Stigma and Reproductive Health Service Access Among Women in Treatment for Substance Use Disorder



      We aimed to examine the role of perceived and direct stigma on access to reproductive health services among women in treatment for substance use disorders in Michigan.


      We draw on self-interview data from a cross-sectional study of female patients aged 18–50 years who accessed substance use disorder treatment at 22 randomly selected facilities in Michigan from December 2015 to May 2017. We conducted logistic regressions to examine associations between perceived stigma and access to three types of reproductive health services (screening exams, birth control, and prenatal care), as well as direct stigma and access to birth control.


      The final sample included 260 women. A notable percentage of women reported inability to access reproductive health services (24% for screening exams, 14% for birth control, and 12% for prenatal care). Women with higher levels of perceived stigma because of substance use were significantly more likely to report inability to access screening exams (odds ratio [OR]: 2.14; confidence interval [CI]: 1.43–3.20) and birth control (OR: 2.17; CI: 1.36–3.77). Women reporting higher levels of direct stigma were also significantly more likely to report inability to access birth control (OR: 3.87; CI: 2.29–6.53), even after accounting for perceived stigma.


      Perceived and direct stigma because of substance use may be significant barriers to seeking and accessing reproductive health services for women. Health professionals should reduce stigma in health care in order to increase access to necessary services for this population.
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      Madelyn McCartin, BSN, RN, is a registered nurse practicing in oncology at Brigham and Women's Hospital in Boston, Massachusetts. She earned her Bachelors of Science in Nursing degree from the University of Michigan at Ann Arbor.


      Lindsay M. Cannon, MPH, MSW, is a PhD student in Sociology at the University of Wisconsin – Madison and a trainee in the Center for Demography and Ecology. Her research interests include fertility, sexual health and trauma, and gender-based violence.


      Roxanne F. Harfmann, BA, is a PhD candidate in Experimental Psychology at the University of Vermont. Her current research focuses on tobacco use in vulnerable populations, substance use, and sexual and reproductive health.


      Vanessa K. Dalton, MD, MPH, is Associate Chair of Research in University of Michigan's Department of Obstetrics and Gynecology and the Director of the Program on Women's Health Care Effectiveness Research. Her research interests include family planning, contraception, and healthcare utilization.


      Lauren K. MacAfee, MD, MSc, is an Assistant Professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at the University of Vermont. Her research interests are in family planning and barriers to reproductive health care for women with substance use disorder.


      Yasamin Kusunoki, PhD, MPH, is an Assistant Professor in the School of Nursing and a Faculty Associate at the Institute for Social Research at University of Michigan. Her research focuses on reproductive health disparities and relationship dynamics, including intimate partner violence, reproductive coercion, sexual and contraceptive behaviors, and unintended pregnancy.