“I Know They Would Kill Me”: Abortion Attitudes and Experiences Among Youth Experiencing Homelessness

Abstract

Pregnancy rates among youth experiencing homelessness are much higher than those of their housed peers, yet limited research exists on this population’s abortion experiences. This study examined abortion attitudes, experiences, and decision making through individual interviews with 30 female, male, and gender-fluid youth (ages 18-21 years) experiencing homelessness. Respondents indicated that abortions are common in this population. Many youth also reported they either had, and/or knew of others, who had attempted abortions outside of the formal medical system while experiencing homelessness. Most youth noted that self-inductions resulted from not knowing where or how to access abortions safely, and as many feared stigma, judgment, and violence from family members and serious partners in response to obtaining abortions. Most youth reflected inaccurate perceptions regarding abortion cost, accessibility, and legality. Findings should be considered in developing socially contextualized family planning prevention and outreach efforts among this highly vulnerable youth population.

Access experiences and attitudes toward abortion among youth experiencing homelessness in the United States: A systematic review

“…Our systematic search yielded five qualitative research studies eligible for analysis (Fig 1) [6,[15][16][17]28]. As described in Table 1, studies included 132 participants from California (n = 2), Colorado (n = 1), Texas (n = 1), and Washington State (n = 1), were published between 2001 and 2019, and included youth as young as 15.…”

“…This hesitation may arise from a confluence of factors, including lack of provider knowledge about the option of medication; provider perceptions that patients are disinterested in this option; and provider concerns about feasibility related to patients using the medication correctly, managing the abortion in an unstable living situation, and loss to follow up [13,14]. Simultaneously, there is a small but alarming body of evidence that youth, including youth experiencing homelessness, may opt for self-induced abortion using harmful methods rather than seek surgical abortion care [6,8,[15][16][17]. These studies signal the need for improved decision support so that youth can make informed, evidence-based decisions about safe method of abortion.…”

Fatherhood Among Youth Experiencing Homelessness

“…The interviewees framed the issue as a matter of individual virtue, some sharing a determination to do better than their own fathers who abandoned their mothers, while others voicing their commitment to a life of relentless toil so as to support their child and its mother. This assumption of the “knight in shining armor” role—chivalrous posturing—included an almost unqualified recognition of the pregnant woman’s right to decide about the fate of the child, both with regard to abortion (Begun et al, 2018) and with regard to parenting the born child. None of the interviewees expressed any empathy toward fathers who abandon their children, even when talking about their own fathers.…”

“…Street-involved youth pregnancies present the pregnant young women with multiple stressors, risks, and vulnerabilities (Baggett et al, 2010; Weinreb et al, 1998). These result from various factors such as risk behaviors (e.g., substance misuse) and unsafe spaces associated with street involvement (Thompson et al, 2008); insufficient access to health care, prenatal care, and screenings (Baggett et al, 2010); and self-harm due to insufficient access to family planning information and services (Begun et al, 2018). Another and equally critical set of stressors and vulnerabilities result from the fact that young street-involved pregnant women, who carry a pregnancy to term and parent a child, all too often end up doing so alone.…”

“…However, it is far from clear that encouraging them, let alone forcing them, to stay and remain involved is in the interest of the pregnant young women and the child if carried to term. Given some of the views voiced by such young men regarding abortions (Begun et al, 2018), as well as the prevalence of gender-based violence among homeless youth (e.g., Slesnick et al, 2010), one significant concern is that greater involvement of these young men may in some cases circumscribe the agency of the young women in deciding whether to terminate the pregnancy or give up the child for adoption.…”