Original Article

Healthcare Access, Pregnancy Intention, and Contraceptive Practices Among Reproductive-Aged Women Receiving Opioid Agonist Therapy in Northeast Tennessee

Authors: Edward Leinaar, MPH, Leigh Johnson, MD, MPH, Ruby Yadav, DrPH, Abir Rahman, MPH, Arsham Alamian, PhD, MSc

Abstract

Objectives: Women with substance use disorders often experience unique challenges to obtaining contraception and adhering to user-dependent methods. As a result, this at-risk population of women tends to have higher than average rates of unintended pregnancy. The objective of this study was to describe contraceptive use, pregnancy intentions, and adequacy of access to reproductive healthcare among women receiving opioid agonist therapy in northeast Tennessee.

Methods: A cross-sectional survey was piloted among female patients aged 18 to 55 years from two opioid agonist therapy clinics. Descriptive analyses were conducted using logistic regression to evaluate the statistical significance of bivariate associations.

Results: Of 91 participants, 84% reported having health insurance, with 70% perceiving having adequate access to health care. More than half had a history of unwanted pregnancy (53%), among whom few (23.1%) reported the consistent use of contraception at time of conception. Although most desired to avoid pregnancy (90%), only 59% of women reported the current use of regular contraception. Most of those not using regular contraception believed that they were not at risk for pregnancy (54.3%).

Conclusions: Although most participants reported adequate access to health care and a desire to avoid pregnancy, few reported the consistent use of regular contraception. Furthermore, misperceptions regarding pregnancy risk were common among participants. Research is needed to identify barriers to contraceptive acceptance and causes of pregnancy risk misperceptions in this population of women at increased risk of unintended pregnancy.
Posted in: Obstetrics and Gynecology77 Family Planning & Reproductive Health14

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References

1. Warren MD, Miller AM, Traylor J, et al. Implementation of a statewide surveillance system for neonatal abstinence syndrome-Tennessee, 2013. Morb Mortal Wkly Rep 2015;64:125-128.
2. Moody L, Satterwhite E, Bickel W. Substance use in rural central Appalachia: current status and treatment considerations. Rural Ment Health 2017;41:123-135.
3. Parlier AB, Fagan B, Ramage M, et al. Prenatal care, pregnancy outcomes, and postpartum birth control plans among pregnant women with opiate addictions. South Med J 2014;107:676-683.
4. Miller AM, McDonald M, Warren MD. Neonatal Abstinence Syndrome Surveillance Annual Report 2017. Nashville, TN:Tennessee Department of Health;2015.
5. Black KI, Day CA. Improving access to long-acting contraceptive methods and reducing unplanned pregnancy among women with substance use disorders. Subst Abuse 2016;10(suppl 1 ):27-33.
6. Heil SH, Jones HE, Arria A, et al. Unintended pregnancy in opioid-abusing women. J Subst Abus Treat 2011;40:199-202.
7. Winner B, Peipert JF, Zhao Q, et al. Effectiveness of long-acting reversible contraception. N Engl J Med 2012;366:1998-2007.
8. Black KI, Stephens C, Haber PS, et al. Unplanned pregnancy and contraceptive use in women attending drug treatment services. Aust New Zeal J Obstet Gynaecol 2012;52:146-150.
9. Hubacher D, Spector H, Monteith C, et al. Long-acting reversible contraceptive acceptability and unintended pregnancy among women presenting for short-acting methods: a randomized patient preference trial. Am J Obstet Gynecol 2017;216:101-109.
10. Terplan M, Hand DJ, Hutchinson M, et al. Contraceptive use and method choice among women with opioid and other substance use disorders: a systematic review. Prev Med 2015;80:23-31.
11. von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med 2007;4:e296.
12. Kavanaugh ML, Jerman J. Contraceptive method use in the United States: trends and characteristics between 2008, 2012 and 2014. Contraception 2018;97:14-21.
13. Poulton G, Parlier AB, Scott KR, et al. Contraceptive choices for reproductive age women at methadone clinics in Western North Carolina. MAHEC Online J Res 2015;2:1-11.
14. Harding C, Ritchie J. Contraceptive practice of women with opiate addiction in a rural centre. Aust J Rural Health 2003;11:2-6.