| Description |
Background: Homeless women across the US have reduced access to contraception and reproductive healthcare. They are at especially high risk for sexual trauma, contracting HIV or other sexually transmitted infections, and suffering from mental and physical conditions and substance use disorders. The result of the challenges that accompany homelessness is a low prioritization of reproductive planning, putting homeless women at high risk for unintended pregnancy and poor pregnancy outcomes. Objectives: To evaluate the contraceptive needs and pregnancy desires in women experiencing housing instability or homelessness. Methods: A convenience sample of reproductive age women who utilized homeless support or healthcare services across a metropolitan area completed a self-administered survey collecting demographics, reproductive histories and contraceptive experiences. We completed descriptive analyses and a multivariate logistic regression model to explore variables associated with ideal contraceptive method use. Results: We surveyed 76 women with a median age of 29y (range 18-45). Of the total cohort, 56 (74%) had a previous livebirth, 23 (30%) were currently pregnant and 10 (14%) desired a pregnancy in the next year. Current contraceptive methods, among non-pregnant women included 18 (39%) using a Tier 1 method, 9 (20%) a Tier 2 method, and 10 (21) Tiers 3 or 4 methods and 16 (35%) using no method. Of those at risk for unintended pregnancy, 27 (58%) reported not using their ideal contraceptive method and method cost and inability to find a provider were reported as barriers. Women living in transitional housing (motels, doubling up, halfway house, etc.) were less likely to be using their ideal contraceptive method than those established in a shelter (aOR: 0.06, 95% CI: 0.00-0.92). Conclusions: Women living with housing insecurity are less visible in the homeless population than those established in shelters, yet at higher risk for an unintended pregnancy destabilizing a fragile housing situation. Missed opportunities exist for interventions to improve reproductive healthcare coordination, including comprehensive contraceptive care, within transitional housing and homeless outreach services. |
