Another frontier for harm reduction: Contraceptive needs of females who inject drugs in Estonia, a cross-sectional study

Background: Despite increasing contraceptive availability, unintended pregnancy remains a global problem. Developing strategies to reverse this trend and increasing occurrence of withdrawal syndrome among newborn children of females currently injecting drugs warrants special attention. The knowledge base on the uptake of effective contraception among females who inject drugs (FWID) is scant. We aimed to examine the prevalence of and factors associated with the use of non-condom contraceptives among sexually active FWID with the focus on effective contraception. Methods: In a series of cross-sectional studies (2007-2013), 265 current FWID were recruited through respondent-driven sampling (RDS), interviewed, and tested for HIV. RDS weights were used to estimate the prevalence of effective contraception (hormonal contraception, intrauterine device, sterilization) use in the last 6 months. Results: Of the sexually active women with main partners (n = 196) 4.8% (95% CI 2.3-9.7) were using effective contraception, 52.7% (95% CI 42.5-62.7) less-effective or no contraception. 42.5% (95% CI 32.7-52.9) relied on condoms for contraception. The odds for using effective contraception were higher among women with > 10 years of education (OR 7.29, 95% CI 1.4-38.8). None of the women lacking health insurance (n = 84) were using effective contraception. Conclusions: The very low coverage with effective contraception highlights the need to improve contraceptive services for FWID. Reproductive health service including contraception should be considered essential components of harm reduction and of comprehensive prevention and care for HIV among persons who use drugs.