We explored contraceptive use among 45 women who inject drugs in coastal Kenya. Overall, 29% were using contraceptives, motivated by a fear of unplanned pregnancy, a desire to shield children from the difficulties of drug use, the need to prevent HIV and other sexually transmitted infections, encouragement from health providers and outreach workers, or because they had achieved the desired number of children. However, 69% were not using contraceptives. Barriers to use included current pregnancy intentions, perceived infertility due to drug-induced amenorrhea, side effects, intimate partners’ influence, lack of information, complex health care appointments, and transportation costs. Rights-based integration of sexual and reproductive health into harm reduction services for women who inject drugs is required to minimize unmet contraception needs.