Perspectives among women receiving medications for opioid use disorder: Implications for development of a peer navigation intervention to improve access to family planning services

Abstract

Background Studies have consistently found high rates of unintended pregnancy among women with opioid use disorder (OUD). Few interventions have been developed to specifically engage and address the family planning (FP) needs of women in substance use disorder treatment. Objectives: Our goal was to collect formative qualitative data to identify the FP experiences, needs and service preferences of women receiving medications for OUD and to use these data to develop a FP education and navigation intervention that could be tested in diverse, resource-limited treatment settings. Methods: From August 2016 to April 2017, we conducted 21 guided qualitative interviews with women from two outpatient treatment clinics in Denver, Colorado. We recorded, transcribed, and coded all interviews. We then facilitated three focus groups (n = 16) from May to July 2017 to verify or challenge interview themes and to further inform the development of the FP intervention. Results: Most participants expressed ambivalence or low perceived risk regarding unintended pregnancy and desired more information about contraceptive methods. Many participants described mistrust or lack of engagement in the medical system and histories of trauma were a common barrier to seeking services. Focus group participants endorsed a peer-led FP navigation intervention and provided feedback to tailor existing FP educational materials to fit the specific needs of women in recovery. Conclusions/Importance: Results from this qualitative study suggest that women in recovery from OUD have unique, unmet FP education and service needs. These findings provide important information for the development of feasible and acceptable FP service delivery within diverse, resource-limited treatment settings and informed the development of a trauma-informed, peer-led FP education and navigation intervention that would be implemented in a subsequent phase of the study.

Keywords:

• Medications for opioid use disorder
• family planning
• reproductive health
• sexual health
• peer navigation
• contraceptive practices

Acknowledgments

We would like to acknowledge the support of Sarah Leslie; Reina Doyle; Leah Miller; Katie Langland; Mia White; Sarah Warsh; Dr. Michelle Cleeves; Denver Health’s Outpatient Behavioral Health Services, specifically Lisa Gawenus, Ryan Mueller, June Branon, Kacy Behrend, and Robin Govanlu; and the University of Colorado Addiction Treatment & Research Services (ARTS), specifically Paula Woodstrom and Janice Greenwood. This work was presented in part at the Academy Health Annual Research Meeting, Seattle, WA, June 2018; Public Health in the Rockies, Copper Mountain, CO, August 2018 and 2020; CityMatCH’s Annual Conference, Portland, OR, September 2018, and CityMatCH’s Annual Conference, Providence, RI, September 2019.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

All authors contributed to study conception and design. DR and MS contributed to data collection, analysis and interpretation of the results. MS drafted the article and all authors critically revised it. All authors approved the final article.

Trial registration

ClinicalTrials.gov Identifier: NCT02794597

Additional information

Funding

This study was funded by the NIH/National Institute on Drug Abuse Grant # 1R34DA039381-01A1. Contents are the authors’ sole responsibility and do not necessarily represent official NIH views. This work represents the work of the authors and the study sponsors were not involved in the development, study design, analysis or dissemination of the study.