Contraceptive Use Among Women Who Inject Drugs: Motivators, Barriers, and Unmet Needs

Mburu, Gitau; Ndimbii, James; Ayón, S Milder; Mlewa, Onesmus; Mt, Mbizvo; Kihara, Cecilia; Ragi, Allan

doi:10.1080/23293691.2018.1463737

Cited by 12 publications

(22 citation statements)

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“…In addition, IDIs and FGDs were audio-recorded and lasted between 45 and 60 min. Additional details regarding the primary data collection and analysis have been reported in a series of several primary manuscripts [16,[25][26][27].…”

Section: Aims Setting and Methodology Of Primary Data Collectionmentioning

confidence: 99%

“…This paper reports information generated through a secondary analysis of pre-existing qualitative data. The primary study [25,26] was a qualitative study conducted in 2015 with aim of exploring the needs, barrier, and determinants of sexual and reproductive health (SRH) of women who inject drugs in the Kenyan coastal towns of Mombasa and Kilifi.…”

Section: Primary Study Aims and Designmentioning

confidence: 99%

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HIV risk behaviours among women who inject drugs in coastal Kenya: findings from secondary analysis of qualitative data

2019

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Background: Injecting drug users are at high risk of HIV infection globally. Research related to female drug users is rare in Kenya, yet it is required to inform the development of gender-sensitive HIV prevention and harm reduction services in East Africa, where injecting drug use is on the rise. Methods: This study aimed to document the nature of HIV risks encountered by women who inject drugs in the Mombasa and Kilifi, Kenya. Secondary data analysis was conducted on an existing dataset from a 2015 primary qualitative study involving 24 interviews and 3 focus group discussions with 45 women who inject drugs. These were complemented with five interviews with key stakeholders involved in the provision of services to women who inject drugs. Guided by the social ecology theory, a thematic analysis was conducted to identify the nature of HIV risks and their underlying determinants.Results: HIV risk behaviours fell into two broad categories: unsafe injecting and unprotected sex. These risks occurred in the form of sharing of needles, unprotected oral, anal, and vaginal sex, sexual assaults, injecting drug use during sex, sex work, and other types of transactional sex. The primary determinants underlying these risks were a low-risk perception, inequitable gender power, economic pressures, and poor availability of needles and condoms. These social-ecological determinants did not exist in isolation, but intersected with each other to create powerful influences which exposed women to HIV. Social-ecological determinants exerted constant influence and created a persistent 'HIV risk environment' that was involuntarily experienced by women.Conclusion: Individual, interpersonal, and societal-structural factors intersect to produce HIV risk behaviours. As a minimum, these risks will require a combination of multifaceted micro-level interventions including self-efficacy training, risk assessment skills, couple counselling, and universal access to the recommended harm reduction package. In addition, the current focus on micro-level interventions in Kenya needs to shift to incorporate macro-level interventions, including livelihood, employability, and gender norms-transforming interventions, to mitigate economic and gender-related drivers of HIV risks. In the Kenyan context, injecting drug use during sex work is emerging as an increasingly important HIV risk behaviour needing to be addressed.

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Section: Aims Setting and Methodology Of Primary Data Collectionmentioning

confidence: 99%

Section: Primary Study Aims and Designmentioning

confidence: 99%

HIV risk behaviours among women who inject drugs in coastal Kenya: findings from secondary analysis of qualitative data

2019

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“…Evidence suggests that many drug-using women are keen to achieve or maintain identity as a responsible mother, and to live out the values of being a responsible mother [48,49]. Often, they are cognizant that drug use is an impediment to these aspirations, and many are confronted with fear of hostile social judgements of being an addict mother [48].…”

Section: Increasing Demand and Utilization Of Integrated Rmnch Intervmentioning

confidence: 99%

“…Often, they are cognizant that drug use is an impediment to these aspirations, and many are confronted with fear of hostile social judgements of being an addict mother [48]. Despite these adversities however, most of these women aspire to be successful mothers [43,49].…”

Section: Increasing Demand and Utilization Of Integrated Rmnch Intervmentioning

confidence: 99%

“…Therefore, leveraging on these motivations and aspirations would be an important and transformational strategy through which women can be supported to cope with stigma, selfblame, and minimize harm from drug use [48,49], while at the same time improving their access to essential RMCH services and outcomes. Demand can also be increased through specific incentives.…”

Section: Increasing Demand and Utilization Of Integrated Rmnch Intervmentioning

confidence: 99%

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Access and utilisation of reproductive, maternal, neonatal and child health services among women who inject drugs in coastal Kenya: Findings from a qualitative study

Ndimbii

Ayón

Abdulrahman³

et al. 2018

Sexual & Reproductive Healthcare

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Highlights Globally there is limited research concerning women who inject drugs. This paper reports important insights related to the experiences, needs and barriers preventing the utilisation of reproductive maternal, neonatal and child health services among women who inject drugs in coastal Kenya. Findings from this study will inform the development of equitable, comprehensive, and family-centered RMNCH interventions targeting women who inject drugs, including the integration of RMNCH services within harm reduction programs. ABSTRACT Introduction:The Kenyan government has committed to increasing access to comprehensive reproductive, maternal, neonatal and child health (RMNCH) services. However, inequalities still exist.Women who inject drugs are an important sub-population for public health interventions, yet their RMNCH needs have largely been overlooked. Additionally, there is a lack of research to inform RMNCH interventions for this sub-population. Methods:In 2015, we undertook interviews and focus group discussions with 45 women who inject drugs and five key stakeholders to understand these women's RMNCH experiences and needs. Results:Women' access to essential services across the RMNCH continuum was low. Two thirds of the women were not using contraception. Many discovered they were pregnant late, due to amenorrhea of drug use, and thus were unable to enroll for antenatal care early. Facilitybased deliveries were limited with many choosing to deliver at home. Following delivery, women's attendance to immunization services was sub-optimal. Stigma from healthcare workers was a major factor impeding women's use of existing RMNCH services. The prospect of experiencing withdrawals at health facilities where waiting times were long, deterred utilization of these services. Additionally, women faced competing priorities, having to choose between purchasing heroin or spending their money on health-related costs. Conclusions:Several barriers disrupted women's access to services across the RMNCH continuum.Consequently, there is a need to develop equitable, comprehensive, and family-centered RMNCH interventions tailored to women who inject drugs, through a combination of supplyand demand-side interventions. For optimal impact, RMNCH services should be integrated into harm reduction programs.

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Determinants of Women’s Drug Use During Pregnancy: Perspectives from a Qualitative Study

Mburu

Ayón

Mahinda

et al. 2020

Matern Child Health J

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Introduction Drug use during pregnancy can have negative effects on maternal and child health. However, there is a dearth of data regarding drug use among pregnant women in Kenya, where illicit drug use is on the rise. In this paper, we report factors influencing women's decisions to use drugs during pregnancy. Methods In 2015, we conducted in-depth interviews and focus group discussions with 45 women who inject drugs and five key stakeholders involved in provision of services to people who use drugs in coastal Kenya. Inductive thematic analysis was conducted to draw out themes related to key determinants of drug use during pregnancy. Results Four key themes emerged outlining determinants of drug use during pregnancy: (i) the use of drugs to cope with the stress of unexpected pregnancy, (ii) the continued drug use during pregnancy to manage withdrawal, (iii) the dual effect of pregnancy on drug use either as a facilitator or as a moderator of drug use, and (iv) the role of male intimate partner in influencing women's drug use during pregnancy. Conclusion Our paper reports women's drug use during pregnancy and the factors influencing this phenomenon. To safeguard the health and well-being of pregnant women and their unborn children, there is a need for education and awareness raising, implementing couple-based harm reduction approaches to leverage on positive male influences, improving availability of drug treatment, and provision of family planning interventions for women who use drugs.

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Contraceptive Use Among Women Who Inject Drugs: Motivators, Barriers, and Unmet Needs

Cited by 12 publications

References 50 publications

HIV risk behaviours among women who inject drugs in coastal Kenya: findings from secondary analysis of qualitative data

HIV risk behaviours among women who inject drugs in coastal Kenya: findings from secondary analysis of qualitative data

Access and utilisation of reproductive, maternal, neonatal and child health services among women who inject drugs in coastal Kenya: Findings from a qualitative study

Determinants of Women’s Drug Use During Pregnancy: Perspectives from a Qualitative Study

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