Contraceptive risk-taking among substance-using women

Abstract

Substance-using women use contraception less frequently than do women in the general population, and as a result have higher numbers of unplanned pregnancies. In addition, substance-using women regularly utilize abortion as a means for controlling their number of births. A number of factors complicate this phenomenon, including sex-for-drugs exchanges. This study analyzed data from interviews with women receiving substance abuse treatment in San Francisco, CA. Interviews explored behaviors associated with contraception and abortion as well as complicating factors surrounding prostitution. The existing literature in this area lacks theoretical insight into these behaviors. In this article, the Theory of Contraceptive Risk Taking (TCRT) is used to explore the behaviors of this sample. The TCRT predicts that contraceptive risk-taking (i.e. not using contraception) will occur after a woman navigates a series of steps in a decision-making process, including weighing costs and benefits of contraception and pregnancy, estimating her probability of becoming pregnant, and measuring her ability to obtain an abortion should her risk be unsuccessful. The participants identified many costs of contraception. The theory largely explained the behavior of this sample, except that pregnancy costs and benefits were overlooked. Implications for social work include eliminating logistical barriers to contraception and increasing benefits to contraception by offering financial incentives to use.