A look at access to contraception for the homeless

Among populations of women who are of reproductive age, those that are homeless often do not want to get pregnant, and yet are often challenged by not having ready access to contraception. In a multi-methods qualitative study, investigators interviewed women experiencing homelessness, along with health care workers and social service providers to identify preferences for contraception and barriers to attaining pregnancy prevention.

Researchers recruited participants from December 2019 to November 2020 from housing, medical, and community based organizations in North Texas. Nineteen pregnancy-capable women aged 18 years to 44 years in different stages of homelessness (shelter, emergency shelter, rapid-rehousing, and transitional housing) were enrolled in the study.

A survey was used to gather participant socio-demographic information, pregnancy intention, and pregnancy history. Interviews included questions about perceived needs for contraception and barriers to this access. To make sure they were aware of all forms of contraception, participants reviewed a Contraception Effectiveness Chart.

Social service and health care providers were also interviewed, to better understand both facilitators for contraceptive use, as well as barriers, from these perspectives.

The analysis team included a principal investigator, co-investigator, project staff, public health students, and a medical student. The primary preference for birth control of women currently homeless was long-acting reversible contraception, but women noted the difficulties in attaining contraception of any kind, suggesting that contraception be more available in churches, bathrooms, hospitals, schools, food banks, and even street outreach. Additionally, some women said there was also a need for educational pamphlets on sexually transmitted diseases, contraception, and pregnancy.

Investigators noted, “Findings from this study underscore systemic barriers in meeting the reproductive needs of women experiencing homelessness… healthcare providers we interviewed often did not provide contraceptive counseling unless patients initiated the conversation.” Additionally, noted the authors, “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.”

Although this was a small study, it cast a spotlight on the need for more contraception access and additional education regarding pregnancy and sexually transmitted diseases to this population. Perhaps in the near future, larger studies of this type will confirm current findings and encourage more funding for these needed resources.

Reference

Thompson EL, Galvin AM, Garg A, et al. A socioecological perspective to contraceptive access for women experiencing homelessness in the United States. Contraception. 2023;109991. doi:10.1016/j.contraception.2023.109991