"Having a Baby Can Wait": A Mixed-Method Analysis of Homeless Youth Experiences and Longitudinal Contraception Uptake Outcomes Following Holistic Sexual Health Intervention

Background and Purpose: Half of homeless youth become pregnant at least once during adolescence and the majority of these pregnancies are unintended. Homeless female youth have high rates of sexual victimization and many have complex trauma histories, escalating incidence of sexual risk behavior and myriad vulnerabilities. Further, education, healthcare, and social systems are often ill-prepared to address the sexual health needs of homeless youth. In response, we developed and tested Wahine (“woman”) Talk, a trauma-informed intervention delivered via a youth drop-in center in Waikiki (a Honolulu, Hawai‘i neighborhood with high rates of youth homelessness). Wahine Talk functions at the individual, interpersonal, and system level to improve homeless female youths’ overall well-being, linkage to sexual healthcare, and uptake of contraception. Wahine Talk has four components: basic need services, peer mentoring, sexual health education groups, and sexual healthcare. Youth receive a smartphone at enrollment to facilitate engagement, data boosts when they participate in program groups, and an upgraded smartphone and data plan if they adopt a longer-acting birth control. This presentation will describe participants’ program experiences expressed through a youth-led participatory action PhotoVoice project and longitudinal clinic outcomes to nine months following delivery of Wahine Talk.

Methods: Our interdisciplinary team (social work/public health/medicine) delivered Wahine Talk to homeless female youth (N=51) aged 14-22 years (M=17.7, SD=2.47) in a series of cycles. We collected detailed provider- and participant-reported mixed-method process and outcome measures at pre-test, post-test, and for nine months following Wahine Talk. To complement quantitative results and elevate youth voice, at Wahine Talk’s conclusion, youth were invited to participate in a PhotoVoice project focused on how they experienced the Wahine Talk program and what it meant to them to be waiting to start or expand their families at this time in their lives.

Results: Wahine Talk participants’ self-reported readiness to use any type of birth control and linkage to sexual healthcare increased significantly* from pre- to post-test. Birth control usage rates tripled: at post-test, 51% of Wahine Talk participants were using birth control. Longer-acting reversible contraception (LARC) remained particularly stable: at nine months post-Wahine Talk, 33.3% of youth were using LARC. Complementing these findings, youth expressed through their PhotoVoice project a strong connection to program staff and an understanding of the importance of caring for their sexual health and well-being. Participants shared captioned photographs of their everyday lives, including “having a baby can wait - life is full of adventures to take and make it great” and, referring to her child, “she is all I need.”

Conclusions and Implications: Homeless youth, especially young women, are among the most vulnerable populations in society. Addressing their sexual health and well-being requires comprehensive, accessible, and multi-level intervention. Systems that are responsive, inviting, and focused on trauma-informed services are well-positioned to enhance youths’ self-determination and their ability to make well-informed sexual health choices. Holistic approaches such as Wahine Talk have the potential to dramatically improve youths’ sexual healthcare access and adoption of birth control.

(*p < .05)