Improving Reproductive Health Communication Between Providers and Women Affected by Homelessness and Substance Use in San Francisco: Results from a Community-Informed Workshop

• Published in: Maternal and child health journal Vol. 27; no. Suppl 1; pp. 143 - 152
• Main Authors: Wingo, Erin E., Newmann, Sara J., Borne, Deborah E., Shapiro, Brad J., Seidman, Dominika L.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.12.2023; Springer Nature B.V
• Subjects: Birth control; Childbirth & labor; Cisgender; Communication; Confidence; Counseling; Drug use; Empathy; Experience; Female; Gynecology; Health behavior; Health care access; Health Communication; Health services; Homeless people; Homelessness; Housing; Humans; Ill-Housed Persons; Maternal and Child Health; Medicine; Medicine & Public Health; Mental disorders; Mental health services; Parents & parenting; Patients; Pediatrics; Population Economics; Pregnancy; Public Health; Reproductive Health; Research methods; San Francisco; Social services; Sociology; Stigma; Substance abuse; Substance use; Substance-Related Disorders; Trauma; Women; Womens health; San Francisco; United States > US; San Francisco California; Substance use disorder; Homelessness; Professional education; Reproductive health services
• ISSN: 1092-7875; 1573-6628
• DOI: 10.1007/s10995-023-03671-y

Objectives Many cisgender women affected by homelessness and substance use desire pregnancy and parenthood. Provider discomfort with patient-centered counseling about reproductive choices and supporting reproductive decisions of these women poses barriers to reproductive healthcare access. Methods We used participatory research methods to develop a half-day workshop for San Francisco-based medical and social service providers to improve reproductive counseling of women experiencing homelessness and/or who use substances. Guided by a stakeholder group comprising cisgender women with lived experience and providers, goals of the workshop included increasing provider empathy, advancing patient-centered reproductive health communication, and eliminating extraneous questions in care settings that perpetuate stigma. We used pre/post surveys to evaluate acceptability and effects of the workshop on participants’ attitudes and confidence in providing reproductive health counseling. We repeated surveys one month post-event to investigate lasting effects. Results Forty-two San Francisco-based medical and social service providers participated in the workshop. Compared to pre-test, post-test scores indicated reduced biases about: childbearing among unhoused women ( p  < 0.01), parenting intentions of pregnant women using substances ( p  = 0.03), and women not using contraception while using substances ( p  < 0.01). Participants also expressed increased confidence in how and when to discuss reproductive aspirations ( p  < 0.01) with clients. At one month, 90% of respondents reported the workshop was somewhat or very beneficial to their work, and 65% reported increased awareness of personal biases when working with this patient population. Conclusions for Practice A half-day workshop increased provider empathy and improved provider confidence in reproductive health counseling of women affected by homelessness and substance use. Significance Statement In the setting of significant trauma histories, untreated mental illness, and trauma directly related to housing instability, women experiencing homelessness (WEH) in the United States are also frequently affected by substance use. Facing stigma, judgment, mistreatment, and under-trained providers, WEH using substances often have limited access to reproductive health services and experience poor reproductive health outcomes. A half-day provider training, designed in collaboration with a stakeholder group of women with lived experience and community partners in San Francisco, CA increased provider empathy and improved provider confidence in reproductive health counseling of women affected by homelessness and substance use.