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Provider Perspectives of Barriers to Contraceptive Access and Use among Women with Substance Use Disorders

Published:December 17, 2021DOI:https://doi.org/10.1016/j.whi.2021.11.010

      Abstract

      Objectives

      Previous studies conducted from the patient perspective indicate that women with substance use disorders (SUDs) experience extensive barriers to contraceptive access and use (CAU), but there is limited research investigating this topic from the provider perspective. We explored provider perspectives on the barriers to CAU for women with SUDs. As a secondary objective, we highlighted provider contraceptive counseling strategies to address patient CAU barriers.

      Methods

      We conducted 24 qualitative interviews with a purposeful sample of women's health providers, including medical doctors, nurse practitioners, and certified nurse-midwives. We used thematic analysis to code the interviews with inductive codes and organized findings according to levels of influence within the Dahlgren and Whitehead rainbow model, a socioecological model of health.

      Results

      Provider-reported barriers to CAU were identified at four levels of socioecological influence and included reproductive misconceptions; active substance use; trauma, interpersonal violence, and reproductive coercion; limited social support; lack of housing, employment, health insurance, and transportation; stigma; discrimination; and punitive prenatal substance use policies and child welfare reporting requirements. Strategies for addressing CAU barriers mainly focused on patient-centered communication, including open information exchange, shared decision-making, and relationship building. However, providers described disproportionately highlighting the benefits of long-acting reversible contraception (LARC) and directing conversations toward LARC when they perceived that such methods would help patients to overcome adherence and other challenges related to active substance use or logistical barriers. Notably, there was no mention of CAU facilitators during the interviews.

      Conclusions

      Providers perceived that women with SUDs experience a range of CAU barriers, which they addressed within the clinical setting through use of both patient-centered communication and highlighting the benefits of LARC when they perceived that such methods would help clients to overcome barriers. Improving CAU for women with SUDs will require multidisciplinary, multipronged strategies that prioritize reproductive autonomy and are implemented across clinical, community, and policy settings.
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      Biography

      Elizabeth Charron, PhD, MPH, is a postdoctoral fellow in the Program for Addiction Research, Clinical Care, Knowledge, and Advocacy at University of Utah. She is an addiction health services researcher, focused on improving health, health service delivery, and outcomes for vulnerable persons.

      Biography

      Farah Tahsin, MPA, is a PhD candidate in the Policy Studies program in the Department of Political Science at Clemson University. Her research interests includes maternal and child health policy, opioid regulations, and evaluation of comprehensive public health treatment programs.

      Biography

      Rwina Balto, RN, MSN, is a PhD student in the College of Nursing at the University of Utah. She is a nurse-midwife focused on midwifery research. Her particular interests include knowledge, perceptions, and access to midwifery care among women in Saudi Arabia.

      Biography

      Kacey Y. Eichelberger, MD, is Chair, Department of Obstetrics and Gynecology, University of South Carolina School of Medicine Greenville/Prisma Health Upstate. She is medical director of the Magdalene Clinic, a multidisciplinary trauma-informed clinic for pregnant women with substance use disorder.

      Biography

      Lori Dickes, PhD, is an Associate Professor in the Department of Political Science at Clemson University. Her work focuses on health policy and economics focused on women's health, rural populations, and improving policy implementation and outcomes for vulnerable populations.

      Biography

      Sara E. Simonsen, PhD, CNM, MSPH, is an Associate Professor and the Annette Poulson Cumming Presidential Endowed Chair in Women's & Reproductive Health at the University of Utah College of Nursing. Her research is focused on health promotion among reproductive-age women.

      Biography

      Rachel M. Mayo, PhD, is Associate Dean for Research and Graduate Studies and Professor, College of Behavioral, Social and Health Sciences at Clemson University. Her work focuses on health equity, maternal and child health, and women's health issues.