrated approach to caring practice. Nelson Thornes.
 Bronfenbrenner, U., & Ceci, S. J. (1994). Nature-nurture recontextualized in developmental perspective: A bio ecological model. Psychological Review, 101(4), 568-586.
 Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101.
 Bergen, D. (2008). Human development: Traditional and contemporary theories. Recording for the Blind & Dyslexic.
 Bronfenbrenner, U., & Morris, P. A. (2006). The bio-ecological model of human development. Handbook of child psychology.
 Floyd, J., & Forster, L. (2003). The Recipe Reader: Narratives. Contexts, Traditions.
 Stone, R. (2015). Pregnant women and substance use: fear, stigma, and barriers to care. Health &Justice, 3(1), 2.
 Kalichman, S. C., Simbayi, L. C., Jooste, S., & Cain, D. (2007). Frequency, quantity, and contextual use of alcohol among sexually transmitted infection clinic patients in Cape Town, South Africa. The American journal of drug and alcohol abuse, 33(5), 687-698.
 Goliath, V., & Pretorius, B. (2016). Peer risk and protective factors in adolescence: Implications for drug use prevention. Social work, 52(1), 113-129.
 Gharaiben, H., Haddad, L., Alzyoud, S.E., El-Shahawy, O., Baker, N.A., & Umlauf, M. (2011). Knowledge, attitude, and behavior in avoiding secondhand smoke exposure among non-smoking employed women with higher education in Jordan. International journal of environmental research and public health, 8(11), 4207-4219.
 Sung, M. J., & Su, H. C. (2007). How do the risk factors of ecological levels influence the vulnerability of children?
 Tudge, J. R., Mokrova, I., Hatfield, B. E., & Karnik, R. B. (2009). Uses and misuses of Bronfenbrenner's bio-ecological theory of human development. Journal of Family Theory & Review, 1(4), 198-210.
 Steinman, K.J., & Zimmerman, M.A. (2004). Religious activity and risk behavior among African American adolescents: Concurrent and developmental effects. American journal of community psychology, 33(3-4), 151-161.
 Kraus, M.L., Alford, D.P., Kotz, M.M., Levounis,P., Mandel,T.W., Meyer, M., & Wyatt, S.A. (2011). Statement of the American Society of Addiction Medicine Consensus Panel on the use of buprenorphine in office-based treatment of opioid addiction. Journal of addiction medicine, 5(4), 251-263.
 Mohasoa, I.P. (2010). Substance abuse among male adolescents (Doctoral dissertation, University of South Africa)
 Kumar, R., Marks, M., Platz, C., & Yoshida, K. (1995). Clinical survey of a psychiatric mother and baby unit: characteristics of 100 consecutive admissions. Journal of affective disorders, 33(1), 11-22.
 Witt, W. P., Wisk, L. E., Cheng, E. R., Hampton, J. M., & Hagen, E. W. (2012). Preconception mental health predicts pregnancy complications and adverse birth outcomes: a national population-based study. Maternal and child health journal, 16(7), 1525-1541.
 Dawson, D. A., Grant, B. F., & Ruan, W. J. (2005). The association between stress and drinking: modifying effects of gender and vulnerability. Alcohol and Alcoholism, 40(5), 453-460.
 Pilling, J., Thege, B. K., Demetrovics, Z., & Kopp, M. S. (2012). Alcohol use in the first three years of bereavement: a national representative survey. Substance Abuse Treatment, Prevention, and Policy, 7(1), 3.
 Stroebe, M., Schut, H., Boerner, K. (2010). Continuing bonds in adaptation to bereavement: Toward theoretical integration. Clinical psychology review, 30(2), 259-268
 Perreira, K. M., & Sloan, F. A. (2001). Life events and alcohol consumption among mature Adults: a longitudinal analysis. Journal of Studies on Alcohol, 62(4), 501-508.
 Lichtenstein, P., Gatz, M., & Berg, S. (1998). A twin study of mortality after spousal Bereavement. Psychological Medicine, 28(3), 635-643.
 Paquette, D., & Ryan, J. (2001). Bronfenbrenner’s Ecological Systems Theory. Children, 44, 1–105. http://doi.org/viewed at 19 January 2015
 World Health Organization. (2016). Sexual and reproductive health, New guidelines on antenatal care for a positive pregnancy experience. Regional Office for Europe. https://www.who.int/reproductivehealth/news/antenatal-care/en/#
 Tariq, N., Ayub, R., Khan, W. U., Ijaz, S., & Alam, A. Y. (2015). Parenteral iron therapy in the treatment of iron deficiency anemia during pregnancy: a randomized controlled trial. J Coll Physicians Surg Pak, 25(3), 193.
 Anderson, T.L. (2002). Drug use and gender. Encyclopedia of criminology and deviant behavior, 4(2), 286-9.
 Azim, T., Bontell, I., & Strathdee, S. A. (2015). Women, drugs and HIV. International Journal of Drug Policy, 26, S16-S21.
 Nagel, J. B. (2017). Structural barriers to treatment for pregnant Coloured women abusing TIK in Cape Town: The experiences of healthcare providers (Doctoral dissertation, Stellenbosch: Stellenbosch University).