Knowledge, attitudes, and beliefs about contraception and pregnancy among women experiencing homelessness: A theory-informed systematic review

Purpose: Women comprise 39% of people experiencing homelessness, and the number of individual women experiencing homelessness has increased by 3% since 2017. Women who are homeless experience unintended pregnancy at considerably higher rates compared to the general U.S. population. The purpose of the systematic review was to summarize pregnancy prevention and contraception knowledge, attitudes, and beliefs among women experiencing homelessness. Methods: Per protocol, qualitative and quantitative articles published before September 2019 were identified with PubMed, EBSCOHost, and Embase. Inclusion criteria were peer-reviewed articles; U.S.-based observational studies; measured knowledge, attitudes, and beliefs related to contraceptive use for avoiding pregnancy; and sampled women experiencing homelessness. Results were aggregated and thematically analyzed within the context of the Information-Motivation-Behavioral Skills model. Results: After an initial search result of 407 articles, 7 articles met inclusion criteria. Many women reported past use of contraception, but consistency, type, and preferences varied between studies. Despite most women understanding where to get contraception, many had misconceptions about how various contraception methods worked. Personal experience with contraception and dislike of side effects were salient personal motivational factors influencing contraceptive use, as well as the power and social dynamics in their relationship with their partners, peers, and health care providers. Numerous shelter-related and clinic-related contraception barriers were identified that uniquely affected this population. Conclusion: With this consolidated information provided by a systematic review, future interventions can promote theory-informed, non-coercive contraception decision-making with better access to preferred contraception methods for women experiencing homelessness.