Stigma and Reproductive Health Service Access Among Women in Treatment for Substance Use Disorder

McCartin, Madelyn; Cannon, Lindsay M; Harfmann, Roxanne F.; Dalton, Vanessa K.; MacAfee, Lauren K.; Kusunoki, Yasamin

doi:10.1016/j.whi.2022.06.003

Cited by 9 publications

(11 citation statements)

References 18 publications

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“…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 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2023

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Background Individuals with substance use disorders (SUD) have disproportionately high rates of unintended pregnancy. Reducing harm associated with this risk and its biopsychosocial consequences requires evidence-based, non-coercive interventions that ensure access to contraception for individuals who choose to prevent pregnancy. We examined feasibility and impact of SexHealth Mobile, a mobile unit-based intervention that aimed to increase access to patient-centered contraceptive care for individuals in SUD recovery programs. Methods We conducted a quasi-experimental study (enhanced usual care [EUC] followed by intervention) at three recovery centers with participants (n = 98) at risk for unintended pregnancy. EUC participants were offered printed information on community locations where they could access contraception care. SexHealth Mobile participants were offered same-day, onsite clinical consultation on a medical mobile unit and contraception if desired. The primary outcome was use of contraception (hormonal or intrauterine device) at one-month post-enrollment. Secondary outcomes were at two-weeks and three-months. Confidence in preventing unintended pregnancy, reasons for non-use of contraception at follow-up, and intervention feasibility were also assessed. Results Participants (median age = 31, range 19–40) enrolled in the intervention period were almost 10 times more likely to be using contraception at one-month (51.5%) versus the those enrolled in the EUC period (5.4%) (unadjusted relative risk [URR] = 9.3 [95%CI: 2.3–37.1]; adjusted relative risk [ARR] = 9.8 [95%CI: 2.4–39.2]). Intervention participants were also more likely to be using contraception at 2-weeks (38.7% vs. 2.6%; URR = 14.3 [95%CI: 2.0–104.1]) and three-months (40.9% vs. 13.9%; URR = 2.9 [95% CI: 1.1–7.4]). EUC participants reported more barriers (cost, time) and less confidence in preventing unintended pregnancies. Mixed-methods feasibility data indicated high acceptability and feasible integration into recovery settings. Conclusions Mobile contraceptive care based on principles of reproductive justice and harm reduction reduces access barriers, is feasible to implement in SUD recovery settings, and increases contraception use. Expanding interventions like SexHealth Mobile may help reduce harm from unintended pregnancies among individuals in SUD recovery. Trial Registration NCT04227145.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2023

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“…8,10 They may also avoid contraception care-seeking due to experienced or anticipated stigma from providers. 6,8,9,11 Women 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 to have 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 custody).…”

Section: Introductionmentioning

confidence: 99%

Contraception use among individuals with substance use disorder increases 10-fold with patient-centered, mobile services: a quasi- experimental study

Hurley

Goggin

Piña-Brugman

et al. 2022

Preprint

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Background Individuals with substance use disorders (SUD) have disproportionately high rates of unintended pregnancy. Reducing harm associated with this risk and its biopsychosocial consequences requires evidence-based, non-coercive interventions that ensure access to contraception for individuals who choose to prevent pregnancy. We aimed to examine feasibility and impact of SexHealth Mobile, a mobile unit-based intervention aiming to increase access to patient-centered contraceptive care for individuals in SUD recovery programs. Methods We conducted a quasi-experimental study (enhanced usual care [EUC] followed by intervention) at three recovery centers with participants (n = 98) at risk for unintended pregnancy. EUC participants were offered printed information on community locations where they could access contraception care. SexHealth Mobile participants were offered same-day, onsite clinical consultation on a medical mobile unit and contraception if desired. The primary outcome was use of hormonal contraception/IUD at one-month post-enrollment. Secondary outcomes were use at two-weeks and three-months. Confidence in preventing unintended pregnancy, reasons for non-use of contraception at follow-up, and intervention feasibility were also assessed. Results Participants (median age = 31, range 19–40) enrolled in the intervention were almost 10 times more likely to be using contraception at one-month (51.5%) versus the those enrolled in the EUC period (5.4%) (unadjusted relative risk [URR] = 9.3 [95%CI: 2.3–37.1]; adjusted relative risk [ARR] = 9.8 [95%CI: 2.4–39.2]). Intervention participants were also more likely to be using contraception at 2-weeks (38.7% vs. 2.6%; URR = 14.3 [95%CI: 2.0-104.1]) and three-months (40.9% vs. 13.9%; URR = 2.9 [95% CI: 1.1–7.4]). EUC participants reported more barriers (cost, time) and less confidence in preventing unintended pregnancies. Mixed-methods feasibility data indicated high acceptability and feasible integration into recovery settings. Conclusions Mobile contraceptive care based on principles of reproductive justice and harm reduction reduces access barriers, is feasible to implement in SUD recovery settings, and increases contraception use. Following the overturning of Roe v. Wade, expanding interventions like SexHealth Mobile may help reduce harm from unintended pregnancies among individuals in SUD recovery. Trial Registration: NCT04227145

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“…3 We use this example of coercive misuse of contraception to highlight the systematic stigmatization that individuals with SUD experience in reproductive health care. 4 For complex and intersecting reasons including lack of access for placement or removal of contraceptive devices and resistance to reproductive control, individuals who use substances are less likely to use contraception and those who do are less likely to use highly effective forms. 5 Consequently, individuals who use substances have an unplanned pregnancy rate 2-3 times higher than the general population 6 and are more likely to have an abortion.…”

mentioning

confidence: 99%

“…For example, in the 1990s, several statutes required or incentivized those with SUD to receive the Norplant, a 5-year implantable contraceptive device, in an effort to prevent pregnancy in this population 3 . We use this example of coercive misuse of contraception to highlight the systematic stigmatization that individuals with SUD experience in reproductive health care 4 . For complex and intersecting reasons including lack of access for placement or removal of contraceptive devices and resistance to reproductive control, individuals who use substances are less likely to use contraception and those who do are less likely to use highly effective forms 5 .…”

mentioning

confidence: 99%

The Fall of Roe v. Wade: The Addiction Specialist’s Role in Championing Reproductive Rights

Kurtz

Smid

2023

J Addict Med

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Reproductive age-pregnant individuals who use substances are disproportionately impacted by the US Supreme Court reversal of Roe v. Wade. Because of historic and ongoing discrimination against pregnant individuals who use substances, this group is at high risk for inadequate pregnancy options counseling and lack of access to safe and legal abortions. Fetal rights laws set a concerning precedent that further criminalize and penalize substance use in pregnancy. As addiction specialists, we have the professional responsibility to champion the reproductive freedoms of pregnant individuals who use substances. There are several ways that addiction specialists can uphold the reproductive rights of patients on an individual, state, and federal level, including the following: incorporate reproductive healthcare into addiction practices, help those seeking abortion navigate barriers, partner with perinatal healthcare clinicians to provide evidence-based addiction treatment during pregnancy, and support decriminalization and destigmatization of substance use, especially in pregnancy.

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Stigma and Reproductive Health Service Access Among Women in Treatment for Substance Use Disorder

Cited by 9 publications

References 18 publications

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

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

Contraception use among individuals with substance use disorder increases 10-fold with patient-centered, mobile services: a quasi- experimental study

The Fall of Roe v. Wade: The Addiction Specialist’s Role in Championing Reproductive Rights

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