RE: Expanding Contraceptive Access for Women With Substance Use Disorders: Partnerships Between Public Health Departments and County Jails.
RE: Expanding Contraceptive Access for Women With Substance Use Disorders: Partnerships Between Public Health Departments and County Jails.
复制标题
回复：扩大患有药物使用障碍的妇女获得避孕药具的机会：公共卫生部门和县监狱之间的伙伴关系。
DOI：
10.1097/phh.0000000000001078
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发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Roberts,Sarah
中科院分区：
文献类型：
--
作者：
Sufrin,Carolyn;Terplan,Mishka;Scott,Cherisse;Roberts,Sarah
“扩大患有药物滥用障碍的妇女获得避孕药具的机会：公共卫生部门与县监狱之间的合作。” 1 虽然标题暗示了一个重要目标——为访问受限的人群提供计划生育服务，但该计划的目标是减少新生儿禁欲综合症 (NAS)，并且不提供全套可逆节育方法的做法引起了人们对道德、公平和公正的医疗保健和公共卫生实践的严重担忧。 2 作者描述了州卫生部门的一项计划，该计划向田纳西州 15 个农村监狱中被监禁的妇女提供计划生育教育和有限的临床服务，并附有有关 NAS 的信息。作者不仅提倡这种干预措施增加避孕的机会，而且还认为它可以减轻阿片类药物使用障碍 (OUD) 患者所生婴儿给国家带来的经济负担。这个前提是有很大问题的。首先，这个前提贬低了 OUD 患者的繁殖，并传达了这样的信息：他们不应该生孩子，这与抑制“不良”社会群体繁殖的优生运动的历史连续性相一致。 3 将避孕与 NAS 教育联系起来传达了这样的信息：有些人不应该生育。如果患有 OUD 的人希望怀孕，即使是巧妙地劝阻，也不应该劝阻，尤其是国家机构，因为他们可能会从那里获得未来的护理。所有这一切都是在一个已颁布立法将怀孕期间吸毒定为刑事犯罪的州发生的。 4
“Expanding Contraceptive Access for Women With Substance Use Disorders: Partnerships Between Public Health Departments and County Jails.” 1 While the title suggests an important goal—improving family planning service availability for a group of people with constrained access—the program’s goal to reduce neonatal abstinence syndrome (NAS) and practice of not offering the full range of reversible birth control methods raises serious concerns for ethical, equitable, and just health care and public health practice. 2 The authors describe a state health department program providing family planning education and limited clinical services, accompanied by information about NAS, to women incarcerated in 15 rural Tennessee jails. The authors not only promote this intervention as increasing access to contraception but also justify it as reducing the financial burden to the state from babies born to people with opioid use disorder (OUD). This premise is deeply problematic. First, the premise devalues the reproduction of people with OUD and sends the message that they should not be having babies, in historical continuity with eugenics campaigns that suppressed the reproduction of “undesirable” social groups. 3 Linking contraception and NAS education sends the message that some people should not reproduce. If people with OUD desire pregnancy, this should not be discouraged, even subtly, and particularly by a state agency from which they may obtain future care. All this in a state that has enacted legislation to criminalize drug use in pregnancy. 4