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Qualitative Health Research
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Leading by Losing: Sex and Fertility on Crack Cocaine

Margaret H. Keamney

Boston College, Chestnut Hill, MA

Sheigla Murphy

Institute for Scientific Analysis

Marsha Rosenbaum

Center for Substance Abuse Studies at the Institute for Scientific Analysis

Women who use crack cocaine have been characterized as promiscuous and careless about unintended pregnancy or sexually transmitted diseases. To evaluate the validity of these claims, we used the grounded theory approach to analyze transcripts from 100 interviews with women crack users, exploring their experiences and views on sexuality, fertility, contraception, and pregnancy-related decisions. Many women told of unforeseen events in the social world of crack cocaine use, such as pressures to trade sex for drugs, in a cultural and economic milieu already restrictive of women's reproductive and personal goals. The women accommodated shrinking control over their reproductive lives through "learning by losing,"finding out through failure how to protect their remaining options for seljhood. This process included stages of reappraising, limiting, and settling for less, as choices diminished over time. Women's actions were tied to their changing attitudes on motherhood, fertility, and sexuality issues.

Qualitative Health Research, Vol. 4, No. 2, 142-162 (1994)
DOI: 10.1177/104973239400400202
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