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


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

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Health(social science)


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