Qualitative-Intersectional Analysis of Access to Health Care for Pregnant Women Who Use Injectable Drugs in Mexico

Abstract Pregnant or former pregnant women who use injectable drugs (PGWIDs) are often stigmatized and criminalized when health personnel identify them as injectable drugs users. PGWIDs are more vulnerable to stigmas that influence social imaginaries about their reproductive and childbearing capacities. To analyse access to sexual and reproductive health services for PGWIDs based on their lived experiences and those of key actors in Mexicali, Baja California. This feminist qualitative study focused on PGWIDs over the age of 18, as well as key informants who had direct interaction with them. Data collection involved six semi-structured interviews. Following verbatim transcription, a thematic analysis was conducted using NVivo software. Pregnancy contexts, marked by a lack of opioid substitution programs, constant fear of losing custody, and structural violence in drug-using environments (“picaderos”). 2) Access to punitive services, characterized by obstetric violence, stigma from health personnel, and the absence of specific protocols for managing neonatal abstinence. It was identified that the health system operates under a criminalizing logic that prioritizes surveillance over comprehensive care. Barriers to access for PGWID at the border are not only logistical, but also structural and ideological. The intersection of gender, poverty, and substance use creates a “care gap” that violates human and reproductive rights. There is an urgent need to implement public health policies based on harm reduction, awareness-raising among medical personnel, and the creation of care pathways that decouple substance use from the criminalization of motherhood.