“She Was There through the Whole Process”: Exploring How Homeless Youth and Youth at-Risk for Homelessness Access and Select Birth Control

Homeless youth are vulnerable to unintended pregnancies: nearly 50% get pregnant at least once during adolescence. Yet, little is known about homeless youths’ experiences of accessing and selecting birth control, which is critical to informing attuned unintended pregnancy prevention. The current study addresses this gap, guided by the primary research question: How do homeless youth and youth at risk of homelessness experience accessing and selecting birth control?

Twelve girls aged 14-19 (M=16.5) years participated in two focus groups following a holistic sexual health program at a youth drop-in center. Data were naturalistically transcribed, then analyzed using Interpretive Phenomenological Analysis (IPA), a qualitative approach that focuses on the contextual interpretation and meaning of a particular phenomenon of interest (in this case, “accessing and selecting birth control”), often to a particular group of people (in this case, homeless female youth).

Analysis revealed four final themes that characterize how homeless youth experience accessing and selecting birth control: Getting Acclimated, Becoming Close and Building Trust, Addressing Fear, and Making the Choice. Homeless youth were first engaged through basic needs services and receiving a program incentive. Sustained engagement resulted from building trust with staff and other homeless youth. Participants were able to connect with their peers, feel heard, and escape their everyday reality. After building trust, youth began to explore accessing birth control, which was partly influenced by their fear of being sexually assaulted or trafficked. When deciding which birth control to select, youth emphasized the importance of how it would be delivered (e.g., by a large needle, through a “shot in the butt,” into the vagina). Youth ultimately committed to adopting a method of birth control in the context of the medical provider giving detailed information and unwavering support by program staff. When LARC (long acting reversible contraception) was selected, it was due to its low burden in comparison to other methods.

Findings suggest providers working with homeless youth need to consider basic needs first and build in time for development of trust before delivering birth control-related content and supporting youth to make the best birth control choice for themselves. The unique context within which homeless youth are making sexual health decisions needs to be considered. Future research is indicated to examine the process of accessing and selecting birth control with a larger sample and interventions to support homeless youth and healthcare providers in this process.