Long-acting reversible contraceptives (LARCs) as harm reduction: a qualitative study exploring views of women with histories of opioid misuse

Harm Reduction Journal

Sarah Finocchario-Kessler¹  Melissa K. Miller²  Emily A. Hurley³  Kathy Goggin⁴  Stephani L. Stancil⁵  Rachel P. Winograd⁶  Alex Duello⁶ 

[1] Department of Family Medicine, University Kansas Medical School, Kansas City, KS, USA;Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA;Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA;Division of Health Services and Outcomes Research, Children’s Mercy Kansas City, Kansas City, MO, USA;Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA;Division of Health Services and Outcomes Research, Children’s Mercy Kansas City, Kansas City, MO, USA;School of Pharmacy, University of Missouri - Kansas City, Kansas City, MO, USA;Division of Adolescent Medicine, Children’s Mercy Kansas City, 2401 Gillham Rd, 64108, Kansas City, MO, USA;Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children’s Mercy Kansas City, Kansas City, MO, USA;Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA;Missouri Institute of Mental Health, University of Missouri-St. Louis, St. Louis, MO, USA;

关键词: Contraception;    Long-acting reversible contraception (LARC);    Opioid use disorder;    Substance use;    Unintended pregnancy;   

DOI  :  10.1186/s12954-021-00532-1

来源: Springer

【 摘 要 】

BackgroundThe sharp rise in opioid use disorder (OUD) among women coupled with disproportionally high rates of unintended pregnancy have led to a four-fold increase in the number of pregnant women with OUD in the United States over the past decade. Supporting intentional family planning can have multiple health benefits and reduce harms related to OUD but requires a comprehensive understanding of women’s perspectives of preventing unintended pregnancies. The purpose of this study was to comprehensively evaluate the knowledge, attitudes and experiences as they relate to seeking contraception, particularly LARCs, among women with active or recovered opioid misuse.MethodsIn-depth interviews and focus group discussions with 36 women with current or past opioid misuse were recorded and transcribed. Transcripts were coded by ≥ 2 investigators. Themes related to contraceptive care seeking were identified and contextualized within the Health Belief Model.ResultsOur analysis revealed seven interwoven themes that describe individual level factors associated with contraceptive care seeking in women with current or past opioid misuse: relationship with drugs, reproductive experiences and self-perceptions, sexual partner dynamics, access, awareness of options, healthcare attitudes/experiences, and perceptions of contraception efficacy/ side effects. Overall, perceived susceptibility and severity to unintended pregnancy varied, but most women perceived high benefits of contraception, particularly LARC. However, perceived barriers were too high for most to obtain desired contraception to support family planning intentions.ConclusionsThe individual-level factors identified should inform the design of integrated services to promote patient-centered contraceptive counseling as a form of harm reduction. Interventions should reduce barriers to contraceptive access, particularly LARCs, and establish counseling strategies that use open, non-judgmental communication, acknowledge the continuum of reproductive needs, explore perceived susceptibility to pregnancy, and utilize peer educators.

【 授权许可】

CC BY