Information, Motivation, and Behavioral Skills for Contraception Use among Women Experiencing Homelessness

Purpose: Women experiencing homelessness have been reported to have higher rates of sexually transmitted infections, lower rates of contraceptive use, and higher rates of unintended pregnancies than stably housed women. Higher unintended pregnancy and lower contraceptive use in women experiencing homelessness warrant more research on behavioral cognitions for contraception access and utilization in this population. Assessing cognitions that affect contraception behaviors can be guided by utilizing a health behavior theory, such as the Information-Motivation-Behavioral (IMB) Skills model. Therefore, this study explored the IMB characteristics that play an important role in an individual's health behavior and could affect the contraception preferences among women experiencing homelessness. Methods: Semi-structured interviews (n=19) were conducted among women 18-45 years of age, not sterilized, English-speaking, and were currently experiencing homelessness. Women were recruited between December 2019 to March 2020 by convenience sampling through partnerships with local community organizations in Tarrant County. In-person or telephone interviews were conducted. Interviews were audio-recorded, transcribed, coded, and thematically analyzed based on the IMB framework. This study was approved by the North Texas Regional Institutional Review Board. Results: The mean age of women in the study sample was 33.4 years (SD = 7.6) and living situations included emergency shelters (37%), unsheltered locations (32%), transitional housing (26%), and rapid re-housing (5%). In the information construct, most women were aware of different contraceptive methods including intrauterine devices, implants, Depo shots, birth control pills, and condoms; however, many desired to learn more about the side effects of various methods. Additionally, some women had misconceptions regarding the possible side effects of different contraceptive methods. For motivation, most women (n=16) had negative attitudes regarding becoming pregnant at that time. Various reasons for not desiring to become pregnant included age, new responsibilities, presence of other children, finances, health concerns, negative beliefs about abortion, or risks involved with having a baby while being homeless. Additionally, most women had a positive attitude towards their current method of contraception, but their motivation to use a type of contraceptive method depended on side effects and comfort with the method. When examining behavioral skills, benefits and barriers to accessing contraception were inquired. Several women mentioned the better health insurance coverage for birth control would benefit them. Lack of adequate insurance coverage and transportation were the major barriers. Other barriers included financial constraints, not enough knowledge regarding how to use birth control, and not enough information knowing how to get an appointment or start the process of getting birth control. Conclusions: Findings highlight the information, motivation, and behavioral skills for contraception use among women experiencing homelessness. Improving knowledge about side effects of various contraceptive methods, addressing any misconceptions, and increasing accessibility to contraceptive methods by providing transportation and financial assistance while maintaining reproductive autonomy might be effective strategies to improve contraception uptake and reduce unintended pregnancies among women experiencing homelessness.