College of Public Health Faculty and Alumni Author Article on Contraceptive Barriers

Edward Leinaar, Associate Director of Research and Data Management with the Center for Applied Research and Evaluation in Women’s Health, part of East Tennessee State University’s College of Public Health, has authored an article in Southern Medical Journal.  The article, Perceived Barriers to Contraceptive Access and Acceptance among Reproductive-Age Women Receiving Opioid Agonist Therapy in Northeast Tennessee, describes the unique challenges women with substance use disorders experience to obtaining contraceptives and user-dependent method adherence, contributing to higher than average rates of unintended pregnancy.

Bill Brooks, Assistant Professor, and Arsham Alamian, former faculty in the Department of Biostatistics and Epidemiology along with Leigh Johnson, alumna of the college, are co-authors.

From 2013 to 2017, Tennessee experienced a 15.4% increase in Neonatal Abstinence Syndrome, far surpassing increases observed nationally. Incidence of this syndrome varies across the state, with the highest rates occurring in eastern counties, which also have the highest proportions of Neonatal Abstinence Syndrome cases born to mothers receiving opioid agonist therapies.

A cross-sectional survey was piloted among female patients aged 18 to 55 years from two opioid agonist therapies clinics. Of 91 participants, most experienced previous pregnancies (97.8%), with more than half reporting unwanted pregnancies (52.8%). Although 60% expressed a strong desire to avoid pregnancy, ambivalence toward becoming pregnant was common.  Although most study participants had current health insurance coverage and expressed a strong desire to avoid pregnancy, 75.8% experienced barriers to contraception.  The most prevalent barriers were aversion to adverse effects of contraceptives, stigmatization by healthcare providers, scheduled appointment compliance, and prohibitive cost.

Prevention of unintended pregnancy among women with opioid use disorder is an important public health strategy for reducing the incidence of Neonatal Abstinence Syndrome resulting from unintended pregnancy in this population of women with unmet reproductive health needs.  The authors suggest that provision of contraception at opioid use disorder treatment clinics may present an opportunity for improved access to contraception and reduced incidence of neonatal abstinence syndrome and unwanted pregnancy.

“This study demonstrates a need for expanding access to reproductive health services as a means to empower women with substance abuse disorders to plan their pregnancies and lives,” stated Dr. Amal Khoury, Director of the Center for Applied Research and Evaluation in Women’s Health and Chair of the Department of Health Services Management and Policy. “Efforts to improve access to contraceptive education and providers and to reduce the cost of these services can make a real difference for women in our region.”