Contraceptive Utilization and Downstream Feto-Maternal Outcomes for Women with Substance Use Disorders: A Dissertation
Authors
Griffith, Gillian J.Faculty Advisor
Robin E. Clark, PhDAcademic Program
Clinical and Population Health ResearchUMass Chan Affiliations
Family Medicine and Community HealthDocument Type
Doctoral DissertationPublication Date
2016-03-30Keywords
Dissertations, UMMSContraception
Contraceptive Agents
Contraceptive Devices
Family Planning Services
Medicaid
Pregnancy
Pregnancy, Unplanned
Pregnancy Outcome
Reproductive Health
Substance-Related Disorders
Contraception
Contraceptive Agents
Contraceptive Devices
Family Planning Services
Medicaid
Pregnancy
Unplanned Pregnancy
Pregnancy Outcome
Reproductive Health
Substance-Related Disorders
Female Urogenital Diseases and Pregnancy Complications
Health Policy
Maternal and Child Health
Obstetrics and Gynecology
Substance Abuse and Addiction
Women's Health
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Background: One in ten people in the U.S. are affected by a substance use disorder (SUD), roughly one third of whom are women. Rates of unintended pregnancy are higher in this population than in the general public. Little is understood about how women with SUD use prescription contraception and think about pregnancy. Methods: By analyzing Medicaid claims data and conducting qualitative interviews with women with SUD, this doctoral thesis seeks to: 1) compare any use of and consistent, continued coverage by prescription contraceptives between women with and without SUD; 2) determine the extent to which SUD is associated with pregnancy, abortion, and adverse feto-maternal outcomes in women who use prescription contraception; and 3) explore facilitators of and barriers to contraceptive utilization by women with SUD, using qualitative interviews. Results: Compared to women without SUD, women with SUD are less likely to use any prescription contraceptive, particularly long-acting reversible methods. Among women who do use long-acting methods, SUD is associated with less continued, consistent coverage by a prescription contraceptive. Among women who use contraception, SUD is also associated with increased odds of abortion. When interviewed, women with SUD report fatalistic attitudes towards pregnancy planning, and have difficulty conceptualizing how susceptibility to pregnancy may change over time. Women with SUD also report that pregnancy has substantial impact on their drug treatment prospects. Conclusions: This study is the first to examine contraceptive utilization by women with SUD who are enrolled in Medicaid or state-subsidized insurance. Our study may help to inform clinical practice and policy development to improve the reproductive health and wellbeing of women with SUD.DOI
10.13028/M23G65Permanent Link to this Item
http://hdl.handle.net/20.500.14038/32195Rights
Copyright is held by the author, with all rights reserved.ae974a485f413a2113503eed53cd6c53
10.13028/M23G65
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Long acting contraception provision by rural primary care physiciansLunde, Britt; Smith, Paul; Grewal, Manpreet; Kumaraswami, Tara; Cowett, Allison; Harwood, Bryna (2014-06-01)OBJECTIVES: Unplanned pregnancy is a public health problem in the United States, including in rural areas. Primary care physicians are the main providers of health care to women in rural areas and are uniquely positioned to help reduce unplanned pregnancy in rural women. This study documents provision of contraception by rural primary care physicians, focusing on the most effective, long acting methods, intrauterine devices (IUDs) and contraceptive implants. METHODS: We surveyed all primary care physicians practicing in rural areas of Illinois and Wisconsin. Bivariate analysis was performed using chi squared and Fisher's exact test, and multivariable analysis was performed with logistic regression to determine factors associated with provision. RESULTS: The response rate was 862 out of 2312 physicians (37%). Nine percent of respondents place implants and 35% place IUDs. Eighty-seven percent of physicians had not had training in implant placement, and 41% had not had training in IUD placement. In multivariable analysis, factors associated with placement of long acting contraception include provision of maternity care, and female gender of the physician. The most common reasons for not providing the methods were lack of training and perceived low demand from patients. CONCLUSIONS: Many rural primary care providers do not place long acting contraceptive devices due to lack of training. Female physicians and those providing maternity care are the most likely to place these devices. Increased training for primary care physicians both during and after residency would help increase access to these options for women in rural areas.