Pregnancy Ambivalence, History of Pregnancy, Condom Use, and Contraceptive Use Among U.S. Youth Experiencing Homelessness

Abstract

Youth experiencing homelessness (YEH) are 5–8 times more likely than housed peers to become pregnant. A more nuanced examination of YEH pregnancy desire may better inform pregnancy and pregnancy prevention guidance. This study examined pregnancy ambivalence, pregnancy history, condom use, and contraceptive use among sexually active YEH. We utilized baseline data of YEH aged 16–25 from a randomized controlled trial published elsewhere (Santa Maria et al., 2021). Pregnancy desire was categorized as ambivalence (43%) and non-ambivalence: desiring pregnancy (10%) and not desiring pregnancy (47%). We calculated adjusted prevalence ratios (aPRs) and 95% confidence intervals (95% CI) between pregnancy ambivalence with three outcomes (pregnancy history, condom, and any contraceptive use), stratified by male/female participants, controlling for demographics (e.g., gender, sexual orientation). Among YEH (n = 446, 44% female, 50% male, 6% another gender; mean age 21.1 years), 39% reported pregnancy history, 41% reported recent condom use, and 15% reported contraceptive use. Adjusted prevalence ratios stratified by male/female participants indicated that pregnancy ambivalence was notsignificantly associated with pregnancy history, recent condom use, and reported contraceptive use. By characterizing YEH pregnancy ambivalence, condom and contraceptive use, and the pregnancy history, providers may develop tailored policies and programs that respond to the preferences and sexual decision-making needs of YEH who are more vulnerable to undesired pregnancy, regardless of pregnancy desire. Youth experiencing homelessness (YEH) have higher pregnancy rates than housed peers. YEH pregnancy ambivalence or desiring pregnancy may require unique sexual and reproductive decision-making guidance. Among YEH (n = 446), 39% reported pregnancy history, 41% reported condom use, and 15% reported contraceptive use. Pregnancy ambivalence was not associated with outcomes. Healthcare and social service providers can tailor support to align with YEH sexual and reproductive preferences, including YEH who are ambivalent or desiring pregnancy.