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Perceptions of Pregnancy and Contraceptive Use: An In-Depth Study of Women in Los Angeles Methadone Clinics

  • Marta Bornstein
    Correspondence
    Correspondence to: Marta Bornstein, MPH, Department of Community Health Sciences, Fielding School of Public Health, University of California, 650 Charles E Young Drive, South Los Angeles, CA 90095. Phone: 310-7947028; fax: 310-794-1805.
    Affiliations
    Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California

    California Center for Population Research, University of California, Los Angeles, Los Angeles, California
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  • Jessica D. Gipson
    Affiliations
    Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California

    California Center for Population Research, University of California, Los Angeles, Los Angeles, California
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  • Roselle Bleck
    Affiliations
    David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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  • Aparna Sridhar
    Affiliations
    Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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  • Agatha Berger
    Affiliations
    Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California

    Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, Delaware
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Published:November 13, 2018DOI:https://doi.org/10.1016/j.whi.2018.10.004

      Abstract

      Introduction

      In 2016, 2.1 million people in the United States were estimated to have an opioid use disorder. Although the disorder can be safely and effectively treated with prescription methadone, treatment is potentially long term and may span women's peak childbearing ages. Little is known about women's reproductive health needs while on methadone.

      Methods

      We interviewed 22 sexually active, nonpregnant women ages 21–39 years at two Los Angeles methadone clinics in 2016. The interviews were transcribed and coded by four researchers using thematic and open coding techniques.

      Results

      One-half of the women were nulliparous and 17 were in stable, monogamous relationships with men. Women reported a range of feelings and perceptions about pregnancy, but nearly all wanted to delay pregnancy until discontinuing methadone. However, many women indicated limited interest in preventing pregnancy because of the relative stability of their relationships, fear of infertility, and low perceived risk of pregnancy. These factors influenced contraceptive use.

      Discussion

      Women described mixed feelings about pregnancy and many ultimately felt that an unplanned pregnancy would be acceptable in the context of their relationships and uncertain fertility. These findings provide context for previous quantitative findings that women in methadone treatment have higher rates of unintended pregnancy and lower rates of contraceptive use than the general population.

      Conclusions

      Accurate information about pregnancy in the context of methadone treatment may help women to make proactive family planning decisions. Health care providers should discuss the guidelines for pregnancy on methadone and offer a range of options to help women achieve their reproductive goals.
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      Biography

      Marta Bornstein, MPH, is a PhD student in the Department of Community Health Sciences at the UCLA Fielding School of Public Health. Her research focuses on sexual and reproductive health, both in the United States and internationally.

      Biography

      Jessica D. Gipson, MPH, PhD, is an Associate Professor in the Department of Community Health Sciences at the UCLA Fielding School of Public Health. Her research focuses on sexual and reproductive health of marginalized communities and populations.

      Biography

      Roselle Bleck, BA, is a medical student, UCLA David Geffen School of Medicine, and is pursuing an MPH in Health Policy, Columbia University's Mailman School of Public Health. She will devote her career to women's health, focusing on access to reproductive health care.

      Biography

      Aparna Sridhar, MD, MPH, is an Assistant Professor in the Department of Obstetrics and Gynecology at the UCLA David Geffen School of Medicine. Her research interests are focused on contraception, family planning, and the development of patient education tools.

      Biography

      Agatha Berger, MD, MPH, is a faculty member of the Department of Obstetrics & Gynecology, Christiana Care Health System, Newark, Delaware. Her research interests include the impacts of substance use disorders on women's reproductive health and lives and to reproductive health care.