Community-Driven Solutions for Improving Contraception Access for Women Experiencing Homelessness

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Objective: Women experiencing homelessness are a particularly vulnerable population for unintended pregnancy and sexually transmitted infections, which can then potentially perpetuate the cycle of poverty across the lifecourse. Although women experiencing homelessness may have a strong desire to avoid pregnancy, they face unique barriers to contraception. This study aimed to identify barriers to and facilitators of contraceptive access and use among women experiencing homelessness, and then use that information to identify potential solutions for the local community to address this need.

Methods: Semi-structured interviews were conducted with women experiencing homelessness (n=19), healthcare providers (n=6), and social service providers (n=6). Participants were recruited from community-based, housing, and medical organizations. The Information-Motivation-Behavioral Skills Model was used to structure contraceptive use and access questions. Two coders reached consensus for codes, and thematic analysis was conducted. Results were reviewed with community stakeholders who provided feedback through a 3-step process of prioritizing barriers, identifying solutions, and prioritizing solutions. 

Results: Women participants were in emergency shelter (n=7), unsheltered (n=6), or transitional/rapid-rehousing (n=6). Most women reported not wanting a pregnancy in the next year (n=9) or were unsure (n=6). Overall, women knew where to access contraception, but reported wanting contraception to be more accessible. Women primarily received reproductive health services from the county hospital system or emergency department. Providers identified the need for more connection between health and social services to best serve women experiencing homelessness. Providers stated that women often have pressing priorities compared to reproductive health, but it is still a needed service. Potential solutions included: same day long-acting reversible contraception, peer/health navigators, adjusted intake forms to include reproductive health, and increased linkages between social and health services. 

Conclusion: This study identified opportunities throughout the healthcare and social services 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.

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University of North Texas Health Science Center

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