Navigating scarcity and recovery: the lived experience of quality of life for pregnant women using substances in low-income rural communities in the Western Cape, South Africa

Background Maternal substance use is a public health concern in South Africa (SA), where pregnant women using substances face unique contextual challenges impacting their quality of life; including poverty, violence, and illness. Low-income rural living presents additional challenges for pregnant women using substances. Yet, their lived experiences and quality of life (QoL) remain underexplored, particularly in rural SA contexts.Methods This secondary qualitative analysis explored semi-structured interviews with 13 women from low-income rural communities in the Western Cape participating in a substance use support program. Interpretive phenomenological analysis was conducted, and data interpretation was guided by Recovery Capital and QoL Frameworks.Results Financial and psychological stress intersected with relational conflict, community violence, and insufficient psychosocial support. Social support was vital for the QoL of the women but was not consistently available. Participants relied on personal, social and cultural recovery capital through spiritual, religious and community resources. While the women faced multiple layers of adversity, they demonstrated resilience and hope for the future.Conclusion Recovery capital and the relational assets that support women navigating substance use during pregnancy in low-income, rural SA contexts are important. Findings support the development of interventions integrating psychosocial support that are culturally grounded and community driven.