"I Told Him I'm Gonna Get It": Intimate Partner Birth Control Communication Among Female Youth Experiencing Homelessness

Background and Purpose: Female youth experiencing homelessness (YEH) are disproportionately impacted by unintended pregnancies and face unique challenges when choosing to raise children. Though intimate partner sexual health communication shows promise as an effective protective factor against unintended pregnancies among other populations, among YEH it has been associated with both increases and decreases in condom use. The current study explores how female YEH navigate these conversations, guided by the primary research question: How do female YEH who participated in a comprehensive sexual and reproductive health program discuss birth control with their intimate partners?

Methods: Ten semi-structured interviews were conducted with female YEH aged 14-22 (M=18.1) years living in Hawai‘i. Prior to being interviewed all participants completed Wahine Talk, a holistic teen pregnancy prevention program, which includes peer mentoring, group-based sexual health education, basic need services (e.g., drop-in shelter, food, showers), and access to comprehensive SRH services, including a wide array of birth control options. Data were transcribed verbatim and analyzed using inductive thematic analysis, following a five-step process of data orientation, initial coding, development and refinement of themes and subthemes, ending with finalized themes describing YEH’s birth control communication.

Results: Female YEH who discussed birth control with their intimate partner were prompted to do so by their participation in Wahine Talk, side effects resulting from birth control use, and family members’ expressed interest in YEH’s becoming pregnant and having children. YEH who did not discuss birth control with their partner were either fearful or unsuccessfully tried to discuss it while initiating sex. When discussing birth control with their partner, female YEH shared simultaneous desires to delay pregnancy and concerns about side effects of birth control use. These conversations elicited personal emotions including feeling happy to have had the conversation, shocked at their partners response, or disappointed at their partners’ expressed indifference in their choice of birth control use. Intimate partner birth control communication also had lasting impacts on YEH’s family-planning efforts, opened the door for future health-related conversations, and resulted in YEH feeling cared for.

Conclusions and Implications: Female YEH discuss birth control use with their intimate partners when feeling empowered and prompted to do so. These conversations directly impact female YEH’s relationships, family planning and overall health and wellbeing. To take steps towards social justice and reduced health inequities, healthcare providers and existing programs focusing on improving the health of YEH should encourage sexual health communication between partners and support female YEH by discussing potential barriers to birth control communication and identifying an appropriate time for these conversations.