Impossible Identities: The Double-Binds on Drug-Using Women in Rural Appalachia

On March 13, 2017 I settled into my chair in room 220 in the New Classroom Building at Virginia Tech. I was there to listen to a guest lecture by Lesly-Marie Buer, a doctoral candidate at the University of Kentucky. Two overhead screens on either side of the room displayed the title of the lecture: Paradoxical Treatment: Drug-Using Women’s Navigations of Impossible Identities in Rural Appalachia.

Addicted. Pregnant. Poor. book coverWomen in American society are often haunted, to different degrees, by the possibility of pregnancy. Kelly Ray Knight notes in Addicted. Pregnant. Poor. that, “The biological nature of pregnancy, specifically in reference to the potential for shared illicit substance use through shared blood between a fetus and mother, shifts the ontological status of the woman and initiates legal, technical, and political limits on her as an individual” (Knight 2007: p. 12). Due to the specter of pregnancy, women who suffer from addiction are maligned as child abusers or potential child abusers – as those who have failed to meet the ideal of the selfless mother.

Buer’s study looked at programs for women with SUDs in a 5-county area in rural Kentucky. Her aim was to determine what these programs are doing to help and also marginalize women, and their limitations. Buer interviewed 32 “gatekeepers,” or treatment providers and community leaders from different organizations. She also spoke with 40 women who went through the programs, many who did so several times.

The women in rural Kentucky have three treatment options: drug courts (which don’t believe in treatment with medications), buprenorphine clinics, and community mental health centers (such as Horizons). In Horizons, Buer reported that women are in contact with the state on a daily basis through law enforcement and Child Protective Services (CPS). Most of the women in Horizons have lost custody of their children after testing positive for illegal drugs once. Not all of the women in Horizons suffer from addiction. In fact, the women exhibit a wide range of drug use, from having smoked marijuana once or only on weekends to severe addiction to methamphetamine or opioids.

The dominant understanding of addiction at Horizons is that addiction is both a disease and a moral failing. Staff believe that the women made choices that caused a disease, that they will then pass on to their children through exposure to the drug and through genetics. Buer’s research revealed that some professionals selectively cite studies that appear to justify this concept.

Women in Horizons are thus doubly stigmatized by this “moral failure rooted in genetics and passed through generations.” They are categorized as “bad” mothers. This prevailing belief extends to all women as potential mothers, and asserts that women who use drugs “put all children in danger,” not only their own. Buer described a presentation she attended in which women using drugs were blamed as the cause of all disorders in the education system, without evidence.

As an example of the stigma women face, legislators and media have continually emphasized a notion of “babies born addicted,” where infants exhibit withdrawal symptoms at birth. The concept of “addicted babies” is a misunderstanding of addiction itself. The babies may be born dependent on an opioid, for example, but they do not persist using despite negative consequences so they are not addicted. Babies born dependent to substances are weaned off, and there is no evidence of adverse effects later in life. Yet, the myth of “babies born addicted” persists and stigmatizes mothers who do suffer from addiction.

Women who lose their children also lose human connection, and exchange their identities as “mothers” for “addicts.”

Women in rural Kentucky also suffer from another stereotype, that they are coping poorly with a “hyper-violent Appalachian culture that victimizes women.” The women are doubly dis-empowered as having no control over addiction, or over the presumed violent culture of which they are “victims.”

“The idea of these women as victims is used as a target for coercive state intervention,” Buer reported. Women must agree to urine tests for drugs, and if they do not agree, CPS will be called immediately. Buer, when hospitalized for an early delivery, underwent this urine test herself, and later her blood was tested for drugs without her consent.

Funding is a huge issue for Horizons. Administrators of Horizons recognize that stigma is a problem, but they do not have enough money to change the behavior of their clinicians. Sometimes they knowingly perpetuate stigmatizing practices in order to qualify for limited funding. More funding is clearly needed for these programs to combat the stigma that is causing so many problems for women in poverty. Unfortunately, funding is likely to be lost if the ACA is repealed.

The stigma isn’t limited to Horizons or to the medical system, however. Buer told the story of a program called CRACK that was started by a woman, a community member, who admitted to having race-related motivations. CRACK payed women $300 to get sterilized. An advertisement saying, “attention drug addicts & alcoholics,” targeted low-income neighborhoods, and especially those of people of color.

Women with addiction in poverty in rural Kentucky, beyond stigma, are subject to a practical double bind. They are forced to choose between childcare and self-care for addiction. Buer documented that men in NA groups criticized women for not doing more in the programs, though women needed to leave early to care for their children. The women were thus either “bad moms” for neglecting their children or “bad citizens” for neglecting to seek help for their “disease.”

Worse, Buer said that women in abusive situations feared calling the police, because CPS would intervene and take their children away. One woman was charged with neglect for not being with her children while her husband was beating her. The husband was not punished, which, Buer said, is often the case. The unequal treatment women receive from the state extends beyond domestic violence. Buer reported that police officers pull women over and check their arms for track marks, as a pseudo-drug-test.

Women in Horizons are stigmatized by law enforcement, medical practitioners, and the surrounding community. To regain agency and positive identity, Buer said that the women found ways to be good mothers while using by providing food and shelter and shielding their children from their drug use. They view themselves as strong in coping with adversity, and focus on proving people wrong, affirming things like, “I neglected myself, not my kids.” Some women choose to give up custody on their own terms, finding a friend or family member willing to assume custody and visiting their children whenever possible.

The paradoxical and stigmatizing identities of “bad mothers,” “bad citizens,” and “addicts,” combined with the extra stigma associated with poverty or race make for an impossible situation for these women in rural Appalachia. Many in American society have been passionate activists for “the rights of the fetus” and to safeguard children in unstable situations. Rarer are those who focus on the needs of women and mothers, and at some point the conflicting demands placed upon women in poverty are unrealistic and counterproductive.

In Addicted. Pregnant. Poor., Knight writes that, “Addicted, pregnant women are biopolitical projects on which social and legal interventions are attempted as pregnant, addicted women travel between environments of drugs and hustling and institutions of care and coercion. whether biological mechanisms or social-psychological histories are evoked to explain addiction, the path from pregnancy to mothering a child ultimately demands stability and abstinence” (Knight 2007: p. 31). To provide that stability, the addictions treatment and criminal justice systems need massive overhaul to combat stigma, and to increase access to treatment and vital resources for women in poverty.

On the Effects of Mobile Phones on Poverty in Africa

It may come as a surprise that mobile phones are increasingly becoming a commonplace investment in households throughout the developing world. India and Africa have been particularly targeted. Phone manufacturers worldwide are competing to flood African markets with their products, banking on the prediction that the African market for smartphones will double in the next four years. Africa is second only to Asia in number of subscribers, and its mobile penetration rate is the highest in the world.
Rural System visiting UgandaPhoto taken by Risa Pesapane, project director of Rural System, during the Rural System visit to Uganda in 2013.

“With 650 million mobile phone subscribers in Africa, there are already about 100 million smartphone users with the number set to double to 200 million users in the next four years.” –CNN

It is no accident that mobile technology has become so valued in developing African countries. In some ways, increased access to communication has made Africa safer for indigenous people; one USAID-supported program informs users which areas to avoid due to ethnic violence, 93% of female mobile phone users feel safer with a phone, and 85% of female users feel more independent. Mobile phones also make times of crisis easier to manage for residents.

“In the case before mobile phones, families would spend tremendous cost on travel and time in contacting family members about a funeral or sickness. From the results, Katote households agreed that this communication device provided a means of timely responses, reduced surprises with available information, allowed the ability to multi-task and plan during shocks, engaged less time to physically search individuals and less emotional stress during the really difficult ordeals.” –Diga et al.

Mobile devices are useful in other ways as well; 42% of mobile phone owners use their phones to increase their income and professional opportunities. Phones are also used to increase educational opportunity within classrooms, to improve diagnostic precision in medical centers, to reduce corruption within some state agencies, and to provide affordable mobile banking.

Yet the effects of mobile phones on poverty in Africa are still debatable. One might think that the prevalence of mobile phones in Africa would indicate that the people are coming out of poverty and are able to afford new technology. The grim reality is that households are sacrificing money for food and clean water for the sake of mobile airtime. The following information is quoted from a research article from the Department of Geography at Trinity College Dublin and the Department of Geography, Environmental Management, and Energy at the University of Johannesburg in South Africa:

  • In Ethiopia, the poorest 75% of the population who use mobile phones spend 27% of their income on them.
  • In Niger, the cost of a one minute call off-network is $0.38 per minute, representing 40% of a household’s daily income.
  • Research among university students in Tanzania found that they were spending five times more on mobile phone connectivity than they were on food.
  • There are instances in Africa—in the Millennium Villages, for example—where people have chosen to spend money on mobile phone credit rather than school fees for their children.

This research paper from the International Development Research Center reports that many people are willing to sacrifice significantly in the short term in the interest of perceived long-term gains. Whether or not the phones are actually used for business, their perceived role in long-term prosperity is enough to make African people sacrifice what are seen as basic needs in the present. It can be difficult to determine whether mobile phones are actually useful to the people who sacrifice to have them, or whether they are a matter of social status or fear of exclusion from the process of globalization.

Even beyond the high costs for residents, there are some serious issues to consider regarding the influence and effects of mobile phones in developing countries such as those in Africa. The following is paraphrased from the same research article quoted above:

  • Mobile phones foster a continuing dependence on foreign countries for technology. (This is another form of imperialism.)
  • Infrastructure, such as base transceiver stations, phones, and mobile credit is extremely expensive. Imports of office and telecommunication equipment for the 32 countries in Africa for which data are available were US$18 billion in 2009 (calculated from WTO, 2011).
  • The very construction of mobile phones involves the mineral ore coltan, which has caused serious conflict in the Democratic Republic of Congo. This conflict has added to poverty rather than reduced it.
  • Traders may have difficulty and even fall into poverty as mobile phones cut middle men out of trading in a process known as disintermediation.
  • Rather than helping people across the board, mobile phones may create a new economic inequality. Businesses that have mobile phones will have a significant advantage over those who don’t, which may reduce market diversity and even economic growth.
  • Mobile phones may increase import penetration into African economies. If domestic manufacturers cannot compete, they may be displaced by foreign manufacturers.

The role of mobile phones in developing countries continues to be hotly contested, with some people promoting their usefulness in alleviating poverty (a palliative perspective) and others pointing out that the phones do not change the way economic and political structures produce poverty (a structural perspective). It is still early to know for sure, but it is clear already that mobile phones have had mixed effects on people in developing countries. Though mobile phones are clearly not a panacea for poverty, time will tell if they are useful tools of development in the hands of the people.

The Human Health Costs of Environmental Degradation

We’ve talked about how land management practices can affect long-term profits off the land, but profits aren’t the only thing at stake. Land management directly affects how ecological functions help or harm human health. Effects on human health can be as obvious as how pollution affects the lungs or as convoluted as how forest cover affects malaria. This is best illustrated with examples.Photo by Risa Pesapane in Uganda: deforestation and erosion.Children in Uganda pose before deforested hills with erosion problems. Photo courtesy of Risa Pesapane. [Read more…]

Five Microfinance Options for Americans

In Reaching for Economies of Scale we discussed how small businesses might band together and share resources to cut costs and maximize profits. But  in order for a system of small businesses to thrive each one must first begin. It’s old news that about 80 percent of small businesses fail. Less often do we hear about the microfinance options that may have helped them stay afloat. Microfinance Options for Americans

Developing countries have been helped tremendously by systems of microfinance. Communities of men, and more often women, can lend each other money and resources in order to get their various small enterprises going. As they pay each other back and make profit, they can take their profits to the bank. Savings allows a measure of financial security and stability previously unknown to such impoverished comnunities. Virginia’s own Virginia Tech created a game in 2013 that teaches illiterate or semiliterate women how to cooperate in a microfinance community. [Read more…]