Narratives of Reproductive Health Rights and Trauma Among Mothers Experiencing Homelessness

Introduction: Women who are experiencing homelessness are at an increased risk for a variety of reproductive health traumas including unplanned and unwanted pregnancy, miscarriage, and abortion. Still, the knowledge remains largely quantitative, and we know little about women’s firsthand experiences with these traumas. The purpose of this study was to capture the women’s narratives around sexuality, pregnancy, and birth in order to inform evidence-based prevention efforts that protect these women and their reproductive health rights.

Methods: Semi-structured interviews were conducted among 20 mothers (42.1% African American; Mean age=38.25, SD=9.38) living in transitional or emergency homeless shelters. Four researchers double-coded the interviews using grounded coding theory in Atlas.ti. The theme of reproductive health rights emerged and was represented by two subthemes: traumas experienced during pregnancy and loss of reproductive decision-making.

Results: Mothers in our sample disclosed traumatic pregnancy experiences such as late-term miscarriages, stillborn births, and being faced with life or death choices resulting in the death of the mother or the fetus. The mothers also disclosed situations across their lifespan where they lost control over their reproductive decision-making. Women were coerced or forced into getting abortions or manipulated into receiving tubal ligation. One woman was raped and impregnated by her father and then sought an abortion at the age of 16. Prenatal and postnatal health care was conspicuously absent from their pregnancy narratives and caesarean sections were common birth experiences. Frequently, the women were discharged to homeless environments post-birth. 

Conclusion: Results of this study provide critical information to prevention and intervention research. The themes suggest that female reproductive health care providers need to be better trained to identify housing insecurity as a risk factor for poor pregnancy outcomes. In addition, all service providers working with this population need to adopt trauma-informed models of care. Many of these women presented narratives of profound reproductive health trauma as though these events were common occurrences. As such, providers may need to work with the women to assess the trauma and receive the necessary mental and physical health care. Finally, all practitioners working with women in these vulnerable situations can empower these women to regain control over their reproductive health rights through education, self-confidence, and self-esteem building therapies.