Principles of Provision: Understanding Occupational Enactment and Provider Activism in Substance-Use Treatment for Pregnant People

Abstract

As reproductive politics have grown increasingly volatile, the prosecution of pregnant people for their behavior during pregnancy has become a growing issue. Healthcare providers often operate as mandatory reporters in these situations, complicating their role as medical professionals. In this study, I utilize a Millsian framework to explore the ways in which biography, social structure, and history impact the entrance of mission-driven providers into pregnancy care for people with substance use issues, and the degree to which these providers engage in forms of advocacy when working within institutional and policy constraints. First, I outline the biographical pathways preceding their entrance into their profession. Next, I examine how they navigate their current occupational landscape and the ways in which competing patient logics complicate patient care. Finally, I explore the degree to which these providers seek to advance health equity and social justice by engaging in occupational activism within the workplace in spite of institutional and policy constraints. I find that, overall, these individuals operate as mission-driven professionals in the healthcare field and seek to deliver high-quality care that centers patient rehabilitation rather than punishment. This research is one step in uncovering the micro-level interactions that result in population-level health inequalities in reproductive health.