Introduction

I am creating this blog while pursuing a doctor of nursing practice degree and studying to become a women’s health nurse practitioner. The topic is important to me because I have spent the past 20 years working as a nurse caring for women and their families. I have seen firsthand the profound joy and profound complications that pregnancy can bring to women’s lives. Women need quality health information and care to support their pregnancy intentions. However, the United States has a problem: our country has high levels of unintended pregnancies; but certain groups of women have disproportionately high rates of pregnancy (Black & Day, 2016).

My recent work has been with women in one of Arizona’s largest substance use recovery programs. I had an opportunity to ask a new residential client One Key Question,

“Would you like to become pregnant in the next year?”

One Key Question is a registered trademarked program of Power to Decide

Her response tells a story that gets to the heart of the problem:

“No one has ever asked me that before, not once. And it’s so important as I know so many women who have had babies only to have them taken away and that makes recovery so much hard… there’s no pain like that”

anonymous 32 year old women in recovery

She had been in 18 different treatment programs over her lifetime.

In our siloed care, we are missing opportunities to connect services with people who need them.

The outcomes are devastating:

Approximately 86% of pregnancies among substance-using women are unintended compared to approximately half of pregnancies among women in the general population (Black & Day, 2016).

Women with substance use disorders experience significant physical and psychosocial risks during pregnancy (Black & Day, 2016).

The incidence of newborn withdrawal, referred to as neonatal abstinence syndrome (NAS) has increased nearly fivefold over that past decade (Patrick & Schiff, 2018).

NAS costs an estimated 1.5 billion dollars in hospital charges each year (Patrick & Schiff, 2018).

Why is this conversation important?

• Because women in recovery need more support to prevent unintended pregnancies, prepare for desired pregnancies, and receive basic reproductive healthcare.
• Because currently folks that are trying to support women in recovery are often disconnected from others trying to support women in recovery.
• Building connections has the power to improve the lives of women in recovery and our communities.

The goal of this blog is to explore ways to create innovative polices or strengthen existing policies to better support women in recovery to receive the care they desire to determine their reproductive future. Policy making is about people… clearly identifying the problem people are experiencing, connecting with people who have expertise with people who have the power to affect change with funding and policymaking (Patton, Zalon, & Ludwick, 2019).

Work has begun. Key expert groups working on this issue are:

• The World Health Organization
• The Center for Disease Control and Prevention
• The American College of Obstetricians and Gynecologists
• The American Academy of Pediatrics
• The American Public Health Association
• Substance Abuse and Mental Health Services Administration
• American Society of Addiction Medicine

Current legislative position:

Action is needed. Currently no legislation mandates recovery programs to integrate reproductive health services or screening with substance use treatment. However, a few programs have begun co-locating family planning with SUD recovery programs. Women find these programs acceptable and even preferable to traditional separated services (Robinowitz et al., 2016). These innovative integrated programs have managed to reduce barriers and are making promising strides (Black & Day, 2016). Coalition building with leaders in women’s health, addiction health, and legislation is needed to build on these fledgling successes and create effective guidelines and policies for further implementation efforts. Health policy enables improvement beyond the individual patient, it serves to organize, deliver, and ensure compensation for quality health services across systems, states, or nations (Longest, 2010). It is with policy changes that we can make a real impact to reduce unintended pregnancy rates for women in recovery.

References

ACOG Committee on Health Care for Underserved Women, American Society of Addiction Medicine.  (2012).  ACOG Committee opinion no. 524: Opioid abuse, dependence, and addiction in pregnancy.  Obstetrics and Gynecology, 119, 1070-1076.

ACOG Committee on Gynecologic Practice, Long-Acting Reversible Contraception Working Group.  (2018).  ACOG Committee opinion no. 642: Increase access to contraceptive implants and intrauterine devices to reduce unintended pregnancy.  Obstetrics and Gynecology, 126, e44-48.

Black, K.I., & Day, C.A. (2016).  Improving access to long-acting contraceptive methods and reducing unplanned pregnancy among women with substance use disorders.  Substance Abuse: Research and Treatment, 10(S1), 27-33.

Ko, J.Y., Wolicki, S., Barfield, W.D., Patrick, S.W., Broussard, C.S., Yonkers, K.A., Naimon, R., & Iskander, J. (2017).  CDC grand rounds: Public health strategies to prevent neonatal abstinence syndrome.  MMWR: Morbidity and Mortality Weekly Report, 66(9), 242-245.

Longest, B.B. Jr. (2010). Health policymaking in the United States. (5^th ed.). Chicago, IL: Health Administration Press.

Patrick, S.W., & Schiff, D.M. (2018).  A public health response to opioid use in pregnancy.  Pediatrics, 139(3),1-7.

Patton, R.M., Zalon, M.L., & Ludwick R. (2019). Identifying a problem and analyzing a policy issue. In R.M. Patton, M.L. Zalon, & R. Ludwick (Eds.), Nurses making policy: From bedside to boardroom (2^nd ed.) (pp. 103-128). New York, NY: Springer Publishing Company.

Robinowitz, N., Muqueeth, S., Scheibler, J., Salisbury-Afshar, E., & Terplan, M.  (2016). Family planning in substance use disorder treatment centers: Opportunities and challenges. Substance Use and Misuse, 51(11), 1477-1483.U.S. Department of Health and Human Services (2020). Title X family planning. Retrieved from https://www.hhs.gov/opa/title-x-family-planning/index.html