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Limited data exist surrounding family planning decision making of people who inject drugs (PWID). This study explored the contraceptive practices and needs of PWID for the purpose of implementing values-based contraceptive resources at a syringe exchange program (SEP).
Using a mixed-methods design, we collected 68 quantitative surveys and 16 qualitative, semi-structured interviews with female-identifying, English-speaking clients of a SEP in Rochester, New York. Quantitative data was analyzed with descriptive statistics and qualitative data was coded and analyzed using grounded theory until thematic saturation was reached.
63.2% of survey respondents did not desire pregnancy in the next year, and 52.2% have experienced unintended pregnancy in the past. Of the 51.5% of respondents not using contraception, 54.3% were interested in initiating it. When deciding contraceptive methods, participants valued ease of access (37.5%), effectiveness (34.4%), and limited required follow up (21.9%). Qualitative interviewees described their “ideal pregnancy” as including increased financial and relationship stability, a decrease in drug use, and the ability to provide their children with opportunities to thrive. Provider stigma often prevented PWID from obtaining contraception through traditional healthcare settings, but SEPs were trusted resources in the community. Both survey and qualitative participants felt contraceptive services through an SEP would be convenient and comfortable, with 54.6% of total survey respondents interested in these services.
PWID identify key values in contraceptive choices and future pregnancies and view SEPs as trusted service providers. Although decision-making is complex and individualized, understanding the experiences of PWID is an important step in making family planning services equitable.
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