Women experiencing homelessness and their knowledge, attitudes, and beliefs about contraception and pregnancy: A systematic review

PURPOSE: Women who are homeless experience unintended pregnancy at considerably higher rates compared to the general U.S. population. This systematic review aims to summarize pregnancy prevention and contraception knowledge, attitudes, and beliefs among women experiencing homelessness to identify information, motivation, and behavioral skill barriers and facilitators to planned pregnancy and contraception use among this high-risk population. METHODS: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, this study examined qualitative, quantitative, and mixed-method articles published before September 2019, via PubMed, EBSCOHost, and Embase databases. Inclusion criteria were English, peer-reviewed, U.S.-based observational studies measuring knowledge, attitudes, and beliefs related to contraceptive use for avoiding pregnancy, specifically sampling women experiencing homelessness. Article quality was calculated, and results were thematically synthesized using the Information-Motivation-Behavioral Skills model. RESULTS: The initial search identified 407 articles, and seven met inclusion criteria. Many women reported past use of contraception, but consistency, type, and preferences varied. Many women also knew where to get contraception but had misconceptions about how various contraception methods worked. Salient motivational factors influencing contraceptive use included personal experience with contraception, dislike of side effects, and the power and social dynamics within partner, peer, and health care provider relationships. Numerous shelter-related and clinic-related contraception barriers were identified that uniquely affected this population. CONCLUSIONS: 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.