Homeless Women: Who is Really at Risk for Unintended Pregnancy?


Objective To identify correlates of failure to use contraception among homeless women at risk for unintended pregnancy. Study Design A representative sample of 974 homeless women surveyed in Los Angeles County in 1997 included 457 who were at risk for unintended pregnancy. Logistic regression modeling was used to identify important predictors of contraceptive nonuse or rare use in the past year. Results One third of the sample used contraception rarely or never in the past year. Having a partner, being monogamous, and not engaging in sex trade predicted contraceptive nonuse or rare use (odds ratios 2.43–4.73, P < .05). Partner dislike and uncertainty about which contraceptive to use were also associated with failure to use contraception (odds ratios 2.64–2.96, P < .05). Having a regular source of care and having been encouraged to use contraception protected against failure to use contraception. Conclusions Homeless women, including those at apparently low risk for unintended pregnancy, need to be targeted with integrated services that include education, a regular source of medical care, and encouragement to use contraception.

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  1. 1.

    Herndon, B., Asch, S., & Kilbourne, A., et al. (2003). Prevalence and predictors of HIV testing among a probability sample of homeless women in Los Angeles County. Public Health Report, 118, 261–269.

    Google Scholar 

  2. 2.

    Bassuk, E., Weinreb, L., Buckner, J., Browne, A., Salomon, A., & Bassuk, S. (1996). The characteristics and needs of sheltered homeless and low-income housed mothers. JAMA, 276, 640–646.

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Bassuk, E., Browne, A., & Buckner, J. (1996). Single mothers and welfare. Scientific American, 275, 60–67.

    CAS  Google Scholar 

  4. 4.

    Robrecht, L., & Anderson, D. (1998). Interpersonal violence and the pregnant homeless woman. Journal of Obstetric, Gynecologic & Neonatal Nursing, 27, 684–691.

    Article  CAS  Google Scholar 

  5. 5.

    Gelberg, L., Leake, B., Lu, M., et al. (2001). Use of contraceptive methods among homeless women for protection against unwanted pregnancies and STD’s. Prior use and willingness to use in the future. Contraception, 63, 277–281.

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Finer, L. B., & Henshaw, S. K. (2006). Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspectives on Sexual and Reproductive Health, 38, 90–96.

    PubMed  Article  Google Scholar 

  7. 7.

    Henshaw, S. (1998). Unintended pregnancy in the United States. Family Planning Perspectives, 30, 24–29.

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Piccinino, L., & Mosher, W. (1998). Trends in contraceptive use in the United States: 1982–1995. Family Planning Perspectives, 30, 4–10, 46.

    Google Scholar 

  9. 9.

    North American Primary Care Research Group Committee on Building Research Capacity. (2002). What does it mean to build research capacity? Family Medicine, 34, 678–684.

    Google Scholar 

  10. 10.

    Gelberg, L., Leake, B., Lu, M., et al. (2002). Chronically homeless women’s deterrents to contraception. Perspectives on Sexual and Reproductive Health, 34, 278–285.

    PubMed  Article  Google Scholar 

  11. 11.

    Ensign, J. (2000). Reproductive health of homeless adolescent women in Seattle, Washington, USA. Women & Health, 31, 133–151.

    Article  CAS  Google Scholar 

  12. 12.

    Brown, S. S., & Eisenberg, L. (Eds.) (1995). The best intentions—unintended pregnancy and the well-being of children and families. Washington, D.C.: National Academy Press.

    Google Scholar 

  13. 13.

    Sumner, G., Andersen, R., Wenzel, S., & Gelberg, L. (2001). Weighting for period perspective in samples of the homeless. The American Behavioral Scientist, 45, 80–104.

    Article  Google Scholar 

  14. 14.

    Stein, J., Lu, M., & Gelberg, L. (2000). Severity of homelessness and adverse birth outcomes. Health Psychology, 19, 524–534.

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Gelberg, L., Andersen, R., & Leake, B. (2000). The behavioral model for vulnerable populations: Application to medical care use and outcomes. Health Services Research, 34, 1273–1302.

    PubMed  CAS  Google Scholar 

  16. 16.

    Rost, K., Burnam, M., & Smith, G. (1993). Development of screeners for depressive disorders and substance disorder history. Medical Care, 31, 189–200.

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Rosenberg, M. (1965). Society and the adolescent self-image. Princeton, NJ: Princeton University Press.

    Google Scholar 

  18. 18.

    Pearlin, L. I., Lieberman, M. A., Menaghan, E. G., & Mullan, J. T. (1981). The stress process. Journal of Health and Social Behavior, 22, 337–356.

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Bailey, S., Camlin, C., & Ennett, S. (1998). Substance use and risky sexual behavior among homeless and runaway youth. Journal of Adolescent Health, 23, 378–388.

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Booth, R., Zhang, Y., & Kwiatkowski, C. (1999). The challenge of changing drug and sex risk behaviors of runaway and homeless adolescents. Child Abuse & Neglect, 23, 1295–1306.

    Article  CAS  Google Scholar 

  21. 21.

    Koopman, C., Rosario, M., & Rotheram-Borus, M. (1994). Alcohol and drug use and sexual behaviors placing runaways at risk for HIV infection. Addictive Behavior, 19, 95–103.

    Article  CAS  Google Scholar 

  22. 22.

    Greenblatt, M., & Robertson, M. (1993). Life-styles, adaptive strategies, and sexual behaviors of homeless adolescents. Hospital & Community Psychiatry, 44, 1177–1180.

    CAS  Google Scholar 

  23. 23.

    Marin, B. V., Tschann, J. M., Gomez, C. A., & Kegeles, S. M. (1993). Acculturation and gender differences in sexual attitudes and behaviors: Hispanic vs. non-Hispanic white unmarried adults. American Journal of Public Health, 83(12), 1759–1761.

    PubMed  CAS  Article  Google Scholar 

  24. 24.

    Amaro, H. (1995). Love, sex, and power. Considering women’s realities in HIV prevention. American Psychology, 50, 437–447.

    Article  CAS  Google Scholar 

  25. 25.

    Brien, T., Thombs, D., Mahoney, C., & Wallnau, L. (1994). Dimensions of self efficacy among three distinct groups of condom users. Journal of American College Health, 42, 167–174.

    PubMed  CAS  Article  Google Scholar 

  26. 26.

    Gelberg, L., Browner, C. H., Lejano, E., & Arangua, L. (2004). Access to women’s health care: A qualitative study of barriers perceived by homeless women. Women Health, 40, 87–100.

    PubMed  Google Scholar 

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This research was supported by a grant from the Agency for Health Care Policy and Research (R01 HS08323) and a grant from the Robert Wood Johnson Foundation. Dr. Gelberg was a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar at the time of this study and the George F. Kneller Professor of Family Medicine. Dr. Lu is a Women’s Reproductive Health Career Development Fellow supported by the National Institutes of Health. Drs. Gelberg and Andersen are members of the National Academy of Sciences, Institute of Medicine. The authors wish to thank Ellen Silk for providing assistance with this manuscript.

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Gelberg, L., Lu, M.C., Leake, B.D. et al. Homeless Women: Who is Really at Risk for Unintended Pregnancy?. Matern Child Health J 12, 52–60 (2008). https://doi.org/10.1007/s10995-007-0285-1

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  • Homeless persons
  • Contraception
  • Women’s health