(PS13-A1) Correlates of Unmet Need for Modern Contraception Among Reproductive-aged Women Who Use Drugs Involved in New York City Criminal Legal Systems

Background: The population of women involved in criminal legal systems (WICL), a majority of whom are reproductive-aged, has risen steadily in the U.S.  These women face high rates of unintended pregnancy and unmet need for contraception: they are fecund, sexually active, not wanting any more children or wanting to delay the next child, but not using any form of contraception. Most of the research on sexual behavior among WICL has focused on condom use in the context of HIV prevention. The smaller body of research that has focused on unmet need for contraception in the U.S. has revealed important demographic and socioeconomic factors associated with unmet need but has been less consistent on the effects of interpersonal-level predictors such as intimate partner violence and individual-level predictors such as substance use and mental health diagnoses.

Methods: Given the limited data on unmet need for contraception in the U.S. and the mixed findings related to interpersonal- and individual-level predictors, we explored the effects of intimate partner violence, substance use, and lifetime psychiatric diagnoses, adjusting for significant demographic and socioeconomic factors, on women’s unmet need for modern contraception. Our sample consisted of 132 non-pregnancy-seeking reproductive aged WICL enrolled in the baseline assessment of the HIV prevention intervention, “Women on the Road to Health” (WORTH).  We conducted a multivariate generalized linear logistic regression model with robust estimation predicting unmet need for contraception and then determined bivariate associations between variables significantly predicting unmet need with instances of condomless sex and other contraceptive use.

Results: Women who were younger in age, without a regular gynecologist, reporting lifetime diagnoses of anxiety disorders were more likely to have unmet need for contraception. Specifically, women younger in age had greater instances of condomless sex and were less likely to use other forms of contraception. Women without a regular gynecologist had greater instances of condomless sex. Women reporting lifetime diagnoses of bipolar disorder and endorsing sexual IPV were less likely to have unmet need for modern contraception. Specifically, women with bipolar disorder were more likely to use other forms of contraception than condoms.

Conclusions: There is a dearth of research on unmet need for contraception in the U.S., and this study provides important preliminary data on a vulnerable population of women facing multiple barriers to sexual and reproductive health care.  These findings underscore the multiple ways that individual- and interpersonal- level factors may influence contraceptive use and provide important takeaways for health providers who work with WICL.