The study has several major findings. First, there is the concerning rate of methamphetamine use among pregnant women compared with nonpregnant women. The fact that over 90% of the pregnant women reported recently using methamphetamine is consistent with another recent study in Cape Town, which showed that among a group of pregnant women who smoked tobacco, up to 78% reported methamphetamine use [18
]. These results are also consistent with other reports of high rates of methamphetamine use observed in Cape Town among the general population, its women, and its out-of-school young women between 13 to 20 years old [4
]. Taken together, the past and current data highlight the urgent need to develop and implement effective women-focused interventions to reduce this epidemic. The high rate of methamphetamine use among pregnant women may also be a reflection of the relationship between methamphetamine use and sexual risk behavior, which can result in pregnancy. On a positive note, the majority of the pregnant women made attempts to reduce their drug use after learning that they were pregnant, which is an encouraging sign. However, more than 30% of the pregnant sample either used at the same level or increased use of methamphetamine. Given the potentially adverse impact of stimulants on fetal brain development, particularly in the context of multiple environmental risk factors, there is a clear need for prevention initiatives in the Western Cape of South Africa, similar in scope and focus to efforts for informing the public about fetal alcohol spectrum disorders.
The second major finding of this secondary analysis is the pervasive need for comprehensive treatment for pregnant Black and Coloured women in Cape Town, South Africa. Although these women have myriad needs, the pregnant women in this sample necessarily required medical and obstetrical care. The literature from South Africa suggests that over the 16 years since National Health System has provided free antenatal and intrapartial care to all uninsured women, many women have not been accessing or have been underutilizing care before delivery [19
]. The reasons underlying this underutilization are complex and include structural barriers (e.g., inconvenient hours of clinic operation, inability to take time off from work, too long a wait to be seen, lack of child care, and/or transportation); relationship issues (e.g., unstable relationship with the father of the baby); psychological factors (e.g., unwanted pregnancy, pregnancy denial); lack of education as to the need for prenatal health care; negative interactions with the medical professionals [20
]. The current findings, in context with the prior literature, suggest that women want medical care as well as drug and alcohol treatment, yet interventions must be implemented where they can be reached and at multiple levels to concurrently address the structural barriers to care, improve the actual care these women receive, and reduce the perceived and actual stigma and discrimination the women feel and encounter.
The third finding of note is that the pregnant women had a lower rate of condom use than did the nonpregnant women. This result suggests that a significant proportion of methamphetamine-using Black and Coloured women consider condoms to serve the primary role of birth control rather than of disease prevention. If this conclusion is supported by future research, community outreach efforts need to be made to educate this high-risk population regarding the crucial role that condoms can play in HIV/sexually transmitted infection prevention.
Finally, it is notable that these women made a clear distinction between mental health services and alcohol/drug services. Fewer than 1 in 5 women expressed a need for mental health services, despite the CES-D mean score being almost twice that of the clinical cutoff used previously in low-income US and South African women. Although increased depressive symptoms are associated with being of color, lower educational attainment, and low income; having substandard living conditions; living in stressful neighborhoods; possibly, lacking support of a partner [17
], this finding underscores the need for intervention to ameliorate the symptoms of depression while concurrently treating drug addiction.
In contrast to the low self-reported need for mental health services, almost 1 in 2 women expressed a need for alcohol/drug services. Moreover, the most pressing needs expressed were for economic support, with more than three-quarters of the women wanting employment and financial aid; housing only slightly trailed the former two needs. These conclusions appear to be equally valid for the pregnant women as for the nonpregnant women.