For women grappling with substance use, navigating reproductive health care is usually a nightmare. An internet of obstacles and restrictions, each implicit and specific, make it troublesome to entry the whole lot from contraception to abortion to pre- and postnatal care. Meanwhile, stigma infiltrates the general public dialog, typically dissuading women from acquiring wanted health care and hindering efforts to deal with what all of us agree is a serious drawback: the opioid disaster and its impression on Maine households.
Studies present charges of unintended being pregnant amongst women who use opiates vary from 67 percent to 86 percent, versus roughly 31 percent to 47 percent within the basic inhabitants. Empowering and educating women to handle fertility with contraceptive strategies till they’re prepared for a being pregnant would significantly enhance the health and futures of moms, youngsters and our communities. To achieve this requires a humane and knowledgeable strategy.
A invoice into account in Augusta gives one answer. L.D. 1063, “An Act to Reduce the Number of Substance-Exposed Infants,” is one a part of what have to be a delicate, multi-pronged struggle for women’s health and restoration.
The laws would require MaineCare to cowl counseling on and provision of postpartum contraception strategies, together with long-acting reversible contraceptives, for women who qualify for pregnancy-related care underneath MaineCare. Giving women the choice to entry high-quality contraception earlier than they depart the hospital is proven to dramatically reduce the risk of an unintended second being pregnant.
Recognizing the significance of bodily autonomy, the laws expressly prohibits any sort of coercion and seeks to be sure that women are in a position to settle for or deny household planning providers with out disgrace or worry of repercussions. This is an important element of the invoice, and an acknowledgment of a problematic historical past of coercive practices associated to contraception, notably aimed toward poor women of shade.
Of course, the best way we speak about this drawback will dictate how nicely we’re in a position to clear up it. In this case, we should look past the invoice’s title and think about that each women and infants would benefit by enacting L.D. 1063. Increasing women’s entry to handy, simply reversible and long-lasting types of contraception provides them extra management over their reproductive futures, and, within the case of opioid-dependent women, would assist keep away from unplanned pregnancies that could possibly be affected by substance use.
The proposal additionally requires outreach and academic packages relating to household planning for these vulnerable to utilizing substances throughout being pregnant. (This, too, have to be carried out in such a method that emphasizes “the right to individual self-determination regarding family planning and childbearing.”)
This is an effective begin. But women coping with poverty, substance use and ensuing stigmatization typically lead unpredictable and precarious every day lives rife with obstacles to prioritizing and acquiring contraception. We want to attain out with a number of avenues of help.
That’s why Maine Family Planning is partnering with substance remedy and harm-reduction packages, such because the Portland Needle Exchange, to launch the Reproductive Empowerment Project, an initiative that may mix values-free outreach and schooling with same-day medical providers by way of telemedicine. We’ll meet women the place they’re (drug-treatment packages, needle-exchange packages, pre-release packages for women transitioning from incarceration to unbiased dwelling, group foster houses for older teen women, protected houses for home violence survivors or gender-specific sober homes), hyperlink them up by means of our telemedicine system to one in every of our nurse practitioners, and have the opportunity to distribute oral contraception, on the spot, as well as to an array of different reproductive health providers.
In many instances, the rhetoric round substance use causes women who use opiates to really feel remoted and ashamed to search assist. Often, reliable worry of felony expenses or Child Protective Services eradicating youngsters from their custody creates a basic distrust of health professionals who might both stigmatize individuals utilizing medicine or misunderstand them. L.D. 1063 and the Reproductive Empowerment Project are simply two makes an attempt to take away these limitations to care. More forward-thinking options, knowledgeable by these with lived expertise of habit and parenting, are needed.
As Maine and the nation proceed to battle the opioid epidemic, we should embrace holistic options that dignify women and youngsters and advance entry to all types of health care.
Zoe Odlin-Platz is a group health promotion specialist on the Portland Needle Exchange, and George A. Hill is president and CEO of Augusta-based Maine Family Planning, which offers reproductive health providers at 18 health facilities all through the state.