Expanding Contraceptive Access for Women With Substance Use Disorders: Partnerships Between Public Health Departments and County Jails

Abstract

Context: Law enforcement has been the primary strategy for addressing the opioid epidemic. As a result, the incarceration rate for women in county jails has increased more than 800% since 1980, and most women inmates struggle with substance use disorders. There is a large unmet need for contraception among women in county jails. Program: The East Region of the Tennessee Department of Health partnered with county correctional facilities to provide comprehensive family planning education and voluntary long-acting reversible contraception (LARC) to women in 15 jails. Implementation: Incarcerated women were invited to attend a comprehensive family planning education session conducted in the jail by health department nurses. The sessions included information on neonatal abstinence syndrome. The nurses explained that the women could receive intrauterine devices, implants, and injectable progesterone while incarcerated and come to the health department for all contraceptive methods upon release. Between January 2014 and June 2017, nurses conducted 182 education sessions, and 794 women received a LARC. Method placement occurred in the jails or at the local health department. No adverse effects were known to have occurred. Evaluation: We collected pilot data to explore the accuracy and the comprehensiveness of the family planning education session and whether the incarcerated women experienced the program as voluntary. All 18 women inmates interviewed reported experiencing the program as voluntary. Using published and administrative data, we roughly estimated that the program prevented between 270 and 460 unintended pregnancies and between 40 and 52 cases of neonatal abstinence syndrome in the first year after the women received a method. This represents a cost savings to Medicaid of $1.4 million. Discussion: The partnership demonstrated the feasibility of providing voluntary comprehensive family planning education and access to highly effective contraception for women inmates who, as a group, face a host of political, socioeconomic, and personal barriers to reproductive health care.

Overlapping needs for sexual and reproductive health and HIV prevention in women with substance use disorders

“…63 These findings are consistent with literature showing lower rates of contraceptive use and higher rates of unintended pregnancies among WICJ 37 , 58 , 64 – 67 and other women with SUDs. 29 – 31 , 33 While only 15% of participants reported interest in becoming pregnant, more than three-quarters reported being sexually active in the last 6 months and nearly all sexually active women reported condomless sex. There was no significant difference in contraceptive use based on interest in becoming pregnant, and yet most women in our study said they could readily access contraception, so it remains to be understood why they were not using it.…”

“…According to the Guttmacher Commission and the World Health Organization, essential SRH services include “a choice of safe and effective contraceptive method”; “safe and effective abortion services and care”; and “prevention, detection, and treatment of sexually transmitted infections including HIV and reproductive cancers.” 27 Women with SUD are often stigmatized, lack the social capital and power to assert their right to reproductive autonomy, and may be overtly coerced or pressured into decisions on their SRH. 28 Prior research has shown that women with SUD face disproportionately high rates of unintended pregnancies, 29 – 31 and subsequent pregnancy terminations, 32 as well as lower rates of contraception use, 33 which may be proxies for limited access to reproductive care or degree of reproductive control. High rates of sexually transmitted infections 34 – 36 and abnormal Pap tests 37 – 39 exemplify SRH burdens experienced by women with SUD.…”

Contraception among women on probation and parole on the United States–Mexico border

“…TA B L E 3 Results of hierarchical logistic regression analysis of use of effective contraception guided by the contraceptive use among female probationers model in a sample of 52 women Innovative programs offer various contraceptive methods, including LARC, prior to release from both urban and rural detention facilities on-site, or off-site at public health offices McNeely et al, 2018;Sufrin et al, 2017).…”

“…LARC is an appealing option for women leaving the carceral environment at high risk for unintended pregnancy, but providers must consider coercive influences inherent in these methods for they require provider intervention for initiation and safe removal. Mitigating coercion risk at initiation includes counseling on reproductive life planning and scheduling waiting periods prior to insertion to allow time to consider the decision (McNeely et al, 2018;Schonberg et al, 2015;Sufrin et al, 2015). Continuation post-incarceration requires access to reliable care in the community.…”

Revisiting the Fetal Assault Law in Tennessee: Implications and the Way Forward

“…However, the risk of maternal relapse and overdose following detoxification therapy is high without intense behavioral follow-up in the postpartum period (Bell et al, 2016;Terplan et al, 2018); thus, ACOG emphasizes that detoxification should only be attempted with informed consent and access to adequate behavioral support in the postpartum period (ACOG, 2017 (Smith & Hanlon, 2017). Given that over 80% of pregnancies among women with OUD are unintended, postpartum access to Long Acting Reversible Contraception has expanded in recent years (McNeely et al, 2019;Meschke et al, 2018;Public Chapter No. 686, 2018).…”