Pressure and Pain: A Qualitative Pilot Study Describing the Complexity of Unhoused Women’s Experiences with Reproductive Care

Abstract

Introduction: While there is extant literature surrounding barriers to reproductive care in the unhoused population—especially regarding access to contraception—little attention has been given to patient perspectives and the quality of care that is received. The unhoused population, which is disproportionately persons of color and low income, has a higher prevalence of psychiatric and physical disabilities. This is a population that has historically been a victim of eugenics and coercive practice. Study Objective: The purpose of the study is to qualitatively understand the experiences of currently unhoused women with pregnancy, birth control, and sterilization, as well as analyze their perspectives in their clinical encounters over their lifetime. Materials and Methods: Participants (n = 10) were recruited from two shelters in a midwestern city. The sample consisted of those assigned female at birth, are currently experiencing homelessness, and have experience with obstetrical and gynecological health care. A semistructured interview was conducted with each participant utilizing a question bank. Audio was recorded, transcribed, and coded for themes. Results: The main themes coded from the interviews were negative birthing and/or sterilization experience, lack of shared decision-making for birth control and/or sterilization, pressure to undergo sterilization and/or go on birth control, the desire for a nonjudgmental provider, and sexual violence experience. Conclusions/Implications: Our data indicate that women experiencing homelessness (WEH) may prefer contraceptive conversations that are trauma-informed and rooted in a shared decision-making model, which in turn may help WEH develop more agency around their reproductive health care. This pilot study also emphasizes the need for more qualitative research to evaluate experiences directly in the population of interest.