Asked but not received: postpartum contraception access in opioid-using pregnant patients

To identify differences between desired and received postpartum contraception in opioid-using pregnant patients.

This single-centre retrospective study included pregnant patients who reported current opioid use, with a positive urine drug screen (UDS) for opioids, and a documented contraceptive plan in the medical record who delivered between December 1, 2016, and December 31, 2020. Patients who delivered outside the sponsoring institution and those taking medications for opioid use disorder (MOUD) or hospital-administered opioids were excluded. Descriptive statistics were performed including counts, percentages, and means.

A total of 101 patients met the criteria for inclusion. Over two-thirds of patients did not receive their desired form of contraception at the time of hospital discharge. Long-acting reversible contraception (LARC) was the most preferred form of contraception at the time of admission. Depot medroxyprogesterone acetate (DMPA) was the most common contraceptive received at the time of hospital discharge, with around one-third of patients receiving DMPA. Only 25 patients (24.8%) presented for a postpartum follow-up appointment. Of the women who did not receive their desired form of contraception at the time of discharge, 19 (27.9%) were pregnant again within two years.

Increased focus is needed on the prevention of unintended pregnancies in opioid-using patients, including policies to increase access to contraception, including LARCs.