Alcohol and other drugs, sexual and reproductive health and right and pregnancy

Alcohol and other drug (AOD) use have many various effects on sexual and reproductive health which can sometimes be serious and cause severe consequences.

Problematic AOD use can decrease fertility indirectly by undermining both general health and nutrition of WUD, while heroin can affect fertility directly. The effects of heroin on menstruation and fertility are heightened by the associated chaotic lifestyle and poor nutrition. Drug use, and especially heroin use, can cause amenorrhea and an ovulation, but not necessarily at the same time. Many women and even some service providers mistakenly assume that conception cannot occur in the absence of menstruation; this is not true and leads to unexpected and, very often unwanted, pregnancies.

Methadone prescription to opiate users increases WUD’s fertility with the resumption of menstruation, but it is important to be aware that any treatment improving their general health and the adoption of correct nutritional habits will also increase fertility. This can happen before menstruation are resumed.

WUD who do not plan to become pregnant should therefore use effective contraception, since their bodies often do not follow the average menstrual cycle and experience irregular periods. It is practically impossible to determine when ovulation occurs and peak fertility days. It is extremely important that service providers are trained to offer appropriate information on fertility issues and effective contraception.

Contraception helps to ensure that WUD have planned pregnancies, i.e. that they get pregnant only if and when they choose to have a baby. Planned pregnancies improve the likelihood of good medical and social outcomes and optimize treatment efficacy, since during this very special period, WUD are motivated to stay in good health so that they can be good caregivers.

WUD may be concerned about infertility and seek advice to restore their menstrual periods. The stabilization of AOD use and lifestyle habits may be sufficient to restore them. It must be noted, though, that infertility treatment for WUD is often viewed as inappropriate by conservative and judgmental public health services, which believe. WUD should not have children and take on the related parental responsibilities. This is exactly where specific services targeted to WUD are needed, in order to help and support WUD to conceive and plan a pregnancy, by providing the opportunity to address AOD use and associated medical and social problems.

The alleged failure of WUD to appeal early for antenatal care is sometimes attributed to a lack of awareness about their pregnancy, since it is not infrequent that ovulation and fertility are restored even in the absence of menstruation. Free pregnancy testing available in HR gender-specific services increases early detection of pregnancy and brings important benefits:

• Earlier referral for termination if pregnancy is unwanted.
• Provision of effective contraception if WUD are not pregnant and do not want to conceive.
• Provision of pre-pregnancy care including prescription of folic acid if planning pregnancy.