Uptake of long-acting reversible contraception among homeless versus housed women veterans

Abstract

Objectives: We aimed to assess the uptake of long-acting reversible contraceptive (LARC) methods and prevalence of psychiatric and medical comorbidities among homeless versus housed women veterans accessing care within the Veterans Healthcare Administration (VHA), the largest US provider of homeless health care services. Methods: All women veterans aged 18–44 who accessed VHA services in FY2001–2015 with administrative evidence of homelessness were identified. Controls were identified by matching on military service period. We extracted demographic characteristics, ICD-9 codes for chronic diseases based on the CDC Medical Eligibility high-risk conditions and other prevalent mental health disorders in veterans and ICD-9/CPT/HCPCS codes for LARC method insertion, removal or surveillance. Comparisons were made between homeless and housed veterans on all variables. Results: Some 42,197 homeless women veterans and 46,768 housed women veterans were included. Mean age at first homeless designation was 38. Uptake of a LARC method was 9.4% among homeless veterans and 5.6% among housed veterans (p<.001). Prevalence of all comorbidities was significantly higher among homeless versus housed veterans: mental health disorders, 84.5% versus 48.9% (p<.001), substance abuse disorders, 35.9% versus 8.6% (p<.001) and one or more high-risk medical conditions, 74.9% versus 56% (p<.001). Conclusions: Homeless women veterans seeking care in the VHA are a vulnerable population with an extremely high prevalence of comorbidities that increase risk of adverse pregnancy outcomes. Despite their higher rate of LARC method uptake, their frequency of medical complexities mandates further prioritization of comprehensive contraceptive services to minimize risk of an unintended pregnancy.