Knowledge of and concerns about long-acting reversible contraception among women in medication-assisted treatment for opioid use disorder

Abstract

Objectives: To assess interest in, concerns about and knowledge of long-acting reversible contraceptives (LARC) among women in medication-assisted treatment (MAT) for opioid use disorder who were at risk for unintended pregnancy.

Study design: Women in MAT completed a survey on contraceptive use, attitudes and knowledge, including LARC methods, as part of eligibility screening for an ongoing trial evaluating family planning interventions for this population.

Results: Eighty-three women at risk for unintended pregnancy completed the survey, and a subset of 51 completed supplemental questions about implants. All participants had heard of IUDs and 75/83 (90%) had heard of implants, but only 34/83 (41%) and 14/51 (27%) reported being likely to use IUDs and implants, respectively. Thirty-five women reported they were unlikely to use IUDs, with 29/35 (83%) citing unspecified "other reasons" for this position and 24/35 (69%) endorsing concerns about side effects. Seventeen women reported they were unlikely to use implants, with 8/17 (47%) citing "other reasons" and 9/17 (53%) and 10/17 (59%) reporting concerns about insertion and removal, respectively. Participants reported they knew "a little" about LARCs, but only their knowledge of implants was limited. Only 50/83 (60%) participants were aware of the superior effectiveness of IUDs and 26/51 (51%) were aware of the superior effectiveness of implants relative to other reversible methods.

Conclusions: Participants reported relatively low interest in LARCs. Many women had unspecified reasons for not using LARCs. Participants also lacked information about LARC safety and effectiveness, especially with regard to implants.

Implications: Women in medication-assisted treatment for opioid use disorder are at high risk of unintended pregnancy, yet contraceptive use is low and use of less effective methods is common. Women in MAT may benefit from efforts to increase knowledge about implants and assuage concerns about their insertion and removal as well as more general efforts to improve knowledge about the relative efficacy of LARCs. Many women in MAT endorsed unspecified "other reasons" for not using LARCs, which should be explored further.

Keywords: Long-acting reversible contraception; Medication-assisted treatment; Opioid use disorder; Unintended pregnancy.

Figure 1

Self-rated likelihood of birth control pill, injection, intrauterine device (IUD) and implant use in the future among women in medication assisted treatment for opioid use disorder and at risk for unintended pregnancy. Note that the original survey did not ask about the likelihood of future condom use. N = 83 for pills, injections and IUDs and n = 51 for implants.

Figure 2

Mean ± standard error of the mean of self-rated contraceptive knowledge (left panel) and percentage of correct responses to contraceptive knowledge questions (right panel) as a function of method type (IUDs = intrauterine devices) among women in medication assisted treatment for opioid use disorder and at risk for unintended pregnancy. N = 83 for pills, injections and IUDs and n = 51 for implants.