Women and substance use: a qualitative study on sexual and reproductive health of women who use drugs in Delhi, India

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Objectives
To explore contextual factors that increase vulnerabilities to negative sexual and reproductive health (SRH) outcomes and possible differences in SRH-related behaviours and the needs of women who use drugs (WUD) through non-injecting and injecting routes.
Design
Qualitative study design using semi-structured in-depth interviews.
Participants
Twenty women who injected drugs in the past 3 months and 28 women who reported using drugs through non-injecting routes in the past 1 month.
Setting
Interviews were conducted at community-based, drop-in centres in Delhi, India.
Results
Study findings illustrate that WUD were sexually active and had multiple sex partners including clients of sex work. Transient relationships were reported and many participants engaged in unsafe sex. Factors which affected safe sex behaviours included: gender power imbalance, limited agency for decision-making, lack of accurate information for correct self-risk assessment, and being under the influence of drugs. Despite high awareness, low and inconsistent contraceptive use was reported. Some participants were coerced to conceive while a few others reported their inability to conceive. Violence was a key determinant for SRH outcomes. Perception of certain adverse health outcomes (such as infertility) to be ‘common and expected among WUD’ influenced access to healthcare. Further, healthcare providers’ stigmatising attitudes and lack of women-centric services deterred women from uptake of healthcare services.
Conclusion
Findings highlight that SRH-related behaviours and needs of this group are a complex interplay of multiple determinants which need to be addressed at all levels: individual, family, community and institutional. It is imperative to roll out a ‘one-stop-shop’ for a comprehensive package of health services. Expansion of existing drop-in-centres could be considered for setting-up community-based women-centric services with appropriate linkage to drug dependence treatment and reproductive health services.
Keywords: qualitative research, public health

Authors & affiliation: 
Vartika Sharma,1 Avina Sarna,2 Waimar Tun,3 Lopamudra Ray Saraswati,2 Ibou Thior,4 Ira Madan,5 and Stanley Luchters1,6,7 1International Centre for Reproductive Health, Ghent University, Belgium (former Population Council), Ghent, Oost-Vlaanderen, Belgium 2Population Council, New Delhi, India 3Population Council, Washington, DC, USA 4PATH, Washington, DC, USA 5Sahara Centre for Residential Care and Rehabilitation, New Delhi, India 6Burnet Institute, Melbourne, Victoria, Australia 7School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Published In: 
Sharma V, et al . BMJ Open 2017; 7 :e018530. doi:10.1136/bmjopen-2017-018530
Publication date: 
Wednesday, September 27, 2017