Challenges in homeless health care: Improving reproductive health services for homeless women

Facing disproportionately high rates of unplanned pregnancy, poor reproductive health, and adverse birth outcomes, homeless women are in particular need of comprehensive reproductive healthcare services tailored to their circumstances. They are often confronted with geographic, social, and political barriers to accessing reproductive health care, and minimal data exists regarding best practices.

In collaboration with Boston Health Care for the Homeless Program (BHCHP), our team, members of an MCH leadership course at Boston University School of Public Health, assessed the needs of homeless women in the Boston area to improve their reproductive health planning capacity. To this end, we identified reproductive health and life planning tools in the literature, conducted stakeholder interviews, shadowed BHCHP providers, and conducted informal interviews with shelter residents.

The consultation project demonstrated a need for reproductive health care tools and services tailored towards homeless women. We presented BHCHP with a Reproductive Health Toolkit to strengthen the organization’s practice and empower clients to make informed reproductive life decisions. The Toolkit included i) a World Health Organization reproductive health decision-making tool adapted for homeless women; ii) provider resources on reproductive life planning, motivational interviewing, and trauma-informed reproductive health care; iii) a tailored list of reproductive health smartphone applications for patient use; iv) practical implementation and sustainability strategies for each tool.

The Reproductive Health Toolkit, adapted from existing tools used in lower-resource settings, should be evaluated and replicated among other homeless healthcare initiatives to fill a severe gap in reproductive health resources for homeless women and their providers.