Abstract
BackgroundMultiple factors are linked to extremely high unintended pregnancy rates among women who use opioids, including various barriers to contraception adherence. These include patient level barriers such as lack of knowledge and education about highly effective contraception, and potential provider barriers. Using a mixed-methods framework to examine the contraception-related perceptions and preferences of opioid using women is a necessary next step to understanding this phenomenon.MethodsA mixed-method study was conducted which included both self-report questionnaires along with a semi-structured qualitative interview of opioid-using pregnant or recently pregnant women in two drug treatment facilities in Ohio.ResultsForty-two women completed the study. The majority of recent (75%) and total pregnancies were unintended. Male condoms were reported as the highest form of lifetime contraception used within the present sample (69%). Participants reported low lifetime use of long acting reversible contraception (LARC) (ranging from 5 to 12%). Participants preferred hormonal injections first (40%), followed by IUDs (17%). Reasons for preferences of injections and LARC were similar: not needing to remember, side effects, and long-term effectiveness.ConclusionsMost of the study population participants stated they would utilize contraception, particularly Tier 1 LARC methods, if freely available; however, high rates of unintended pregnancy were observed in this sample. This indicates the need for contraception education, and addressing the procedural, logistical and economic barriers that may be preventing the use of LARC among this population.
Highlights
Multiple factors are linked to extremely high unintended pregnancy rates among women who use opioids, including various barriers to contraception adherence
It is possible long acting reversible contraceptive (LARC) methods reduce the likelihood of unintended pregnancy among opioid using populations
Pregnancy history The participants reported a total of 137 pregnancies in the lifetime, of which 24 were ongoing
Summary
Two participants (10.5%) reported they would use birth control with a new partner. Injections were the most frequently reported method participants would use if freely provided, with 41% of women indicating they would choose this type. IUDs, and oral contraception were the most frequently reported preferred types of contraception if freely provided. Eighteen participants indicated a total of 24 reasons why they would use a specific type of contraception if free. Most of these responses centered around not needing to remember to take the contraception (n = 10, 56%), side effects with other types of methods (n = 5, 28%), and long-term effectiveness (n = 4, 10%). Maybe I would get the thing in my arm.”
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