“Having a Baby Can Wait”: Experiences of a Sexual and Reproductive Health Promotion Program in the Context of Homelessness among Asian American, Native Hawaiian, and Other Pacific Islander Youth Captured Through PhotoVoice

Abstract

Nearly half of female youth experiencing homelessness (YEH) become pregnant due to myriad individual, family, community, and structural factors. In response, our team developed and tested Wahine (“woman”) Talk, a multilevel, trauma-informed sexual and reproductive health intervention created with and for female YEH aged 14 to 22. After Wahine Talk, youth were invited to participate in a participatory action PhotoVoice project regarding experiences of the program, waiting to start or expand their families, and homelessness. Photographs were taken and captioned by youth, and then further examined through Thematic Analysis. Final project themes include (a) Youth-Driven Birth Timing Decisions; (b) A Sense of Place: Finding Safe Spaces; and (c) Glimpsing Hope. Because YEH live under society’s radar, it is critical to understand their experiences from their own perspectives to improve interventions at multiple levels. Implications for meeting the needs of YEH in the areas of reproductive justice, financial stability, and affordable housing are discussed.

Counter-Narratives of Structural Oppressions, Stigma and Resistance, and Reproductive and Sexual Health Among Youth Experiencing Homelessness

“…Though it is of great importance to amplify the voices and resistance of YEH in all dimensions of research, service provision transformation, and policy change, the onus for dismantling structural inequity does not lie solely within YEH; social workers, frontline service-workers, advocates, community members, and policy decision-makers alike must step up as part of the process of influencing change and disrupting the root causes of these oppressions and stigmas that so disproportionately harm young people. As such, we join with Aparicio et al (2021), in calling for structural interventions to address the financial instability and lack of affordable housing which prevent youth from maintaining housing, beginning with a universal basic income program, and a Housing First approach which prioritizes stable housing for all as the first necessary step toward ending homelessness.…”

“…YEH, consequently, show higher rates of sexually transmitted infections (STIs), including HIV, compared to housed youth (Beech et al, 2003). Recent participatory research with female YEH highlights the importance youth place on being able to make their own decisions about their bodies, and the necessity of using a reproductive justice approach in sexual health interventions for YEH (Aparicio et al, 2021).…”

What about Using Photovoice for Health and Safety?

“…A wide variety of photovoice application design examples is found in public health improvement activities [6,7,15,16,19,20,53,75,83,[109][110][111][112]. Other health promotion examples deal with, e.g., accurate representation of a group viewpoint [113], improving family relations and stimulation of healthier behaviour [114], teaching at school [94,115,116], train the trainers to be facilitators rather than experts [111], exploring homelessness [117], the situation of refugees [118], sex and drugs related behaviour [119,120], assessing needs of marginal groups in society [110,121], better understanding of a group experiencing problems, e.g., in coping with a disease [112,122,123], with the troubles of adolescence [75,124], with access to local bus-stops [125] or with poor housing [126].…”

“…In such projects, neither empowerment nor social action steps are planned beforehand, since the study outcome cannot be sufficiently predicted. Examples of this are finding a cultural identity [20], obtaining insight in the lifeworld of a specific group [153][154][155][156][157][158][159] or gaining understanding about, e.g., health, food and sports, abuse or drugs related behaviour within a group [16,49,110,112,[117][118][119][120][121][160][161][162][163][164][165][166][167][168][169][170][171]. Health and safety risk assessment can be assisted by using this generic photovoice design for exploration, e.g., of a work environment such as in mining, construction, waste handling, etc., occupational hazards in a workplace, social factors, a neighbourhood, or challenges experienced by foreign workers [24,25,85,99,101,102].…”

Moving Beyond Text-and-Talk in Qualitative Health Research: Methodological Considerations of Using Multiple Media for Data Collection

“…The sustained growth and versatility of arts-based approaches to research and the ever-expanding prominence of qualitative methods makes this an exciting time to be a qualitative health researcher. Qualitative methods have a long-standing and well-established place in health research, and the expansion in the range of qualitative methods has seen increasing use of approaches to data collection which rely on more than just text-and-talk, including photovoice (Aparicio et al, 2020; Greene et al, 2018; Han & Oliffe, 2016; Hunt et al, 2018; Macdonald et al, 2019; Watchman et al, 2020), digital and other forms of storytelling (Bulk et al, 2020; de Jager et al, 2017; Douglas & Carless, 2018; Greene et al, 2018; Moreau et al, 2018; Tatano Beck, 2020), walking methodologies (Springgay & Truman, 2017), video methods (Baumann, Lhaki, & Burke, 2020; Hansen, 2018), theater methods (Bleuer et al, 2018; Erel et al, 2017; Parent et al, 2017; Torrissen & Stickley, 2018), and a range of other arts-based methods (Candy & Edmonds, 2017; Chamberlain et al, 2018; Coemans & Hannes, 2017; Hammond et al, 2018; Wolf, 2011). A recent review of arts-based methods with vulnerable populations (Coemans & Hannes, 2017) shows that researchers in this field are using an array of media across different arts modalities, although photographic-based methods dominate in the field, with theater-based methods a distant second.…”