Sexual and reproductive health needs of homeless women in Los Angeles during the COVID-19 pandemic: A qualitative analysis
Abortion, Contraception
Awarded 2020
Complex Family Planning Fellowship Research
Hana Reissner, MD
University of Southern California

Rationale: The Los Angeles (LA) homelessness crisis continues to worsen with the current estimate of 60,000 homeless individuals expected to rise annually and women make up one-third of this population. Homeless women live in a unique sociocultural context that warrants in-depth exploration of sexual and reproductive (SRH) behaviors and needs, focusing on the variations in and capacities of available services, which may differ from those used by the general population. The COVID-19 pandemic exacerbates the economic struggle of women with housing insecurity, impacting their family planning goals, risk of sexual coercion, and engagement in sex trade as a survival method. The pandemic also compounds the struggle to access reproductive health among vulnerable communities, putting them at risk of unplanned pregnancies. The unique SRH behaviors and needs of homeless women in the state of the pandemic is unknown, thus warranting exploration in order to suggest timely interventions, as reproductive agency is a critical component towards women’s escape from homelessness.
Objectives: While the COVID-19 pandemic is affecting all individuals within Los Angeles, homeless women may be disproportionately at risk and affected by the pandemic and its external effects on access to sexual and reproductive healthcare, as well as risky sexual behavior like transactional sex. To better understand how to reduce their risk and manage their concerns, we will:
-Explore the experience of homelessness during the pandemic and its influence on:
(1) women’s pregnancy intentions, (2) use of SRH services, (3) use of contraception
-Identify modifiable barriers to homeless women’s receipt of contraception and SRH care during the pandemic, with attention to the unique challenges faced by unsheltered women.
-Develop/brainstorm/obtain feedback on potential SRH service models for homeless women in order to develop timely interventions.
-Learn about homelessness service providers’ experiences caring for homeless women and gather their opinions on opportunities to improve SRH services during the pandemic
-Provide SRH services to homeless participants at the time of research encounter depending on the participant’s needs- condoms, menstrual hygiene products, information about SRH clinics and services in the region, and bus tickets to attend a Family PACT clinic.
Study Outcomes: Through semi-structured interviews with homeless women and homelessness service providers, we will gain insights that can be compared and contrasted to pragmatically improve on current interventions aimed at caring for this vulnerable population in the face of the pandemic. The project will identify areas that can be addressed clinically in order to provide timely interventions, with the provision of condoms, menstrual hygiene products, and resources to access SRH services at FPACT clinics.