Substance use and substance use disorder remain significant public health crises. Substance use disorder or addiction, is a stigmatized and misunderstood disease. Accessing contraception and abortion care is particularly challenging, as people who use substances or are diagnosed with substance use disorder often experience internalized stigma and over discrimination within the healthcare system. There are limited recommendations for the clinical care of persons with substance use disorder who seek abortion or contraception care, and limited data to support these recommendations. This Society of Family Planning clinical recommendation addresses counseling and provision of contraception and abortion for persons who use substances or have substance use disorder. As there are almost no safety or efficacy data on contraception, abortion and substance use, the recommendations utilize extrapolations of substance use disorder-adjacent medical conditions when necessary.