Contraceptive choice and power amongst women receiving opioid replacement therapy: qualitative study

Joanne Neale, Helena Werthern, Nour Alhusein, Angel Chater, Jenny Scott, Hannah Family

Research output: Contribution to journalArticlepeer-review


Background: Women receiving treatment for opioid use disorder have low levels of contraception use and high rates of unintended pregnancies, abortion and children being adopted or fostered. This paper aims to understand the relationship between contraceptive choice and power amongst women receiving Opioid Replacement Therapy (ORT). Methods: During 2016/17, semi-structured interviews were undertaken with 40 women (aged 22–49 years) receiving ORT in the South of England. Data relating to the latent concept of power were inductively coded and analysed via Iterative Categorisation. Findings: Power manifested itself through six interconnected ‘fields’: i. ‘information about fertility and contraception’; ii. ‘access to contraception’; iii. ‘relationships with professionals and services’; iv. ‘relationships with male partners’; v. ‘relationships with sex work clients’; and vi. ‘life priorities and preferences’. Each field comprised examples of women’s powerlessness and empowerment. Even when women appeared to have limited power or control, they sometimes managed to assert themselves. Conclusions: Power in relation to contraceptive choice is multi-faceted and multi-directional, operating at both individual and structural levels. Informed decision-making depends on the provision of clear, non-judgemental information and advice alongside easy access to contraceptive options. Additional strategies to empower women to make contraceptive choices and prevent unplanned pregnancies are recommended.

Original languageEnglish
Pages (from-to)655-666
Number of pages12
JournalDrugs: Education, Prevention and Policy
Issue number6
Early online date26 Jul 2021
Publication statusPublished - 31 Dec 2022

Bibliographical note

Funding Information:
This study was funded by a Medical Research Council Public Health Intervention Development (PHIND) award: grant number [MR/N011147/1] J.N. is part-funded by the NIHR (National Institute for Health Research) Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, UK. The views expressed are those of the authors and not necessarily those of the MRC, the NIHR, the NHS, or the Department of Health. The authors would like to thank all women who participated in the study, staff from all services who supported the recruitment of women to the study, members of our patient and clinical advisory groups who gave invaluable advice throughout, and two anonymous reviewers who provided helpful feedback on an earlier version of the manuscript.

Funding Information:
In the last three years, J.N. has received, through her university, research funding from Mundipharma Research Ltd and Camurus AB (for unrelated research) and an honorarium from Indivior (for an unrelated conference presentation). J.S. holds a clinical post with Turning Point which supported recruitment for this study, but she does not work in any of the services involved in the research. H.W., N.A., A.C. and H.F. have no interests to declare.

Publisher Copyright:
© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.


  • contraception
  • opioid replacement therapy
  • Opioids
  • power
  • pregnancy
  • qualitative research
  • women

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Health(social science)


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