Postpartum contraceptive plans and fulfillment for pregnant people experiencing incarceration with substance use histories.

BackgroundPregnant patients experiencing incarceration with a history of substance use face complex challenges accessing reproductive health services. Despite research indicating interest in these services, contraception counseling and services are often excluded from routine carceral health services.ObjectivesWe sought to examine the postpartum contraceptive plans and fulfillment of pregnant patients in the North Carolina prison system with histories of substance use.DesignThis is a secondary analysis of a retrospective chart review quantifying the contraceptive plans and fulfillment of pregnant people experiencing incarceration.MethodsWe abstracted chart data from the prenatal records and scanned delivery records of patients experiencing incarceration in the North Carolina state prison system who accessed prenatal care. We categorized substance use as licit (e.g., tobacco, alcohol, and cannabis) or illicit (e.g., opioids, amphetamines). We assessed postpartum contraceptive plan documentation and contraception type provided at delivery overall and across type of pre-incarceration substance use.ResultsOf the 890 patients that met eligibility criteria, the majority (90.9%) reported the use of at least one type of substance during pre-incarceration and 72.1% reported use of multiple substances. Among patients with either licit or illicit substance use, 167 (20.6%) had a documented plan for long-acting reversible contraceptive (LARC), 119 (14.7%) for permanent contraception, 107 (13.2%) for a non-LARC method, 50 (6.2%) with a documented plan for no method or plan to be abstinent, and 366 (45.2%) had no documented contraception plan. Among the patients who delivered while incarcerated, 17.6% of patients received a non-LARC method, 9.5% received a LARC, 5.3% of patients received permanent contraception, three participants (0.6%) received no contraceptive method, and 316 (66.9%) had no documentation of receiving postpartum contraception. The proportion of patients receiving each postpartum contraceptive method type did not differ by pre-incarceration substance use type.ConclusionPostpartum contraceptive preferences of pregnant patients experiencing incarceration may not be adequately prioritized. Our findings indicate a potential unmet need for contraceptive services for pregnant and postpartum people with history of substance use experiencing incarceration.