Predicting Positive Attitudes Toward Pregnancy Among Homeless Youth in Los Angeles

Background and Purpose:  Homeless youth are at increased risk of engaging in unprotected sex, thereby amplifying their pregnancy likelihood.  However, it is unknown whether female and male homeless youth want to become pregnant.  To the best of our knowledge, this is the first study to assess homeless youths’ attitudes toward pregnancy. 

Methods:  Homeless youth at Santa Monica and Hollywood, CA drop-in centers completed a self-administered computer questionnaire (N=386).  Sex behavior questions included engaging in sex under the influence, primary contraceptive method at last vaginal sex encounter, and history of pregnancy (or impregnating a partner).  (For the purposes of analyses, condoms and hormonal contraception were classified as “effective” and withdrawal was classified as “ineffective.”)  Three questions addressed attitudes toward pregnancy using a five-point Likert scale: pregnancy being “one of the worst things that could happen to you,” pregnancy not being “all that bad” if it happened “at this time in your life,” and wanting “to get pregnant… within the next year.”  The first two pregnancy attitudes were adopted from the national Add Health survey; the third item was developed by the research team.  A summary score was created for the three pregnancy attitude items, with the first item reverse coded.  An OLS model was used to predict positive pregnancy attitudes.

Results:  Participants were 14-27 years old, 28% female, 24% non-heterosexual, 36% white, 29% black, and 16% Latino.  Of those who had ever had vaginal sex, 46% reported using an effective contraceptive method, 12% used an ineffective method, and 23% did not use any form of contraception at last vaginal sex.  At last sex, 43% engaged in sex under the influence of drugs and/or alcohol.  Forty-five percent have ever been pregnant or impregnated someone.

Twenty-five percent of respondents disagreed or strongly disagreed with the statement that becoming pregnant now is “one of the worst things;” 30% agreed or strongly agreed that becoming pregnant now “wouldn’t be all that bad;” and 20% agreed or strongly agreed that they would like to become pregnant within the next year.  Comparatively, only 7% of Add Health 15- to 19-year-old women disagreed or strongly disagreed with pregnancy being “one of the worst things,” and 8% agreed or strongly agreed that pregnancy would not be “so bad.”

Multivariate regression results (R²=0.12) indicate that homeless youth who reported effective and ineffective contraception describe significantly lower pro-pregnancy attitudes (β= -0.59, p<0.0001; β= -0.50, p<0.01, respectively).  Whereas, a lifetime history of pregnancy and engaging in sex under the influence are significantly associated with higher pro-pregnancy attitudes (β= 0.30, p<0.05, β= 0.26, p<0.05, respectively).  Interestingly, gender was not significantly associated with pro-pregnancy attitudes.

Conclusions and Implications:  By assessing homeless youths’ pregnancy attitudes, their history of pregnancy, and contraceptive methods, pregnancy prevention programs should be better designed to target the needs of homeless youth.  Homeless youth may have access to contraception, however for those with pro-pregnancy attitudes, other strategies need to be implemented to better inform homeless youth of the challenges of pregnancy and childrearing and/or to increase prenatal care and parenting programs.