"My Initial Instinct Is to Listen": Promoting Reproductive Justice with Under-Housed Youth

Background and Purpose: Under-housed youth face an array of inequities and unmet needs regarding their reproductive health. Pregnancy rates among under-housed youth are eight times higher than their housed counterparts, and 30%-40% indicate having at least one biological child. Further to concerns regarding pregnancy and parenting, this population experiences difficulties accessing medically-accurate family planning supports, including contraception and abortion. Also troubling, under-housed youth frequently encounter stigma and judgment 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 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 10 members of a consortium of 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, challenges and opportunities they see in their practice contexts, and 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 exacerbated by the COVID-19 pandemic, with youth becoming further disconnected from valuable health information and supports. Yet, in this timeframe, youths’ needs for services regarding pregnancy, parenting, contraception, and abortion further amplified. Respondents spoke about complex intersections between youths’ reproductive health concerns and increasing challenges faced regarding mental health, substance use, trauma, and human trafficking. Providers noted that most of what they know about working with youth from lenses of reproductive justice has not come from formal education, but instead was drawn from voluntarily attending trainings, making connections with other providers through the aforementioned consortium, proactively seeking resources on anti-oppressive youth-engagement strategies, learning from experienced colleagues, and from simply listening to and spending extra, often casual and conversational, time with youth. Although professional values of reproductive justice were consistent across the sample, their practices are constantly changing to respond to known or new challenges, which also include funding limitations and the COVID-19 pandemic.

Conclusions and Implications: Respondents suggested there should be 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.