Contraception and Healthcare Utilization by Reproductive-Age Women Who Use Drugs in Rural Communities: a Cross-Sectional Survey

Levander, Ximena A.; Foot, Canyon; Magnusson, Sara; Cook, Ryan; Ezell, Jerel M.; Feinberg, Judith; Go, Vivian F.; Lancaster, Kathryn E.; Salisbury-Afshar, Elizabeth; Smith, Gordon S.; Westergaard, Ryan P.; Young, April M.; Tsui, Judith I.; Korthuis, P Todd

doi:10.1007/s11606-022-07558-6

Cited by 4 publications

(9 citation statements)

References 51 publications

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“…Women who use drugs have higher rates of unintended pregnancies [42] and lower rates of using highly effective contraception compared to women who do not use drugs [43]. Recent use of methamphetamine alone or in combination with opioids compared to no use of methamphetamine has been associated with a lower likelihood of using effective contraception among women living in rural US communities [44]. Women who use drugs incorrectly frequently believe they are unable to conceive [45], which may be partially related to menstrual cycle dysregulation that can continue even after disrupting use [46].…”

Section: Discussionmentioning

confidence: 99%

A gender‐based secondary analysis of the ADAPT‐2 combination naltrexone and bupropion treatment for methamphetamine use disorder trial

et al. 2023

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Background and Aims Socio‐cultural (gender) and biological (sex)‐based differences contribute to psychostimulant susceptibility, potentially affecting treatment responsiveness among women with methamphetamine use disorder (MUD). The aims were to measure (i) how women with MUD independently and compared with men respond to treatment versus placebo and (ii) among women, how the hormonal method of contraception (HMC) affects treatment responsiveness. Design This was a secondary analysis of ADAPT‐2, a randomized, double‐blind, placebo‐controlled, multicenter, two‐stage sequential parallel comparison design trial. Setting United States. Participants This study comprised 126 women (403 total participants); average age = 40.1 years (standard deviation = 9.6) with moderate to severe MUD. Interventions Interventions were combination intramuscular naltrexone (380 mg/3 weeks) and oral bupropion (450 mg daily) versus placebo. Measurements Treatment response was measured using a minimum of three of four negative methamphetamine urine drug tests during the last 2 weeks of each stage; treatment effect was the difference between weighted treatment responses of each stage. Findings At baseline, women used methamphetamine intravenously fewer days than men [15.4 versus 23.1% days, P = 0.050, difference = −7.7, 95% confidence interval (CI) = −15.0 to −0.3] and more women than men had anxiety (59.5 versus 47.6%, P = 0.027, difference = 11.9%, 95% CI = 1.5 to 22.3%). Of 113 (89.7%) women capable of pregnancy, 31 (27.4%) used HMC. In Stage 1 29% and Stage 2 5.6% of women on treatment had a response compared with 3.2% and 0% on placebo, respectively. A treatment effect was found independently for females and males (P < 0.001); with no between‐gender treatment effect (0.144 females versus 0.100 males; P = 0.363, difference = 0.044, 95% CI = −0.050 to 0.137). Treatment effect did not differ by HMC use (0.156 HMC versus 0.128 none; P = 0.769, difference = 0.028, 95% CI −0.157 to 0.212). Conclusions Women with methamphetamine use disorder receiving combined intramuscular naltrexone and oral bupropion treatment achieve greater treatment response than placebo. Treatment effect does not differ by HMC.

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Section: Discussionmentioning

confidence: 99%

A gender‐based secondary analysis of the ADAPT‐2 combination naltrexone and bupropion treatment for methamphetamine use disorder trial

et al. 2023

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“…These results collaborate with findings by researchers like Terplan et al (2015) who noted that women who abused opiates used contraceptives less consistently than women who never abused opiates (56% vs 81%). Levander et al (2023) also found that women who abused opiates and likewise used contraceptives, were enrolled in an opiate treatment course by healthcare providers. Out of 855 opiate users, 63.20% used contraceptives inconsistently (Levander et al, 2023).…”

Section: Impact Of Drug Abuse On Contraceptive Discontinuitymentioning

confidence: 99%

Determinants of Contraceptive Discontinuation among Homeless Women in Kenya

Pkaremba,

Oleche,

Owiti

2023

AEF

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This paper examines factors affecting contraceptive discontinuity among homeless women in Kenya, using data from a sample of 384 homeless women. The findings were estimated using logistic regression. The estimated results from regression analysis show that living with a partner, drug use, health facility delivery, and knowledge of female sterilization and previously emigrating from an urban area, strongly encourage contraceptive discontinuation. The estimated results further show that being assisted by a midwife during delivery, earning above a dollar a day, and going through neonatal or pregnancy loss reduces incidences of contraceptive discontinuation. The study concludes with implications for policies that will encourage consistent use of contraceptives. These policies include the establishment of family planning programs to curb drug abuse and setting up family planning programs to educate women on the importance of initiating a form of contraception after incidences of abortions, stillbirths, or miscarriages. Other policy recommendations include the establishment of drug rehabilitation centers for women struggling with drug abuse and the provision of alternative sources of income. The government is also advised to train more midwives who can offer home based care for homeless women who cannot visit health centers.

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“…Substance use during pregnancy can create unique harms for the birth parent and foetus. In addition to gendered substance-use related harms (e.g., increased risks of HIV and hepatitis C), pregnancy-related harms include transmission of HIV, low birth weight, neonatal abstinence syndrome, preterm delivery, maternal morbidity, placenta rupture, and delayed child development [ 11 – 14 , 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

“…Despite these barriers, there are some promising practices that support PPWUD’s access to SRH services. In the United States, the integration of SRH services in primary care, substance use treatment and harm reduction programs have supported access to contraception and family planning services [ 11 , 29 , 30 ]. Other research has suggested that PPWUD prefer to access SRH services in spaces they already frequent, such as harm reduction programs, or through mobile outreach services [ 15 , 31 , 32 ].…”

Section: Introductionmentioning

confidence: 99%

“…Existing research on PPWUD has focused on access to contraceptives and HIV testing [ 11 , 18 ], access to substance use treatment and harm reduction [ 32 , 54 , 55 ], and barriers to accessing SRH services [ 13 , 32 ]. There is limited evidence regarding promising practices that support PPWUD’s access to SRH services, particularly in Canada [ 56 ].…”

Section: Introductionmentioning

confidence: 99%

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Programs and practices that support pregnant people who use drugs’ access to sexual and reproductive health care in Canada: a scoping review

Mathias,

Foster,

Rushton

2024

BMC Pregnancy Childbirth

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Background Pregnant people who use unregulated drugs (PPWUD) are at high risk of health complications yet experience a range of barriers to sexual and reproductive health care. Given that improving maternal health and access to reproductive health care are key targets underpinning the Sustainable Development Goals (SDG), there is an urgent need to improve access to appropriate supports and services for this population. Little is known about what programs and practices exist to support PPWUD’s access to sexual and reproductive health care. This scoping review aimed to identify the available literature on these programs and practices in Canada. Methods A scoping review was conducted using JBI methodology and reported using PRISMA guidelines. Scholarly databases and grey literature sources were searched to identify literature published between 2016–2023 in English or French that discussed, defined, conceptualised, or evaluated programs and practices that support PPWUD’s access to sexual and reproductive health care in Canada. Identified literature was screened using Covidence. Data were extracted from included texts, then analysed descriptively. Frequencies and key concepts were reported. Results A total of 71 articles were included, most of which were grey literature. Of the total, 46 unique programs were identified, as well as several useful practices. Most programs were in urban centres in Western Canada, and most programs offered holistic ‘wrap-around services.’ Several programs delivered these services on-site or as ‘drop-in’ programs with the support of staff with lived/living experience of substance use. Most frequent program outcomes included keeping parents and children together, improving connection to other services, and reducing substance use harms. Noted helpful practices included non-judgmental care and the use of harm-reduction strategies. Conclusions Several programs and practices that support PPWUD exist in Canada, though few focus exclusively on sexual and reproductive health. There remain opportunities to improve access to programs, including expanding geographic availability and range of services. The review has clinical application by providing an overview of available programs that may support clinicians in identifying services for PPWUD. Future research should consider client perspectives and experiences of these programs. Review registration number Open Science Framework https://osf.io/5y64j.

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Contraception and Healthcare Utilization by Reproductive-Age Women Who Use Drugs in Rural Communities: a Cross-Sectional Survey

Cited by 4 publications

References 51 publications

A gender‐based secondary analysis of the ADAPT‐2 combination naltrexone and bupropion treatment for methamphetamine use disorder trial

A gender‐based secondary analysis of the ADAPT‐2 combination naltrexone and bupropion treatment for methamphetamine use disorder trial

Determinants of Contraceptive Discontinuation among Homeless Women in Kenya

Programs and practices that support pregnant people who use drugs’ access to sexual and reproductive health care in Canada: a scoping review

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