Alcohol, substance use, and birth control
Use of contraception among substance-using women is low, resulting in a high number of unplanned pregnancies. Estimates of unplanned pregnancies among substance-using women range from about two thirds to about three fourths of pregnancies, as compared to just under half of the pregnancies in the general U.S. population. Women who trade sex to support their drug use may be at particular risk for unplanned pregnancy. This dissertation addresses four research questions: (1) What kinds of birth control do substance-using women use? (2) How does alcohol use impact decisions about birth control among substance-using women? (3) What other factors affect birth control use among substance-using women, and how? and (4) To what extent can the Theory of Contraceptive Risk Taking be applied to the birth control experiences of substance-using women? Data were collected via in-depth interviews with 26 current and former substance-using women recruited from service providers in San Francisco. Nine participants were HIV-positive or had AIDS. Among the 24 participants who had ever been pregnant, the mean number of pregnancies was over 4. Participants' experience with contraception was limited. All had used male condoms. Twenty-two had been prescribed oral contraception, but participants usually did not take the pills for more than a few days. Ten had been given a contraceptive shot, but usually did not return for subsequent shots. Twenty participants had received at least one abortion, and 31% of pregnancies ended in abortion. Alcohol use significantly affected judgment about sex, and participants attributed sexual risk-taking to alcohol. Other factors affecting birth control use were lifestyle issues, fertility beliefs, utilization of medical care, side effects of contraception, and prostitution. The Theory of Contraceptive Risk Taking was not fully supported by the data, but may arguably still fit the experiences of substance-using women from one perspective. The implications of this study are many. Abortion should be kept legal and accessible. Contraception was freely available to participants, but more creative ways of distributing it should be explored.
0453: Womens studies
0573: Public health