Reproductive Health in the Unhoused Community
For most people, if they got a bad infection or broke a bone, they would seek out medical care immediately. For unhoused populations, putting off the pain or thinking about whether seeking medical care is worth it comes first. Unhoused people experience a multitude of challenges that housed individuals do not even think about. For homeless women, receiving appropriate medical care for their reproductive needs can be a major obstacle. Around 73% of unhoused individuals report an unmet medical need. For women, having access to contraception, birth control, and abortion are extremely important in order to take steps in controlling one’s health and promoting wellbeing. A woman should never be forced to bear children if she does not want to. Having accessible reproductive health resources is necessary in allowing for women to make decisions about their health and take care of themselves. Providing reproductive health services to unhoused people can positively contribute to their health and create a pathway for them to have housing stability.
In today’s society especially, having access to safe, legal reproductive health care is important. Reproductive health not only affects those that can give birth, it affects all of society as giving birth to children that will not have enough food or fall into the foster care system becomes a larger issue. (Answer why reproductive health care matters) Unhoused people are already at a disadvantage. Not providing accessible and comprehensive reproductive health care is an issue that affects society, especially unhoused individuals. Different measures like family planning programs and raising awareness are helpful in alleviating the issue, but they provide short-term solutions that do not fully address the reproductive care that people are seeking. Shifting the type of care that unhoused people receive in hospital settings and creating a judgment free place for medical care will create more opportunities for unhoused people to have the care they deserve, ultimately being more effective in providing care that is accessible, comprehensive, and also supportive.
Unhoused people are extremely underserved in health care. 57% of unhoused people do not have a regular source of medical care. An overwhelming 73% of unhoused have an unmet medical need. Unhoused people often use the emergency department as a primary source of health care, which can impact their overall health as they are not granted as much specialized attention. Women and families are the fastest growing group of unhoused individuals meaning that greater attention should be directed towards their health needs.
Reproductive health care that is accessible and comprehensive for unhoused individuals is a significant problem that needs to be addressed to ensure proper wellbeing for all. Unhoused people face a higher likelihood of experiencing complications during abortions and are more likely to face health care related trauma. Unhoused individuals report for abortion later than housed individuals with housed reporting at 9.5 weeks while unhoused at 13 weeks. Having an abortion later on in pregnancy is more expensive, requires longer treatment, and performed by a smaller amount of physicians (Kaiser Family Foundation). Unhoused people are also subject to having long observation periods after an abortion causing them to be in a hospital longer than they actually have to. The increased likelihood of complications during abortions for unhoused individuals than housed is an important factor of why reproductive health care services need to change to treating everyone the same way and creating an accepting space. The different treatment for unhoused people when seeking abortions is a problem that affects an individual’s wellbeing and likelihood to seek medical care again. Higher rates of unhoused experienced uterine atony (soft weak uterus) or postabortion hemorrhage. It is more difficult to develop treatment plans for unhoused people where it is harder to keep a supply of medication or certain medications will make them drowsy causing them to be less alert, which is necessary for living on the streets (Institute of Medicine Committee on Health Care for Homeless People).
Seeking abortion care for unhoused individuals is difficult despite a large need for the reproductive care. In unhoused women, around one fifth are pregnant. Unhoused women have twice national rate of unplanned pregnancy. 41% of women who have sexual intercourse at least once per week do not use contraceptives. Only half of women wanting birth control services successfully access them. 53% of homeless mothers do not have a high school diploma. The contraceptives given to unhoused individuals have high user based fail rates. The ineffectiveness of treatment from health care providers indicates the disregard and ignorance the system has for unhoused people.
Many women reported not using contraception for fear of side effects, potential health risks, partner dislike, and cost. 95% of unhoused women are sexually active. However, 65% of women sexually active do not use birth control. Less than 2% unhoused women use condoms. Hispanic women are more likely than white women to not know how to use contraception or know which method to use while Black women are more likely to not know which method to use. Condoms especially are a beneficial contraceptive method as it helps prevent transmission of STIs. Among unhoused people, HIV infections are 3–9 times more prevalent. Using protection is extremely important. Around 50% of unhoused youth engage in survival sex, sex in exchange for drugs, money, goods, shelter, and/or food. More than 20% of women have not gotten a pap smear regularly, only 9% in general population have not.
The unhoused population faces many barriers to receiving accessible and comprehensive health care. The high cost of health care is a large factor that prevents unhoused people from seeking care with one study reporting 38% of unhoused people finding high cost a significant barrier. A large majority, approximately 70% of the unhoused, do not have health insurance (National Coalition for the Homeless). Many of the unhoused do not know where to seek medical care, causing problems for when health issues arise. There is often a lack of transportation to medical services as many unhoused people do not own cars or have the money to pay for public transit. Unhoused individuals with children also find it difficult to visit hospitals because there is no one to take care of their children if they leave.
When it comes to accessing reproductive health care, there are additional challenges in the health care setting that unhoused people face. Embarrassment from health care providers, a lack of privacy about personal life, competing personal demands, and assumptions all plague the reproductive health experience for unhoused individuals. Unhoused people are three to four times more likely to die than the rest of the population and have a significantly lower life expectancy (National Coalition for the Homeless). These barriers and poor health outcomes for unhoused people are extremely alarming. More initiatives and procedures need to be put in place for the unhoused community.
To create reproductive health services that are more accessible and comprehensive, there have been preventative measures such as family planning programs and raising awareness in the unhoused community. These solutions help people become more aware of the sexual activity they are engaging in and prevent them from having unprotected sex, but do not address the need for people seeking services like birth control or abortion. Shelters provide easier access to medical care for unhoused people, however they have limitations and cannot be solely relied on to alleviate health care barriers. Shelters have limited hours and provide limited medical services forcing those needing abortions or Pap smears to seek services elsewhere. Shelter staff are mostly volunteers. Shelters also do not have a regular source of funding and often rely on cash donations as well as supplies from pharmaceutical companies (Institute of Medicine Committee on Health Care for Homeless People).
Nevertheless, providing medical care that is accepting of unhoused people’s situations and creating judgment free spaces in health care is more effective as unhoused people will feel more welcomed and empowered to take care of their health. Shifting the mindsets of health care providers is more effective in providing care that is accessible, comprehensive, and supportive. Modified residency and medical student curricula to increase awareness of health care issues of homeless individuals and promote involvement in direct care.
To ensure that unhoused populations are receiving supportive medical care, health care systems need to invest in communicating clearly with unhoused patients (Institute of Medicine Committee on Health Care for Homeless People). Creating plans for appointments and treatments should detail transportation means and address other barriers to getting medical care. Outreach programs and mobile clinics connected to a hospital provide improved care as the health care professionals that help in these places are often treating the same patients. The continued care by people that patients are familiar with increases cooperation and care (Institute of Medicine Committee on Health Care for Homeless People).
Reproductive health does not only affect those who are able to have children. Allowing all populations accessible health care that is affordable and supportive for each individual is important because a healthy person can contribute more from society and be less likely to run into health or financial issues again. Forcing women to have children without being able to provide them resources to eat or live in only continues to damage society and create more problems that are not being readily addressed currently. Reproductive health affects all individuals but is largely controversial and being controlled by policy makers with no experience on the issue. Adequate solutions surrounding reproductive health must be made in order to help unhoused people and create a society that values all individuals.
