Opioid use disorder (OUD) impacts a growing number of reproductive age women in the United States.
Women with OUD have higher rates of undesired pregnancies and births than peers without OUD. For
pregnant women, contraceptive decision-making is an established part of prenatal care. For pregnant women
with OUD, contraceptive decision-making is uniquely complex, due to a confluence of multiple factors including
stigma and clinician implicit bias and patient experiences with OUD that impact perceptions of fertility and side
effects. Shared decision-making is an established approach to mitigate bias and support values concordant
decision-making for contraceptive choice in the general population, but no tailored contraceptive decision
support tools exist to meet the needs of pregnant women with OUD. Strategies to support pregnant with OUD
and their clinical providers in making values-concordant contraceptive choices are urgently needed.
In order to effectively meet both individual needs and public health aims, and advance the goal of high quality
contraceptive decision-making for pregnant women with OUD, three aims are planned: 1) Qualitative
interviews exploring patient and clinician experiences with stigma, coercion and ethical contraceptive
counseling, as well as feedback on sample existing contraceptive decision aids (CDC, Bedsider.org,
Contraceptive Access Project); 2) Iterative development of a tailored contraceptive decision aid for pregnant
women with OUD using an expert panel and modified Delphi process in conjunction with patient cognitive
interviews and feasibility surveys; 3) Pilot the modified contraceptive decision aid for women with OUD and
their providers in a patient-centered medical obstetric home for women with OUD, and assess patient-centered
outcomes including perceptions of autonomy support, shared decision-making and contraceptive knowledge.
My goal is to be a leader in the design, delivery and implementation of high quality reproductive health
decision-making and services for women with OUD. In pursuit of this goal, I have assembled a mentorship
team of senior researchers in relevant disciplines with strong track records of mentorship, collaborative
scholarship and clinical expertise. I have designed a complementary didactic and experiential learning plan to
provide me with needed skills and expertise in applied ethics, decision science, qualitative, survey and mixed
methods, patient centered decision support design and the intersection of addiction medicine and reproductive
health. The proposed career development award includes the necessary mentorship, training and resources to
become an independent investigator.