Access experiences and attitudes toward abortion among youth experiencing homelessness in the United States: A systematic review

Abstract

Objectives We sought to review the literature on the access experiences and attitudes toward abortion among youth experiencing homelessness in the United States. Methods We conducted a systematic review of peer‐reviewed literature published from 2001 to 2019. We included qualitative studies involving US participants that focused on access experiences, views, or accounts of unintended pregnancy and/or abortion among youth experiencing homelessness. We excluded studies published before 2001 as that was the year mifepristone medication abortion was made available in the US and we aimed to investigate experiences of access to both medical and surgical abortion options. Results Our thematic analysis of the data resulted in five key themes that characterize the abortion attitudes and access experiences of youth experiencing homelessness: (1) engaging in survival sex and forced sex, (2) balancing relationships and autonomy, (3) availability does not equal access, (4) attempting self-induced abortions using harmful methods, and (5) feeling resilient despite traumatic unplanned pregnancy experiences. Conclusions Youth experiencing homelessness experience barriers to abortion access across the US, including in states with a supportive policy context and publicly funded abortion services. In the absence of accessible services, youth may consider harmful methods of self-induced abortion. Improved services should be designed to offer low-barrier abortion care with the qualities that youth identified as important to them, including privacy and autonomy.

A scoping review of surgical care for people experiencing homelessness: prevalence, access, and disparities

“…Many studies discussed barriers or challenges PEH face when it comes to surgical care, including 48 primary studies, 19 , 31 , 34 – 36 , 39 – 41 , 43 – 45 , 47 – 50 , 54 , 55 , 57 – 64 , 66 , 69 , 72 , 73 , 75 , 79 – 81 , 86 , 91 , 96 , 98 , 100 , 102 – 105 , 107 – 109 , 111 , 112 , 114 , 116 9 abstracts, 37 , 38 , 42 , 52 , 77 , 84 , 101 , 106 , 118 5 literature reviews, 22 , 74 , 95 , 99 , 110 1 invited article, 51 1 magazine article, 70 1 thought piece, 92 1 ethical essay, 115 1 thesis, 71 and 1 historical analysis. 117 The majority of comments presented concerns regarding living conditions.…”

“… 19 , 69 Studies commented on how PEH can have difficulty accessing medical care, resulting in fragmented or atypical health care utilization. 22 , 43 , 49 , 51 , 59 , 73 , 74 , 84 , 100 , 108 – 110 Specifically, 11 studies commented on challenges for PEH accessing specialty care. 36 , 41 , 43 , 60 , 75 , 92 , 99 , 100 , 103 , 111 , 112 Four studies mentioned their overreliance on visits to the emergency department.…”

Pregnancy and parenting support for youth experiencing homelessness

“…These findings highlight the importance of increasing knowledge about the benefits of pregnancy planning and the need for access to effective reproductive services, including pregnancy prevention. Previous research revealed several barriers to pregnancy prevention services among homeless women, including fear of judgement from their family and partners about abortion or contraceptive use (Begun et al., 2020; Munro et al., 2021). There is a need to create awareness and clarify misconceptions about pregnancy prevention services among families and partners to build a nonjudgmental and supportive network for women.…”

“…In a qualitative study (Begun et al., 2020), young discussed keeping unwanted pregnancies for fear of negative reactions from family and disapproval from male partners toward abortion. Youth perceived that they could not make autonomous decisions about abortion as they were influenced by economic hardships, poor social support, and limited knowledge about accessing abortion services (Begun et al., 2020; Munro et al., 2021).…”

Reproductive justice for unhoused women: An integrative review of the literature

“…Recent reviews examining the reproductive experiences of unhoused women have focused on American youth's attitudes and experiences accessing abortion (Munro et al, 2021) and factors impacting the use of prenatal care among unhoused women in the United States and Europe (McGeough et al, 2020). Guided by the reproductive justice framework, this review is the first to examine barriers to reproductive choice through the inclusion of barriers to contraception, abortion, and prenatal care.…”