School of Medicine, University of California San Francisco, San Francisco, CA, USA.
Department of Obstetrics, Gynecology & Reproductive Services, University of California San Francisco and San Francisco General Hospital, San Francisco, CA, USA.
Womens Health (Lond). 2023 Jan-Dec;19:17455057231152374. doi: 10.1177/17455057231152374.
Women experiencing homelessness with substance use disorders face unique and intersecting barriers to realizing their reproductive goals.
This study explored the reproductive aspirations of this population, as well as the barriers to accessing reproductive services from the perspectives of affected individuals, and the healthcare providers who serve them.
This mixed-methods study included surveys and interviews with women experiencing homelessness with substance use disorders and healthcare providers.
We conducted surveys and semi-structured interviews with women recruited from opiate treatment programs and homeless encampments in San Francisco, California in 2018. We also conducted interviews and focus groups with healthcare providers in reproductive health and substance use treatment settings. Interviews were recorded, transcribed, and coded. Descriptive statistics of survey results were performed.
Twenty-eight women completed surveys, 96% of whom reported current substance use. Ten women participated in interviews. One-third (9/28) reported desiring pregnancy in the next year; over half (16/28) reported they would be somewhat or very happy to learn they were pregnant. A majority used no contraception at last intercourse (14/28). Twenty-six healthcare providers participated in interviews (n = 15) and focus groups (n = 2). Patients and providers identified similar barriers to care access, including discrimination, logistical and financial challenges, and delayed pregnancy awareness. While providers proposed solutions focused on overcoming logistical challenges, patients emphasized the importance of transforming the healthcare environment to treat patients affected by substance use and homelessness with dignity and respect.
Women experiencing homelessness with substance use disorders face intersecting and compounding barriers to accessing reproductive health services. For patients, the impact of stigma and bias on treatment experiences are particularly salient, in contrast to logistical barriers emphasized by providers. Improving access will require structural and individual-level solutions to address stigma and create person-centered, trauma-informed, and respectful care environments.
患有物质使用障碍的无家可归妇女在实现生殖目标方面面临独特且相互交织的障碍。
本研究从受影响个体以及为其提供服务的医疗保健提供者的角度探讨了这一人群的生殖愿望，以及获得生殖服务的障碍。
这项混合方法研究包括对来自加利福尼亚州旧金山的阿片类药物治疗计划和无家可归者营地的患有物质使用障碍的无家可归妇女进行调查和访谈。我们还对生殖健康和物质使用治疗环境中的医疗保健提供者进行了访谈和焦点小组讨论。对访谈进行了录音、转录和编码。对调查结果的描述性统计数据进行了分析。
28 名妇女完成了调查，其中 96%的人报告目前正在使用物质。10 名妇女参加了访谈。三分之一（9/28）报告在明年有生育愿望；超过一半（16/28）表示，如果得知自己怀孕，他们会感到有些或非常高兴。大多数人在上一次性交时没有使用避孕措施（14/28）。26 名医疗保健提供者参加了访谈（n=15）和焦点小组（n=2）。患者和提供者都发现了类似的获得医疗保健障碍，包括歧视、后勤和财务挑战以及怀孕意识延迟。尽管提供者提出了专注于克服后勤挑战的解决方案，但患者强调了改变医疗环境的重要性，以便以尊严和尊重的态度对待受物质使用和无家可归影响的患者。
患有物质使用障碍的无家可归妇女在获得生殖健康服务方面面临相互交织和复杂的障碍。对患者而言，治疗经历中的耻辱感和偏见的影响尤为明显，这与提供者强调的后勤障碍形成对比。要改善获得生殖服务的机会，需要从结构和个人层面来解决耻辱感问题，并创建以患者为中心、注重创伤、尊重患者的医疗环境。
