Pranee Liamputtong (ed.)Women, Motherhood and Living with HIV/AIDS2013A Cross-Cultural Perspective10.1007/978-94-007-5887-2_9© Springer Science+Business Media Dordrecht 2013
9. Dealing with Life: Tactics Employed by Drug-Using Thai Mothers Living with HIV
(1)
Faculty of Public Health, Thammasat University, Piychart Building 10th Floor, Klong Luang, Rangsit, Pathumthani, 12121, Thailand
Abstract
Throughout their lives, women injecting drugs in Thailand have been subjected to stigmatisation, a socially informed, painful experience that has become part of their disposition. Stigma, in fact, dominates their everyday lives. This study argues that Thai women injecting drugs are in effect ‘doubly stigmatised’: As drug users, they fail to fit the Thai ‘good’ women/mothers image, that is, to meet their socially expected or stereotypical gender roles. Constant exposure to stigma sees their clear sense of self-dissipate and replaced by the relational self, in the process rendering their gender and identity hazy and complex. Being a mother requires bridging the public and private lives of women injecting drugs, who find themselves faced with coping with the dual roles of motherhood and drug users. This chapter is based upon my ethnographic data and on in-depth interviews conducted with 25 Thai women living with HIV and injecting drugs, most of whom were informed of their HIV status when tested for pregnancy. Pregnancies among female drug users are invariably unplanned: The women do not consider the absence of menstruation as indicative of pregnancy because taking drugs may cause irregular menstrual periods; thus, they wait until more overt physical signs appear. Drug-using pregnant women are reluctant to share information concerning their drug use with doctors because of the guilt they (are often made to) feel regarding foetal well-being. In this chapter, in which I explore women who use drugs living with HIV/AIDS as mothers, I look at the specific ways in which they deal with their lives in a habitus that constitutes conditions for social suffering. The tactics they use could be informed by the particular form of drug culture they pursue and how it is integrated with their gendered habitus.
1 Introduction
Ped, a female injecting drug user, lived in Bangkok: She worked as an outreach worker. One of my friends told me that she used to live with Kum, an injecting drug user who was also working as an outreach worker. Ped gave birth to a boy and then left her son with Kum. During the course of this research, I heard many stories about Ped, most of them negative, about her inability to fulfil her mothering role and to care for her son. One of the staff at the drop-in centre where Kum was working commented on her inability to take care of her son: “Ped left her boy when he was just three months old. She is such a bad mother. Kum loves his son so much and his son also loves him. The boy has never asked about his mother. He sometimes calls Kum’s mother ‘mae’ (mother) as she is the one raising him. He wouldn’t even recognise his real mom.” Ped left her family after they discovered that she was a drug addict: It is now many years since she has seen them. Ped told me that her mother discriminated against people using drugs: “My mother said she would rather have a daughter working as a prostitute than a drug addict daughter like me. I haven’t been home for many years because she would hit me if she found out I was still using drugs.” After moving out of the family home, Ped lived with Kum, who provided her with drugs. Talking about her time with him, she said: “I just used drugs. I did not have to worry about anything because Kum was a drug dealer at that time.” Ped’s life changed dramatically after she found out about her unplanned pregnancy and HIV status, “It was unintended and unplanned. My periods stopped after I started using drugs. I first thought that maybe drugs caused me to be sterile, but in fact they didn’t. My boyfriend noticed my body changing and asked me to go to hospital. I was so shocked to know that I was seven months pregnant. Worse still, they told me that I was HIV-positive. It was a double shock and I didn’t dare to tell the nurse and doctor I was a drug addict. If the nurse knew, she would suggest terminating my baby.” During the pregnancy, Ped tried to stop using drugs for the sake of her child, but she couldn’t. “When I first knew I was pregnant, I stop injecting drugs for a few months, but later on I start injecting drug again. All my friends are drug users, and we all talked about drugs. I couldn’t stop taking drug that long. My boy was very thin and small. I cried a lot when I first saw him. He had craving symptoms just like me. He was not like other children. He cried a lot.” Ped raised her son for three months before asking Kum’s parents to adopt him. She recalled the time when she gave her son away: “I held him in my arms then handed him to Kum’s mother. I was sad but I couldn’t say anything. He will have a happier life with Kum’s mother. I don’t want to raise him in the drug community … he might grow up to be a drug addict like me and Kum.” Ped’s story is like other women I interviewed, the compelling story this woman told me revolved around the role of motherhood.
Ped’s story is the typical lived story of Thai women using drugs who are faced with decision-making regarding their mothering role and the well-being of their children. The image of parents’ drug use as a form of moral decay is nearly always one that is totally negative and unacceptable in most, if not all, societies worldwide (Keller et al. 2002; Klee 1998). Such images lead to judgements that are based on simple association, for example, assumptions that drugs and femininity are in essence incompatible (Banwell and Bammer 2006; Friedman and Alicea 2001). Because the role of motherhood is strongly linked to social norms, cultures and practises (Woodward 2003), it has a significant impact on the female addict’s sense of self (Rosenbaum 1988; Taylor 1993), with many women who use drugs finding themselves unable to fulfil the mother role. Using drugs distances women from socially ascribed feminine practises (Campbell 2000). Mothers who use drugs face more discriminatory action. While mothers who use drugs are frequently viewed by society as selfish, uncaring women who sacrifice their children’s well-being in the pursuit of their own personal pleasure, the reality is that some women use drugs as a means of coping with the difficulties associated with childrearing (Klee 1998; Rosenbaum 1988).
The majority of women are expected to be first and foremost women – to give priority to the well-being of their children above all else (Bradley 2007). Imbued with this notion, society in general finds female drug users’ modes of caring for their children unacceptable: Pregnant women using drugs are targeted by policy-makers as symbolic distortions of maternity and femininity (Campbell 2000). According to Boyd (2004), maternal cocaine use was initiated in the 1980s based upon the assumption that a mother using drugs was unfit for the mothering role and that her drug use endangered the development of the foetus. In response, the state constructed strategies to mandate the mother’s taking of drugs. Policies ranging from child removal to incarceration are used as forms of punishment for pregnant drug users (Campbell 2000). In some instances, the state uses its power to control or punish the women’s behavior by threatening to remove their children unless they enter treatment programs (Boyd 2004; Paone and Alperen 1998; Taylor 1993). These penalties see pregnant drug users targeted through social policy which leads women injecting drugs to believe that their bodies (and minds) are unfit for reproduction and, that in the interests of all concerned, abortion should be considered (Ettorre 2004).
Such strategies portray drug-using mothers as a collectivist rather than an individualist problem (Campbell 2000; Kandall 1996). Strategies in the form of segregation, controlling and rebellion underpin the particular forms of social distinction and discrimination that impact upon mothers who use drugs in Thailand. These strategies, however, are a symbolic dramatization of drug-using women’s experiences of stigmatization. Gender meaning and imagery, particularly that relevant to the role of mother, become crucial points of the tactics employed by drug-using mothers. Research suggests that women’s representation as “good mothers” is expressed in the form of tactics employed to lessen the impact of their drug lifestyle and HIV/AIDS upon their children. In this chapter, I explore the ways in which Thai women’s injecting practises revolve around the role of mother and the tactics they employ to cope with gender expectations of being a mother, tactics that revolve around social expectations of “good” mothers. Being a mother who use drugs and living with HIV challenge the hegemonic notion of motherhood. Living with HIV exacerbates the life of drug-using mother as AIDS is interpreted to their understanding as well as public recognition as pollution.
2 Conceptual Framework: Gender Habitus and Drugs
The concept of habitus helps us understand the gender constructions which govern men’s and women’s behavioural patterns and actions in each society, particularly the social construction of motherhood. Bourdieu (1977:72) refers to habitus as the “objective structure of subjective experiences”, that is, “habitus” as the objective structure or “the structured structures predisposed to function as structuring structures, that is, as principles of the generation and structuring of practices and representation.” Habitus objective structure acts as a formalised code for regulating behavior, which takes various forms including laws, cultures, norms, roles, religions and beliefs. Through social interaction, the individual living within a particular habitus internalizes these objective structures by extension forming their embedded dispositions (Swartz 1997). The practices of members of the same groups, class or experiences create degrees of group conformity, implying that there is a chance of sharing the same habitus (Earle and Letherby 2003). This has implications for the sharing habitus of men and women.
In principle, habitus represents gendered norms and expectations. The gender habitus has traditionally exercised control over the lives of men and women to ensure cohesion and conformity to gender expectations and norms (Bourdieu 2001).The habitus of males and females differ based on their individual socialization and opportunity structures (Dumais 2002). One important role of women, or what society expects from them, is the duty of reproduction and childrearing (Earle and Letherby 2003; Woodward 2003). What concerns society in general is the impact of unhealthy maternal habits upon children, such as mothers taking drugs or drinking alcohol (Cobrinik et al. 1959; Zelson 1973).
Like gender, drug use is socially constructed based upon expectations and practises. It takes place in a specific, cultural context and is shaped by the structuring structures that inform consumption and experience (Cohen 2006; Lam 2008; McDonald 1994). There are, however, implicit tensions between a drug-using habitus and a female gender habitus in particular to motherhood. Substance-abusing mothers who attribute a polluting and destructive capacity to their children in the process violate the perceived traditional norms of parental care (Kettinger et al. 2000; Street et al. 2008). The duty of the pregnant woman is to protect her developing fetus rather than harm it through drug use; thus, unarguably pregnancy and drug use are incompatible (Rosenbaum 1988). Murphy and Rosenbaum (1998:1) delineate the degree to which the pregnant drug user breaks the gender habitus:
A pregnant woman is supposed to take care of herself to protect her forming fetus. Women who purposely poison their wombs by using drugs are seen as failing in their reproductive role, and they must take their place among the most stigmatized groups in modern society.
The deterioration of the role of drug-using mothers is critical in the Thai context given that traditionally motherhood is the core of family foundation. In Thai society, a mother is referred to as mae, as Mulder (2000:70) describes:
As a source of goodness, mother symbolizes virtue and selflessness. She is the pivot of one’s moral obligations that revolve around the family. Her purity symbolizes the wholeness of the home. It is thus not too far-fetched to conclude that mother easily becomes the foremost reference point of one’s conscience, that conscience is consciousness of her, and that she is the primary superego representative of most Thais.
Understanding the lives of Thai mothers injecting drugs and living with HIV requires interpretation of the meanings of mother. In Thailand, the imposition of the motherhood and reproductive roles on a woman often means she is excluded from male space (Whittaker 2002). Muecke (1984:462) notes on the role of Thai mother as ‘while women could live without husbands, they could not live without children’. As in many societies, motherhood is the pivotal role for Thai women (Keyes 1984; Mulder 2000; Liamputtong 2007). More importantly, it represents the creation of a socially informed gendered role. Liamputtong states that the role of the Thai mother is inextricably linked to the Thai moral framework, that is, the good and responsible mother as she (2007:178) notes that “Women must ensure that their newborn infants and young children are free of ‘risk’, which posts danger on their lives or has ill consequences. As good responsible mothers, women make sure that their children are healthy and well.”
Notably, gender habitus is considered to fundamentally direct how Thai men and women feel, act or think. Mother’s reproduction is seen as being based on the nature of women. Both strategy and agent learn to correspond to the formative conditions of habitus (Hillier and Rooksby 2005; Krais 2006). Mother using drugs employs several tactics associated with prescribed role as mother in gender habitus. Taking drugs impinges upon women’s status. That is, it also has direct implications for the status of mother using drugs in Thai society. Furthermore, taking drugs and living with HIV/AIDS threatened the status of women, especially as a mother. Mothers taking drug and living with HIV/AIDS are perceived to mark harm in the well-being of their children.
3 The Study
Drug users are a hidden population or hard-to-reach group (Lee 1994; Page and Singer 2010). Hence, research requires specific methods of data collection, in particular, the ethnographic method. Significantly, the ethnographer has to try to capture the grassroots’ point of view through living or spending time among them so that he/she can both understand and determine the meaning of their behavior accurately. Page and Singer (2010:17) maintain that “the prime directive in the ethnographic study of drug use is to achieve an understanding of how and why the behaviours of interest take place in a given natural habitat and what forms these behaviours take.” The ethnographic form of research has been used as a key means of studying illicit drug-taking as it provides the researcher with “hands-on” insight into the drug context and drug behaviour (Taylor 1993; Bourgois 1995; Bungay et al. 2010; Page and Singer 2010). The focus of this study is to explore the tactics that drug-using Thai mothers employ and to observe and record their lived experiences.
In order to understand the lived reality of female injecting drug users, I used several forms of qualitative research: ethnography, in-depth interviews, participant observation and focus group discussions. Each of the two focus groups comprised five key informants. I conducted in-depth interviews with 25 female injecting drug users living with HIV/AIDS in Bangkok and its suburbs in 2008. All of the interviews were analyzed using thematic analysis method and transcribed verbatim for coding. Permission for the study was obtained from the Thammasat Ethical Review Committee.
According to the data collected, the women interviewed ranged in age from 20 to 47 years. Twenty were Buddhist and the remaining five were Muslim. They reported a wide range of illicit drug consumption including heroin, methadone and amphetamine, among which heroin was the drug of first choice. All were injecting drug users. Ten had graduated from primary school, 12 from junior high school and the rest were in vocational school. Five of the women are now working as outreach workers with various Thai NGOs. The remainder are unemployed. Fifteen live with either their parents or in-laws, while the rest live with partners who also use drugs. Their average income is between 3,000 and 6,000 baht (US$100–150) per month. Most have government health insurance: The five among them who were outreach workers have social security insurance. All of the women are now on antiretroviral treatment.
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