Gendered Triple Standard and Biomedical Management of Perinatal and Maternal Opioid Use Disorder in the United States

Investigating Bodily, Visceral, and Symbolic Violence


  • Alice Fiddian-Green University of Massachusetts Amherst



Despite trends towards treatment versus punitive-based approaches to addressing opioid use disorders (OUD) in the United States, pregnant and parenting women with OUD remain highly stigmatized, their maternal fitness routinely contested. Biomedical conceptions of OUD as a chronic, relapsing condition often run counter to the abstinence-based models enforced across the myriad institutions that manage OUD, particularly for women whose maternal status is contingent on treatment enrollment and adherence. Exposure to trauma is considered to be nearly universal among women with OUD; biomedical classifications of trauma primarily center on the interpersonal (i.e., adverse childhood [ACEs] and lifetime experiences). This work responds to a call to ‘gender addiction’ (Campbell and Ettorre 2011) and examine the ‘epistemologies of ignorance’ (Tuana 2006) around notions of ‘risk’ by advocating for a broadened definition of trauma that incorporates the institutional violence imbedded into policies and procedures specific to the biomedical management of OUD. Drawing from an 18-month ethnographic investigation of pregnant and parenting women with OUD living in the Northeastern United States., this article argues that the intertwined institutions (e.g. medical, legal, and social services) that manage OUD according to biomedical dictates enact a converging constellation of violence on women; this in turn becomes a form of embodied trauma, directly influencing perinatal and maternal opioid use trajectories. Key findings include: (1) civil commitment to treatment as a form of direct bodily violence, (2) loss of maternal status as visceral violence, and (3) institutional erasures (i.e., intergenerational family separation) as symbolic violence.

Author Biography

Alice Fiddian-Green, University of Massachusetts Amherst

MPH, PhD(c)

Department of Health Promotion and Policy

School of Public Health and Health Sciences