Objectives: This study aimed to create a comprehensive description of the family planning needs and preferences of women who inject drugs (WWID) and are participants in the Community Health Outreach Workers (CHOW) Project’s Syringe Exchange Program (SEP) in Hawaii. Understanding these preferences will support the development of culturally sensitive and appropriate clinical practices for this population. Methods: This needs assessment was conducted using paper-based surveys and a focus group with WWID and with key informant interviews with subject area experts. Results: We collected 50 surveys, conducted one focus group and completed 9 key informant interviews. Data suggested that there is an unmet need for contraception among WWID in Hawaii, with the key drivers for this disparity being competing needs (such as housing), stigmatization and past trauma limiting WWID’s capacity to address family planning. Survey and focus group participants confirmed key informants’ perception that adequate services exist within the community but that WWID may not feel motivated or comfortable to access services. Conclusion: Providing services in a location that is already safe and familiar for SEP participants is key. A same-day DMPA administration process is being developed and piloted with the SEP to assess interest in this service. Simultaneously, a comprehensive referral system that incorporates the concepts of trauma-informed care and patient-centeredness is being developed to support SEP participants in obtaining services.