Abstract
Objective
Although persons who are pregnancy-capable and experiencing homelessness may have
a strong desire to avoid pregnancy, they face unique barriers to contraception. This
multimethod qualitative study aimed to identify preferences for, barriers to, and
facilitators of contraceptive access and use among women experiencing homelessness
in the United States using a systems perspective.
Study design
We conducted semistructured interviews with women experiencing homelessness (n = 19),
healthcare providers (n = 6), and social service providers (n = 6). We recruited participants
from community-based, housing, and medical organizations in North Texas in the United
States. Two coders conducted thematic analysis and reached consensus for codes.
Results
Women participants were in emergency shelter, unsheltered, or transitional/rapid rehousing.
We stratified themes using the Socioecological Framework to illustrate factors affecting
contraception access at individual, interpersonal, organizational and community, and
societal levels. Notable results include women’s preferences for long-acting reversible
contraception, difficulties healthcare providers face in initiating contraceptive
counseling, and the underutilized role of social service providers in reproductive
healthcare. Insurance policies, connections between health clinics and community organizations,
and organizational priorities both facilitated and hindered women experiencing homelessness’s
access to women’s healthcare services.
Conclusion
This study identified opportunities throughout the healthcare and social service systems
to support contraceptive access for women experiencing homelessness. Future interventions
should strengthen and leverage these connections to promote access among this vulnerable
population with the goal of supporting reproductive autonomy.
Implications
This study explored the reproductive health needs of women experiencing homelessness.
Multilevel interventions, such as interdisciplinary care, patient-centered approaches,
and an emphasis on health literacy, are needed to adequately provide the preferred
methods of contraception for women experiencing homelessness, thus enabling reproductive
autonomy for this population.
Keywords
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Article info
Publication history
Published online: February 23, 2023
Accepted:
February 16,
2023
Received in revised form:
February 14,
2023
Received:
February 25,
2022
Publication stage
In Press Corrected ProofFootnotes
☆Conflicts of interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article.
☆☆Funding: This work was supported by the National Institute on Minority Health and Health Disparities funded Texas Center for Health Disparities (5U54MD006882-10).
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
