Sexual and Reproductive Health Behaviors of Women With Criminal Legal Involvement and Substance Use Disorders: A Life Course Perspective

Objective: Early exposure to drug use and sexual abuse may contribute to later substance use, causing downstream effects on sexual and pregnancy-related behaviors. We applied the life course perspective to qualitative interview findings conducted with women with criminal legal involvement to explore connections between participants' early exposure to drugs and childhood sexual abuse with subsequent engagement with substance use and sexual and reproductive behaviors. Method: We analyzed semistructured interviews with 33 racially diverse women with criminal legal involvement, Ages 18-65, who were recruited from a community organization in the Midwestern United States to explore their experiences and perspectives on factors that influenced their substance use and reproductive health behaviors. We used a modified grounded theory approach and retroactively applied the life course perspective model to inform and organize our data. Results: Fifteen participants described exposure to substances and/or sexual abuse at a young age which played a role in influencing later life behaviors involving substance use and sexual and reproductive health. For some participants, the accumulation of experiences further contributed to shared pregnancy behaviors and outcomes including unexpected and rapid repeat pregnancies and difficulty abstaining from drug use while pregnant. Conclusions: Early life experiences may influence later life sexual and reproductive health behaviors. These experiences must be considered when engaging with women in patient-centered and trauma-informed ways in settings where they seek care including carceral facilities, obstetrics and gynecology and primary care clinics, and substance use disorder treatment programs.