Long-acting reversible contraceptives (LARCs) as harm reduction: a qualitative study exploring views of women with histories of opioid misuse

Abstract

Background The sharp rise in opioid use disorder (OUD) among women coupled with disproportionally high rates of unintended pregnancy have led to a four-fold increase in the number of pregnant women with OUD in the United States over the past decade. Supporting intentional family planning can have multiple health benefits and reduce harms related to OUD but requires a comprehensive understanding of women’s perspectives of preventing unintended pregnancies. The purpose of this study was to comprehensively evaluate the knowledge, attitudes and experiences as they relate to seeking contraception, particularly LARCs, among women with active or recovered opioid misuse. Methods In-depth interviews and focus group discussions with 36 women with current or past opioid misuse were recorded and transcribed. Transcripts were coded by ≥ 2 investigators. Themes related to contraceptive care seeking were identified and contextualized within the Health Belief Model. Results Our analysis revealed seven interwoven themes that describe individual level factors associated with contraceptive care seeking in women with current or past opioid misuse: relationship with drugs, reproductive experiences and self-perceptions, sexual partner dynamics, access, awareness of options, healthcare attitudes/experiences, and perceptions of contraception efficacy/ side effects. Overall, perceived susceptibility and severity to unintended pregnancy varied, but most women perceived high benefits of contraception, particularly LARC. However, perceived barriers were too high for most to obtain desired contraception to support family planning intentions. Conclusions The individual-level factors identified should inform the design of integrated services to promote patient-centered contraceptive counseling as a form of harm reduction. Interventions should reduce barriers to contraceptive access, particularly LARCs, and establish counseling strategies that use open, non-judgmental communication, acknowledge the continuum of reproductive needs, explore perceived susceptibility to pregnancy, and utilize peer educators.

Contraception use among individuals with substance use disorder increases tenfold with patient-centered, mobile services: a quasi-experimental study

“…Women with history of SUD often desire contraception but face access barriers [ 6 – 9 ]. They report cost, insurance and/or transportation challenges, and are overall less likely to have regular contact with primary or reproductive health care than women without SUD [ 8 , 10 ]. Women with SUD may also avoid contraception care-seeking due to experienced or anticipated stigma from providers [ 6 , 8 , 9 , 11 ].…”

“…They report cost, insurance and/or transportation challenges, and are overall less likely to have regular contact with primary or reproductive health care than women without SUD [ 8 , 10 ]. Women with SUD may also avoid contraception care-seeking due to experienced or anticipated stigma from providers [ 6 , 8 , 9 , 11 ]. Further, they often lack accurate information about contraception options [ 7 , 8 ] or may not prioritize seeking contraception when actively trying to obtain substances [ 8 ].…”

“…Women with SUD may also avoid contraception care-seeking due to experienced or anticipated stigma from providers [ 6 , 8 , 9 , 11 ]. Further, they often lack accurate information about contraception options [ 7 , 8 ] or may not prioritize seeking contraception when actively trying to obtain substances [ 8 ]. Addressing these barriers can help individuals with SUD gain more control over when and if they become pregnant, and avoid the often devastating health and psychosocial consequences associated with unintended pregnancies (e.g., losing child custody) [ 12 – 15 ].…”

Trusted contraception information sources for individuals with opioid use disorder

“…Given this systems‐level devaluation of their reproductive autonomy compounded by the high‐risk nature of pregnancy for many people with chronic conditions, individuals with OUD may not feel comfortable explicitly stating their pregnancy intentions to a clinician 9 . Contraceptive decision making and use for persons with OUD also occurs in the context of perceived and actual decreased fertility, sexual partner power dynamics, and the intersection of common contraceptive side effects and active opioid use 10–12 . Standard assessments of contraceptive use among women with substance use disorder (SUD) are limited.…”

“…9 Contraceptive decision making and use for persons with OUD also occurs in the context of perceived and actual decreased fertility, sexual partner power dynamics, and the intersection of common contraceptive side effects and active opioid use. [10][11][12] Standard assessments of contraceptive use among women with substance use disorder (SUD) are limited. Yet one systematic review reported that 56% of women with SUD utilized contraception, compared to 81% individuals without SUD.…”