Pregnancy in the context of substance dependence: a qualitative analysis of women’s experiences of social stigma, maternal conflict, and the search for recovery

Pregnancy complicated by substance dependence is a challenging experience that affects both maternal well-being and neonatal outcomes. This study aimed to explore the lived experiences of pregnant women with substance dependence in Kerman, Iran. This qualitative study was conducted in Kerman Province, southeastern Iran, between 2025 and 2026 using a conventional content analysis approach. Twenty-two pregnant women with self-reported substance use were recruited through purposive and snowball sampling from healthcare centers affiliated with Kerman University of Medical Sciences. Data were collected through in-depth, semi-structured interviews and analyzed using the Graneheim and Lundman method. Analysis of the interviews generated three main categories and eight related subcategories. The first category, “Entrapment in a Cycle of Shame and Despair,” reflected experiences of social rejection, compulsive substance use, and hopelessness about the future. The second category, “Maternal Identity Conflict in the Shadow of Addiction,” captured the persistent tension between the desire to protect the unborn child and the compulsive nature of substance dependence. The third category, “Pregnancy as a Turning Point: Seeking Hope for Recovery,” highlighted pregnancy as a potential catalyst for change. Pregnancy for women with substance dependence is not merely a medical problem; it is a period of intense inner struggle where the instinct to protect the baby clashes daily with the physical demands of addiction. Yet, this crisis offers a unique opportunity, creating a strong desire in mothers to quit and prevent their children from repeating their own painful path. To support them, healthcare services must move away from judgment and fear, providing safe and welcoming spaces where these women feel supported rather than threatened.