Integration of a contraception clinic into an opioid treatment setting to improve contraception knowledge, accessibility and uptake: a pilot study

Guideline No. 443a: Opioid Use Throughout Women's Lifespan: Fertility, Contraception, Chronic Pain, and Menopause

OBJECTIVE

To provide health care providers with the best evidence on opioid use and women's health. Areas of focus include general patterns of opioid use and safety of use; care of women who use opioids; stigma, screening, brief intervention, and referral to treatment; hormonal regulation; reproductive health, including contraception and fertility; sexual function; perimenopausal and menopausal symptoms; and chronic pelvic pain syndromes.

TARGET POPULATION

The target population includes all women currently using or contemplating using opioids.

OUTCOMES

Open, evidence-informed dialogue about opioid use will lead to improvements in patient care and overall health.

BENEFITS, HARMS, AND COSTS

Exploring opioid use through a trauma-informed approach offers the health care provider and patient with an opportunity to build a strong, collaborative, and therapeutic alliance. This alliance empowers women to make informed choices about their own care. It also allows for the diagnosis and possible treatment of opioid use disorders. Use should not be stigmatized, as stigma leads to poor "partnered care" (i.e., the partnership between the patient and care provider). Therefore, health care providers and patients must understand the potential role of opioids in women's health (both positive and negative) to ensure informed decision-making.

EVIDENCE

A literature search was designed and carried out in PubMed and the Cochrane Library databases from August 2018 until March 2023 using following MeSH terms and keywords (and variants): opioids, illicit drugs, fertility, pregnancy, breastfeeding, and aging.

VALIDATION METHODS

The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations).

INTENDED AUDIENCE

All health care providers who care for women.

TWEETABLE ABSTRACT

Opioid use can affect female reproductive function; health care providers and patients must understand the potential role of opioids in women's health to ensure informed decision-making.

SUMMARY STATEMENTS

RECOMMENDATIONS.

Reproductive Rights Knowledge, Health Care Utilization, and Contraceptive Use in Pakistan: A Reproductive Rights Perspective

INTRODUCTION

This study investigates the effects of utilization of health care and the level of reproductive rights knowledge on contraceptive use. Current family planning programs in developing countries utilize a two-pronged strategy involving improvement of level of reproductive rights and, right to access health care systems. The effectiveness of this strategy in developing countries such as Pakistan remains poorly investigated. This study aimed at examining the effect of reproductive rights knowledge on contraceptive use.

METHODS

The target population is educated, 18- to 45-year-old married Pakistani women. The sample is composed of 160 nonrandomly selected purposive group of women. We gathered data using a structured questionnaire and analyzed the data using several multivariate methods such as latent class analysis and multiple classification analysis.

RESULTS

Our results suggest that reproductive rights knowledge has no direct effect on contraceptive use. Furthermore, the level of utilization of the health care system plays a significant intervening role between reproductive rights knowledge and contraceptive use.

DISCUSSION

Our results call for improving access and availability of health care while strengthening the awareness and knowledge of reproductive rights among women to improve their capacity to utilize family planning methods. Public awareness and educational programs are indeed necessary to promote knowledge of reproductive rights among women in developing countries. As public health campaigns propagandize the crucial role reproductive rights play in improving women's reproductive health, it is important to maintain a structurally harmonious relationship between health care systems and family planning programs promoting contraceptive use. This approach is more likely to result in significant returns for public awareness campaigns promoting reproductive rights in developing countries.

Postpartum contraceptive planning of women with substance abuse disorders

BACKGROUND

Women with substance abuse disorders have lower use of contraception. Unplanned pregnancies increase risk of fetal exposure to addictive and teratogenic substances. Postpartum inpatient periods for these women can be challenging times to facilitate contraception planning.

OBJECTIVE

To explore postnatal contraceptive planning practices, patient preferences for contraception, and supply challenges, and to identify how clinical pharmacists may best provide care in this context.

SETTING

A tertiary maternity referral hospital in metropolitan Victoria, Australia (January 2015-December 2018).

METHOD

A retrospective cohort study was conducted on postnatal women with substance abuse disorders. Patients were excluded if they had delivered at another health service, had inadequate documented evidence of a substance abuse disorder, or had incomplete or unavailable medical records. Records were reviewed for demographic data, admission details, and documented contraceptive planning.

MAIN OUTCOME MEASURES

Documented contraceptive planning, patient contraception preferences and identified supply challenges.

RESULTS

Ninety-three women were included. Seventy-one (76.3%) had psychiatric disorders or impairments, and 92 (98.9%) had identifiable follow-up challenges (eg. Homelessness). Nine (9.7%) self-discharged/absconded. Eighty-seven (93.5%) had documented postnatal contraception discussions. Sixty-two of 87 (71.3%) considered a medicine/device, three (3.4%) preferred condoms, 10 (11.5%) considered sterilisation, 2 (2.3%) preferred no contraception, and 16 (18.4%) undecided. Etonogestral 68 mg implants were most commonly prescribed (28 of 42; 66.7%).

CONCLUSION

Inpatient postpartum periods for this cohort were characterised by psycho-social complexities, inconsistent contraceptive planning documentation, and patients seemingly unprepared to consider contraception. This study highlights a need for an earlier decision-making process and pragmatic counselling with antenatal pharmacists.