Perceptions of Pregnancy and Contraceptive Use: An In-Depth Study of Women in Los Angeles Methadone Clinics

Abstract

Introduction: In 2016, 2.1 million people in the United States were estimated to have an opioid use disorder. While the disorder can be safely and effectively treated with prescription methadone, treatment is potentially long-term and may span women's peak childbearing ages. Little is known about women's reproductive health needs while on methadone. Methods: We interviewed 22 sexually active, non-pregnant women ages 21-39 at two Los Angeles methadone clinics in 2016. The interviews were transcribed and coded by four researchers using thematic and open coding techniques. Results: Half of women were nulliparous and 17 were in stable, monogamous relationships with men. Women reported a range of feelings and perceptions about pregnancy, but nearly all wanted to delay pregnancy until discontinuing methadone. However, many women indicated limited interest in preventing pregnancy because of the relative stability of their relationships, fear of infertility, and low perceived risk of pregnancy. These factors influenced contraceptive use. Discussion: Women described mixed feelings about pregnancy and many ultimately felt that an unplanned pregnancy would be acceptable in the context of their relationships and uncertain fertility. These findings provide context for previous quantitative findings that women in

Contraceptive Method Choices in Women With and Without Opioid Use Who Have Infants in the Neonatal Intensive Care Unit and Nursery

“…23 Low uptake of contraception in opioid using women has been attributed to numerous factors, including poor postpartum visit attendance, 3,24,25 stigma and fear of losing custody of their child(ren), 26 lack of information regarding both LARCs and short-acting methods, 27 and misunderstanding of their fertility. 3,28 Interestingly, we also found that more than half of women with self-reported opioid use in our study chose immediate tier 1 method uptake, of which Data are represented as n (%), unless noted as means in which case it is meanstandard deviation. a Tier 1 contraceptive methods according to the WHO classification 13,14 : female/male sterilization, intrauterine device, and contraceptive implant.…”

“… 23 Low uptake of contraception in opioid using women has been attributed to numerous factors, including poor postpartum visit attendance, 3 , 24 , 25 stigma and fear of losing custody of their child(ren), 26 lack of information regarding both LARCs and short-acting methods, 27 and misunderstanding of their fertility. 3 , 28 …”

Factors Affecting Contraception Access and Use in Patients With Opioid Use Disorder

“…7 Attitudes were similar among teenagers who used intravenous drugs and adults who used methadone, as contraceptive use decreased when they perceived they were in stable or longer-term sexual relationships. 17,28 Additionally, women may choose not to use contraception because of previous adverse experiences with contraception or a desire for pregnancy.…”

“…One study found that over one‐third of women surveyed stated they would not use any form of contraception with a monogamous partner, whereas women in new relationships were more likely to use external condoms 7 . Attitudes were similar among teenagers who used intravenous drugs and adults who used methadone, as contraceptive use decreased when they perceived they were in stable or longer‐term sexual relationships 17,28 . Additionally, women may choose not to use contraception because of previous adverse experiences with contraception or a desire for pregnancy.…”

“…However, it is important to acknowledge that not all pregnancies among women with opioid use disorder are unintended, and all women desiring pregnancy deserve access to patient-centered care. Most women realize that opioid use may negatively impact a pregnancy 8,17 ; however, health care providers need to be familiar with factors that affect contraceptive access in women with opioid use disorder to provide comprehensive, patient-centered care.…”