Integration of a facilitated access pathway for contraception into alcohol and other drug treatment services: A cohort study comparing metropolitan and regional settings

Kelly A McNamara; Bridin Murnion; Nicholas Lintzeris; Vicki Chase; Emma Black; Annie Malcolm; Lucy Harvey Dodds; Natasha Nassar; Kirsten I Black

doi:10.1111/dar.13957

Integration of a facilitated access pathway for contraception into alcohol and other drug treatment services: A cohort study comparing metropolitan and regional settings

Drug Alcohol Rev. 2024 Oct 8. doi: 10.1111/dar.13957. Online ahead of print.

Authors

Kelly A McNamara^{1

2

3

4}, Bridin Murnion^{1

5}, Nicholas Lintzeris^{1

6

7}, Vicki Chase², Emma Black^{1

6

7}, Annie Malcolm⁷, Lucy Harvey Dodds⁷, Natasha Nassar⁸, Kirsten I Black¹

Affiliations

¹ Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
² Drug and Alcohol Services, Central Coast Local Health District, Wyong, Australia.
³ Royal Hospital for Women, Sydney, Australia.
⁴ School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
⁵ School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia.
⁶ Drug and Alcohol Clinical Research and Improvement Network, NSW Health, Sydney, Australia.
⁷ Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia.
⁸ Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.

PMID: 39380287
DOI: 10.1111/dar.13957

Abstract

Introduction: Women who attend alcohol and other drug (AOD) services experience higher rates of unintended pregnancy, and access less contraception, than the general population. This study aims to observe contraceptive initiation and use after contraception services were offered at metropolitan and regional AOD services.

Methods: Clinical staff were provided contraception education. One hundred women aged 16-49 were recruited from two services between 2017 and 2021. Women completed a questionnaire on their obstetrics and gynaecological history, pregnancy plans and contraception use. Women were provided education on contraception options and offered referral to a contraception pathway. The primary outcome was initiation of highly reliable contraception; secondary outcomes were the types of contraception initiated, and contraception use and pregnancy at 12 months. We compared the initiation of contraception across the two study sites.

Results: At baseline, 91% of women were not planning a pregnancy within 12 months, with 21% of these using highly reliable contraception. Of all women not planning a pregnancy, 28% initiated highly reliable contraception via the pathway (2% metropolitan, 51% regional, p < 0.001), with intrauterine devices being the most frequent method initiated (15%). At 12 months, 44% were using highly reliable contraception and 15% had recorded pregnancies.

Discussion and conclusions: Contraception pathways for women in AOD treatment can improve initiation of highly reliable methods of contraception, although pregnancy rates were still high and there were large differences between the study sites. Care navigation and clinical champions are some potential facilitators to contraception access, and understanding additional barriers to access may be useful.

Keywords: contraception; delivery of health care; health services accessibility; reproductive history; substance‐related disorders.

Abstract

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