Which women are missed by primary health-care based interventions for alcohol and drug use?

Abstract

Background Women of reproductive age who binge drink or have alcohol-related problem symptoms (APS) and who do not use contraception are considered at risk of an alcohol-exposed pregnancy (AEP). In the U.S., efforts to prevent AEPs focus largely on delivering interventions in primary health care settings. While research suggests that these interventions are efficacious for women reached, it is unclear to what extent these interventions are likely to reach women at risk of AEPs. Methods Data are from the Turnaway Study, a study of 956 women seeking pregnancy termination at 30 U.S. facilities between 2008 and 2010, some of whom received and some of whom were denied terminations because they were past the gestational limit. We examined associations between binge drinking, APS, and drug use prior to pregnancy recognition and having a usual source of health care (USOC). Results Overall, 59% reported having a USOC. A smaller proportion with than without an APS reported a USOC (44 vs. 60%, p<.05) and a smaller proportion using than not using drugs reported a USOC (51 vs 61%, p<.05). This pattern was not observed for binge drinking. In multivariate analyses, an APS continued to be associated with lack of a USOC, while drug use was no longer associated with lack of a USOC. Conclusions As more than 40% did not have a USOC, with higher proportions among women with an APS, primary health-care based approaches to AEP prevention seem unlikely to reach the majority of women who have an APS and are at risk of an unintended pregnancy.

A Qualitative Study of Substance use during Pregnancy: Implications for Reproductive Healthcare in Western Kenya

“…Programs for women should be holistic and integrated, accounting for contextual factors that initiate substance use and sustain it during pregnancy 47 . Integrating HIV/STI care, alcohol and drug screening and education, programs to address violence and mental health, and linkages to economic and material support for women outside of clinical settings as part of an enhanced health systems approach could improve maternal and child health in Kenya.…”

The Efficacy of Technology‐Based Interventions for Alcohol and Illicit Drug Use Among Women of Childbearing Age: A Systematic Review and Meta‐Analysis

“…Despite their efficacy, little progress has been made in the broad implementation of evidence‐based interventions into clinical practice (Gardiner et al., ; McKnight‐Eily et al., ; Roberts et al., ). This is often because providers lack time and resources to effectively screen for and intervene on alcohol and illicit drug use behaviors among women of childbearing age (Agley et al., ; Friedmann et al., ; Nygaard and Aasland, ).…”

“…This is often because providers lack time and resources to effectively screen for and intervene on alcohol and illicit drug use behaviors among women of childbearing age (Agley et al., ; Friedmann et al., ; Nygaard and Aasland, ). In addition, traditional intervention modalities have limited capacity to reach populations who might not otherwise receive care (Griffiths et al., ; Roberts et al., ). Geographical barriers disproportionately affect low‐income women in rural areas with few healthcare options, especially services for women (Griffiths et al., ; Terplan et al., ).…”