Saving Mothers' Lives: - Public Health Agency for Northern Ireland

Commentary on deaths related to drug and alcohol misuse
Judy Myles
Introduction
Fifty-seven women out of the 98 women whose deaths are discussed in this Chapter had problems with
substance abuse. Forty fi ve were misusing drugs and twelve were alcohol dependent. A further six cases
of substance abuse were identifi ed this triennium but have not been assessed in this Chapter. Although
the majority of those who were drug dependent were using heroin, most were also using methadone,
amphetamines, cocaine, benzodiazepines and some alcohol as well.
A small number died from suicide, the rest died from an “accidental” but lethal overdose of their drug of
abuse, the physical consequences of their abuse or from related medical conditions. Some died from
domestic abuse.
Many of these women were socially excluded and most were homeless or living in very poor circumstances.
The majority were late bookers and poor attenders for antenatal care. Most had previous children in the care
of the local authority and were subject to child protection conferences in their current pregnancy.
Substance misuse therefore makes a signifi cant contribution to maternal mortality in general and to
psychiatric causes of maternal death in particular. As shown in Chapter 1, 11% of all the women who
died this triennium, of any cause, had problems with drugs or alcohol. Sixty per cent were registered drug
addicts The care of these women during pregnancy and the postnatal period presents a challenge to
maternity, drug treatment and social services.
Service delivery
Although pregnant women are fast tracked into treatment in the majority of drug and alcohol services in
the UK, there is still a signifi cant disparity in the numbers of women, in comparison to men, recruited into
treatment services. The rate remains at a ratio of three males to one female, despite efforts to increase the
number of women attending14 . This is particularly of concern as the numbers of women misusing drugs and
alcohol are rising. Women over the age of 16 have markedly increased their levels of harmful and hazardous
alcohol consumption in comparison to men. Amongst women between the ages of 16 and 24, 24% have used
an illicit drug in the previous year. Both drug and alcohol use in women of fertile age is becoming normative
behaviour with a consequent increase in the numbers of exposed pregnancies and the refl ected increase in
maternal mortality either directly or indirectly associated with drug or alcohol misuse.
It is of utmost priority, therefore, that substance misuse services should provide environments that are
acceptable to women of reproductive age, both for access and for retention in treatment. This is particularly
an issue for women from ethnic minorities where drug or alcohol use is deemed unacceptable and
consequently service access is particularly problematic:
A mother of Asian origin died in early pregnancy from hepatic failure. She had been abusing
alcohol for several years and had a long history of related gastrointestinal problems. She had not
taken up the offer of help from her GP and the local alcohol services. Her GP did not convey this
information to the maternity services and her family actively concealed her alcohol problem from
those caring for her.
This case also illustrates the particular diffi culties that women from an ethnic minority group may have in
accessing substance misuse services and the importance of GPs informing maternity services about a
previous psychiatric of substance misuse history.
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