Reproductive Autonomy and Postpartum Contraceptive Care for Individuals With Substance Use Disorder: A Scoping Review.

BACKGROUND: The postpartum period-when supports often wane and stressors intensify-is a time of heightened risk for individuals with substance use disorder (SUD), including a markedly elevated likelihood of overdose. In this context, contraception is considered vital to supporting recovery, stability, and reproductive health and autonomy. However, individuals with SUD encounter persistent barriers to postpartum contraceptive care, resulting in lower rates of usage and higher unintended pregnancy rates than those without SUD. PURPOSE: This scoping review maps impediments to postpartum contraception for individuals with SUD, identifies potential avenues for clinical and community-based practice improvements, and highlights literature gaps to inform future research. METHODS: We conducted a search of seven databases for studies that examined access to postpartum contraception for individuals with SUD as a core research aim. Eligible articles were peer reviewed and based in the United States. Each of the databases were searched independently on July 15, 16, 18, and 22, 2024. An updated search was conducted on May 17, 2025. RESULTS: Twenty studies ultimately met the criteria for inclusion and were analyzed using a qualitative descriptive methodology. Common barriers included limited availability of immediate postpartum contraception, low postpartum visit attendance, care discontinuity, stigma, coercion, criminalization, and broader structural hindrances. Author-identified suggestions included co-locating contraceptive and SUD services, strengthening provider training in patient-centered care modalities, implementing prenatal contraceptive planning, and expanding immediate postpartum contraception availability. CONCLUSIONS: Few studies assessed patient autonomy or satisfaction with postpartum contraceptive care, underscoring the necessity for research that goes beyond measuring uptake rates to define intervention success. Qualitative inquiry is particularly warranted. Additionally, other avenues of co-location and service integration should be explored in greater depth.