Original Research Article|Articles in Press, 109991

A socioecological perspective to contraceptive access for women experiencing homelessness in the United States



      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.


      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.


      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.


      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.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Contraception
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hwang S.W.
        • Tolomiczenko G.
        • Kouyoumdjian F.G.
        • Garner R.E.
        Interventions to improve the health of the homeless: a systematic review.
        Am J Prev Med. 2005; 29: 311-319
        • Dasari M.
        • Borrero S.
        • Akers A.Y.
        • Sucato G.S.
        • Dick R.
        • Hicks A.
        • et al.
        Barriers to long-acting reversible contraceptive uptake among homeless young women.
        J Pediatr Adolesc Gynecol. 2016; 29: 104-110
        • Gelberg L.
        • Leake B.
        • Lu M.C.
        • Andersen R.
        • Nyamathi A.M.
        • Morgenstern H.
        • et al.
        Chronically homeless women's perceived deterrents to contraception.
        Perspect Sexual Reprod Health. 2002; 34: 278-285
        • Ajayi K.V.
        • Panjwani S.
        • Wilson K.
        • Garney W.R.
        Using the Social-Ecological Model to understand the current perspective of contraceptive use in the United States: a narrative literature review.
        Women. 2021; 1: 212-222
      1. Tarrant County Homeless Coalition. State of the Homeless Report. Available from: 〈〉, 2018.

        • Guest G.
        • Bunce A.
        • Johnson L.
        How many interviews are enough?: an experiment with data saturation and variability.
        Field Methods. 2006; 18: 59-82
        • Kennedy S.
        • Grewal M.
        • Roberts E.M.
        • Steinauer J.
        • Dehlendorf C.
        A qualitative study of pregnancy intention and the use of contraception among homeless women with children.
        J Health Care Poor Underserved. 2014; 25: 757-770
      2. Power to Decide. Understanding Effectiveness Poster, 2017.

        • Corey E.
        • Frazin S.
        • Heywood S.
        • Haider S.
        Desire for and barriers to obtaining effective contraception among women experiencing homelessness.
        Contracept Reprod Med. 2020; 5: 12
        • Begun S.
        • Combs K.M.
        • Torrie M.M.
        • Bender K.
        "It seems kinda like a different language to us": homeless youths' attitudes and experiences pertaining to condoms and contraceptives.
        Soc Work Health Care. 2019; 58: 237-257
        • Azarmehr H.
        • Lowry K.
        • Sherman A.
        • Smith C.
        • Zuñiga J.A.
        Nursing practice strategies for prenatal care of homeless pregnant women.
        Nurs Womens Health. 2018; 22: 489-498
        • Hammock K.
        • Velasquez M.M.
        • Alwan H.
        • von Sternberg K.
        Alcohol screening, brief intervention, and referral to treatment (SBIRT) for girls and women.
        Alcohol Res Curr Rev. 2020; 40: 7
        • Beeson T.
        • Wood S.
        • Bruen B.
        • Goldberg D.G.
        • Mead H.
        • Rosenbaum S.
        Accessibility of long-acting reversible contraceptives (LARCs) in Federally Qualified Health Centers (FQHCs).
        Contraception. 2014; 89: 91-96
        • Zolna M.R.
        • Frost J.J.
        Frost Publicly funded family planning clinics in 2015: patterns and trends in service delivery practices and protocols.
        Guttmacher Institute, 2016
        • Goldberg D.
        • Sahgal B.
        • Beeson T.
        • Wood S.F.
        • Mead H.
        Patient perspectives on quality family planning services in underserved areas.
        Patient Exp J. 2017; 4: 54-65
        • Okoroh E.M.
        • Kane D.J.
        • Gee R.E.
        • Kieltyka L.
        • Frederiksen B.N.
        • Baca K.M.
        • et al.
        Policy change is not enough: engaging provider champions on immediate postpartum contraception.
        Am J Obstet Gynecol. 2018; 218 (e1-590.e7): 590