title: Unplanned pregnancy and contraceptive use in women attending drug treatment services.
abstract: BACKGROUND
  At an international level, there are calls for a greater focus on women and harm reduction in recognition that female drug users have a unique set of issues that are not routinely assessed in drug treatment programs.
  
  
  OBJECTIVE
  To assess the pregnancy history, current pregnancy risk and contraceptive use of nonpregnant women attending opioid treatment programs (OTPs).
  
  
  METHODS
  This study involved a structured questionnaire survey of 204 women attending outpatient OTP services within the Sydney South West Area Health Service.
  
  
  RESULTS
  Two hundred and four women of 302 (67.5%) enroled in OTPs at the time completed surveys. Key findings were high pregnancy rates, with 28.9% of women reporting six or more pregnancies, high rates of adverse pregnancy outcomes (miscarriage, termination and stillbirth) compared with national data and poor uptake of contraception, with only 54.7% of sexually active women not wanting to get pregnant using a method. Women expressed diverse preferences for the type and location of women's health services they felt would meet their needs.
  
  
  CONCLUSIONS
  Women in OTP clinics have unaddressed reproductive health issues, particularly around contraception. Addressing these will potentially minimise the risk of material deprivation and social exclusion in these women and improve their well-being through greater control and choice over their fertility. Current women's health service provision in OTP programs involves referral to external services, but an integrated model of care may best address the unmet contraceptive needs of these women.
authors.affiliation: Discipline of Obstetrics, Gynaecology and Neonatology, Central Clinical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia. kirsten.black@sydney.edu.au
authors.forename: Kirsten I
authors.initials: KI
authors.lastname: Black
authors.forename: Christine
authors.initials: C
authors.lastname: Stephens
authors.forename: Paul S
authors.initials: PS
authors.lastname: Haber
authors.forename: Nicholas
authors.initials: N
authors.lastname: Lintzeris
mesh_terms: D000328:Adult; D002047:Buprenorphine / Q000627:therapeutic use; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D019033:Delivery of Health Care, Integrated / Q000706:statistics & numerical data; D055030:Drug Users / Q000706:statistics & numerical data*; D005260:Female; D006306:Health Surveys / Q000706:statistics & numerical data*; D006801:Humans; D008691:Methadone / Q000627:therapeutic use; D008875:Middle Aged; D058850:Opiate Substitution Treatment; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D049168:Pregnancy, Unplanned; D011795:Surveys and Questionnaires; D014932:Women's Health Services / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D002047:Buprenorphine; D008691:Methadone