"My First Instinct Is to Just Listen" Promoting Reproductive Justice with Under-Housed Youth

Background: Under-housed youth face an array of challenges, and among these are inequities and unmet needs regarding their reproductive health. Pregnancy rates among under-housed youth are eight times higher than their housed counterparts. Studies report that 30%-40% of under-housed youth indicate having at least one biological child. In addition to concerns regarding pregnancy and parenting, research documents that this youth population experiences considerable difficulties accessing medically-accurate family planning supports, including contraception and abortion. Also troubling, under-housed youth note that they frequently encounter stigma and judgment, specifically from healthcare and frontline service providers, when seeking reproductive health information and services. Yet, there are many healthcare and frontline service providers who are deeply committed to working with young people from anti-oppressive, reproductive justice lenses. This study qualitatively explored, among a sample of interdisciplinary healthcare and frontline service workers, how they approach their work with under-housed youth, also examining where and how they learned to affirmatively support youth with their reproductive health needs.

Methods: Qualitative data were collected from semi-structured individual interviews with 15 members of a consortium of healthcare and frontline service providers who work with pregnant and/or parenting under-housed youth. The consortium’s intent is to gather and share interdisciplinary knowledge and resources among youth-serving professionals and agencies across an urban area, such that youths’ connections to reproductive health supports may be met as seamlessly and holistically as possible. Interviews asked professionals about their experiences and training related to working with young people, including how they approach their work, what challenges and opportunities they see in their practice contexts, and what recommendations they might share for supporting this population through a reproductive justice lens. Interviews were transcribed and coded, using a constructivist grounded theory approach, engaging iterative phases of open, axial, and selective coding.

Results: Interviews captured insights from hospital-based nurses and physicians, drop-in and street-nurses, midwives, doulas, and social workers. Results indicated that under-housed youths’ reproductive health inequities have been dramatically exacerbated by the COVID-19 pandemic, with many youth being even further disconnected from valuable health information and supports. Yet, in this timeframe, youths’ needs for services regarding pregnancy, parenting, contraception, and abortion have also amplified. Respondents spoke about complex intersections between youths’ reproductive health concerns and increasing challenges faced regarding mental health, substance use, trauma, and human trafficking. These professionals indicated that most of what they know about working with youth from lenses of reproductive justice has not come from formal education or degree programs, but instead have drawn from voluntarily attending trainings, making connections with other service providers through the aforementioned consortium, proactively seeking resources on anti-oppressive youth-engagement strategies, and from simply listening to and spending extra, often casual and conversational, time with youth.

Conclusions and Implications: Respondents suggested there should be much greater emphasis placed in formal degree programs to educate trainees on tenets of reproductive justice and “best practices” for providing non-judgmental, person-centered care with equity-seeking groups. Interviewees also believed that health interventions tailored to under-housed youths’ intersectional contexts are urgently needed, especially amidst this ongoing pandemic.