CPH Publishes on Substance Use Disorders and Contraceptive Practices

Edward Leinaar, Associate Director of Research and Data Management for the Choose Well research initiative in the East Tennessee State University College of Public Health Department of Health Services Management and Policy, has authored an article describing dynamics of healthcare access and contraceptive utilization among women in Northeast Tennessee seeking treatment for opioid use disorder.

The article, “Healthcare Access, Pregnancy Intention, and Contraceptive Practices Among Reproductive-Aged Women Receiving Opioid Agonist Therapy in Northeast Tennessee”, was published in the Southern Medical Journal.  Co-authors include college alumni Dr. Ruby Yadav, Dr. Leigh Johnson, and Abir Rahman along with Dr. Arsham Alamian, associate professor in the college’s Department of Biostatistics and Epidemiology.

Approximately half of all pregnancies in the United States are unintended, resulting from contraceptive failure, inconsistent use, or absence of a contraceptive method.  Unintended pregnancy rates are higher among women with user-dependent methods of contraception, compared with those using long-acting reversible contraceptives, such as intrauterine devices or subdermal implants.  Women with substance use disorders have lower rates of contraceptive utilization and higher rates of unintended pregnancy than the general population. 

The objective of this study was to describe access to reproductive healthcare, pregnancy intentions, and contraceptive use among women receiving medication for management of opioid use disorder in northeast Tennessee, and to generate hypotheses for future research.  A cross-sectional survey was piloted among female patients aged 18 to 55 years from two opioid agonist therapy clinics. 

Of 91 participants, 84% reported having health insurance, with 70% perceiving having adequate access to healthcare. 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%).

Although most participants reported adequate access to healthcare and a desire to avoid pregnancy, few reported the consistent use of regular contraception. Furthermore, misperceptions regarding pregnancy risk were common among participants. Further research is needed to understand material and cultural barriers to contraceptive use among women receiving treatment for opioid use disorder in the central Appalachian region, who are at disproportionate risk of unintended pregnancy and delivery of babies with neonatal abstinence syndrome.