Reproductive Health Care Utilization by Women Who Inject Drugs and Exchange Sex in the Seattle Area

Abstract

Background

Few data exist regarding reproductive health needs of women who inject drugs (WWID) and exchange sex. This group is at increased risk of unintended pregnancy and sexually transmitted infections (STI). They also face stigma and other barriers to accessing reproductive health care. Purpose: To evaluate contraceptive usage, pregnancy intention, and uptake of general and reproductive health services among WWID and exchange sex. Methods: This analysis of the 2016 Seattle area National HIV Behavioral Surveillance survey included women aged 18–49 years who exchanged sex for money or drugs and injected drugs in the last year. We evaluated contraceptive utilization, pregnancy intention, and reproductive health care access. Results: Among 144 respondents meeting inclusion criteria, the median age was 39 (IQR 33–45), the median age at first injection was 22 (IQR 17–28), and the most commonly injected drug was heroin (62.0%). A minority (10.3%) desired pregnancy in the next year. Among women wanting to avoid pregnancy, 65.5% had not used any prescription contraception (pill/patch/ring, injection, intrauterine device, or implant) in the last year. In the last year, nearly all (92.4%) respondents had received health care and over half (59.0%) had had an STI test. Of women eligible for the HPV vaccine, 28.6% had received at least one dose. Conclusions: Most WWID and exchange sex want to avoid pregnancy. Despite accessing health care, a minority are using prescribed contraception. Health care tailored to these women's preferences may reduce unmet contraceptive need and improve access to well-woman care and preconception counseling.

Keywords:

• Reproductive health
• substance use
• contraception
• exchange sex
• pregnancy intention

Disclosure statement

Elizabeth Micks is a Nexplanon trainer for Merck and has research funding from Sebela. The other authors report no conflicts of interest.

Data availability

Individuals interested in the dataset need to follow standard procedures for access to surveillance data collected by Public Health - Seattle & King County (e.g. IRB review, data use agreement, data confidentiality training).

Additional information

Funding

This work was supported by Society of Family Planning Research Fund under Grant Award Number SFPRF17-11. Funding for the National HIV Behavioral Surveillance survey came from a cooperative agreement with the Centers for Disease Control and Prevention (1U62PS005094).