Partnering with recovery community centers to build recovery capital by improving access to reproductive health

• Published in: Journal of nursing scholarship 2023-05, Vol.55 (3), p.692-700
• Main Authors: Feld, Hartley, Elswick, Alex, Goodin, Amie, Fallin‐Bennett, Amanda
• Format: Article
• Language: English
• Subjects: Access; Adaptation; Advocacy; Autonomy; Barriers; Best practice; Birth control; Child; Childbearing; Childbearing age; Childrens health; Clinical outcomes; Community centers; Contraception; Delivery of Health Care; Drug abuse; Drug overdose; Drug use; Empowerment; Family planning; Feasibility; Female; Gender; Harm reduction; Health care; Health disparities; Health needs; Health services; Health status; Humans; Maternal & child health; Maternal characteristics; Maternal mortality; Narcotics; Needle exchange programs; Opioids; Peers; Pilot Projects; Pregnancy; Prenatal care; Public Health; Recovery (Medical); Reproductive Health; Substance use disorder; Trauma; United States; Women; Womens health
• ISSN: 1527-6546; 1547-5069
• DOI: 10.1111/jnu.12836

Background People with substance use disorders (SUD), especially opioid use disorder (OUD) have the highest rates of unintended pregnancies (80–95%) and report unmet reproductive health needs. Women of childbearing age have some of the highest death rates from opioids and are notably rising the most rapidly, and when pregnancy does occur overdose is one of the leading causes of maternal mortality. There are numerous gender‐based health disparities and social determinants of health shaped by the distribution of power and privilege that influence the risk trajectories of people who can get pregnant or are pregnant with a substance use disorder (SUD). Purpose The purpose of this paper is to describe how reproductive health is essential to recovery and building recovery capital for people who can get pregnant, (1) introduce a pilot implementation science study working with trained peer support coaches to promote reproductive autonomy in the community, and (2) make policy and advocacy recommendations relevant to the new reproductive health landscape in the United States. We will also describe the adaptation and feasibility of the initial pilot study where we partnered with a recovery community center to train peer recovery coaches to provide low barrier resources (contraception, pregnancy tests and prenatal vitamins) and referrals to health care. Methods This initiative is the merging of best practices in recovery and community‐based global reproductive health, to empower people with SUD who can get pregnant in an implementation science framework. The pilot study will last 3 months in each city and aims to (1) assess and describe the effectiveness of the training of local peer recovery coaches on the link between recovery capital and reproductive health, and (2) assess the feasibility, acceptability, appropriateness, scalability, sustainability, and uptake and reach of low barrier reproductive health resources (pregnancy tests, prenatal vitamins, and emergency contraception). In this paper we are only reporting the initial findings regarding adaptation and feasibility. Findings Informed by qualitative interviews with stakeholders and participants, the method of contraception was adapted from injectable to emergency to meet the needs and context of the community with SUD. Early outcomes such as uptake and acceptability indicate that this is a feasible model with peer recovery coaches and recovery community centers, with the greatest uptake of emergency contracep