Attitudes toward pregnancy intention and pregnancy prevention among women recovering from substance use disorders
Awarded 2018
Complex Family Planning Fellowship Research
Courtney Forbis, MD
University of Chicago

Background: Substance use disorder is a diagnosis that encompasses a constellation of behaviors surrounding the use of an addictive substance that may result in severe physical, social, or psychological impairment. Substance use disorder is common in the United States; over 40% of those affected are women. Upon entering recovery for substance use disorder, women may develop a need for family planning services; however, the details of their family planning needs are currently unknown. This qualitative study explores recovering women’s attitudes towards pregnancy intentions and pregnancy prevention and seeks to better address and serve the family planning needs of women in recovery from substance use disorder.  
Objectives: This study seeks to answer the following questions: 
What are the main attitudes of women in recovery towards pregnancy as it relates to their recovery from substance use disorder?
Do women receiving care in substance use treatment centers identify as having a need for family planning services, and if so, are they receiving these services while in recovery? 
How do women in recovery feel about receiving their reproductive health care at their current treatment center? 
Methods: This is a qualitative study using in-depth interviews with 22 women aged 18-35 currently in recovery from substance use disorder who are enrolled in residential and outpatient treatment centers in Chicago, Illinois. Interviews explored women’s current sexual practices, current and past use of contraception, attitudes towards pregnancy in relation to their recovery from substance use disorder, experiences with family planning services while in treatment, and opinions about integrating  services into their current treatment program. 
 Results: Most women (82%) were currently sexually active, but only 46% were using contraception. Women are advised to avoid sex and pregnancy for the first year of recovery. However, women reported a lack of pregnancy prevention education. Women expressed concerns about how pregnancy might impact their recovery (stress, trigger for relapse). At the same time, many women identified a desire for pregnancy or motherhood in the future. Most (90%) were open to receiving reproductive health services at their treatment center.
Conclusions: There is an unmet need for family planning services among women recovering from substance use disorder. Though many women desire pregnancy in the future, most feel that pregnancy at this time would be stressful and potentially negatively impact their recovery. Women in treatment from substance use disorder may benefit from family planning services and would prefer to receive these services while in treatment.