Editorial

Women and drugs across the globe: A call to action

Despite increased public awareness and use of opioid agonist therapy (OAT), there is little published data on contraception among women on methadone or buprenorphine/naloxone. This study aimed to characterize patterns of contraception use among this population.

We conducted a cross-sectional survey between May 2014 and October 2015 at 6 medical clinics, pharmacies, and community organizations in British Columbia. Trained surveyors used the Canadian Sexual Health Survey (CSHS) to collect information on contraceptive practices and barriers to health care access. Descriptive analysis was performed on the subset of women on OAT who were at risk for unintended pregnancy.

Of the 133 survey respondents, 80 (60.2%) were at risk for unintended pregnancy. Among the 46 respondents with a recent pregnancy, 44 (95.7%) reported it as unintended. Of those at risk for unintended pregnancy, the most common contraceptive methods used were “no method,” male condom, and depo-medroxyprogesterone at 28.8%, 16.3%, and 12.5%, respectively. Only 5% reported dual protection with a barrier and hormonal or intrauterine method. Barriers to contraception access included difficulty booking appointments with providers and cost, although 97% of all respondents reported feeling comfortable speaking with a physician about contraception.

We found that most respondents using OAT reported prior pregnancies that were unintended, and used less effective contraceptive methods. Health care professionals who provide addiction care are uniquely positioned to address their patients’ concerns about contraception. Incorporating family planning discussions into OAT services may improve understanding and use of effective contraceptive methods. Addressing unmet contraceptive needs may enable women on OAT to achieve their reproductive goals.

En dépit de la sensibilisation accrue du public et de l'augmentation du recours au traitement par agonistes opioïdes (TAO), il existe peu de données publiées sur la contraception chez les femmes qui suivent un traitement par méthadone ou buprénorphine-naloxone. Cette étude visait à caractériser les habitudes contraceptives de cette population.

Nous avons mené une enquête transversale entre mai 2014 et octobre 2015 dans 6 cliniques médicales, pharmacies et organismes communautaires de la Colombie-Britannique. Des enquêteurs qualifiés ont utilisé l'enquête canadienne sur la santé sexuelle (Canadian Sexual Health Survey) pour recueillir des données sur les méthodes contraceptives et les obstacles à l'accès aux soins de santé. Une analyse descriptive a été effectuée sur le sous-groupe de femmes suivant un TAO qui présentaient un risque de grossesse imprévue.

Parmi les 133 répondantes, 80 (60,2 %) étaient à risque de grossesse imprévue. Parmi les 46 répondantes ayant récemment été enceintes, 44 (95,7 %) ont déclaré qu'il s'agissait d'une grossesse imprévue. Chez les femmes à risque de grosse imprévue, les méthodes contraceptives les plus utilisées étaient « aucune méthode » (28,8 %), le condom masculin (16,3 %) et l'acétate de médroxyprogestérone (12,5 %). Seulement 5 % ont signalé une double protection avec une méthode de type barrière et un contraceptif hormonal ou un stérilet. Les obstacles à l'accès à la contraception comprenaient la difficulté à fixer des rendez-vous avec les fournisseurs de soins et les coûts, bien que 97 % de toutes les répondantes aient indiqué être à l'aise de parler de contraception avec un médecin.

Nous avons constaté que la plupart des répondantes suivant un TAO ont signalé des grossesses imprévues antérieures et utilisaient les méthodes contraceptives les moins efficaces. Les professionnels de la santé qui offrent des soins en matière de dépendance sont dans une position idéale pour répondre aux inquiétudes de leurs patientes sur la contraception. L'intégration des discussions sur la planification familiale dans les services de TAO peut aider les patientes à comprendre et à utiliser des méthodes contraceptives efficaces. Le fait de répondre à ces besoins contraceptifs non satisfaits pourrait outiller les femmes suivant un TAO de sorte qu'elles puissent atteindre leurs objectifs de planification familiale.

The Kenyan government has committed to increasing access to comprehensive reproductive, maternal, neonatal and child health (RMNCH) services. However, inequalities still exist. Women who inject drugs are an important sub-population for public health interventions, yet their RMNCH needs have largely been overlooked. Additionally, there is a lack of research to inform RMNCH interventions for this sub-population.

In 2015, we undertook interviews and focus group discussions with 45 women who inject drugs and five key stakeholders to understand these women’s RMNCH experiences and needs.

Women’ access to essential services across the RMNCH continuum was low. Two thirds of the women were not using contraception. Many discovered they were pregnant late, due to amenorrhea of drug use, and thus were unable to enroll for antenatal care early. Facility-based deliveries were limited with many choosing to deliver at home. Following delivery, women’s attendance to immunization services was sub-optimal. Stigma from healthcare workers was a major factor impeding women’s use of existing RMNCH services. The prospect of experiencing withdrawals at health facilities where waiting times were long, deterred utilization of these services. Additionally, women faced competing priorities, having to choose between purchasing heroin or spending their money on health-related costs.

Several barriers disrupted women’s access to services across the RMNCH continuum. Consequently, there is a need to develop equitable, comprehensive, and family-centered RMNCH interventions tailored to women who inject drugs, through a combination of supply- and demand-side interventions. For optimal impact, RMNCH services should be integrated into harm reduction programs.