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Contraceptive usage in homeless women accessing a dedicated primary care service in Scotland, UK: a case note review
  1. Katie Eirian Hawkins1,2,
  2. Eliza Montague-Johnstone3
  1. 1Usher Institute, The University of Edinburgh, Edinburgh, UK
  2. 2Edinburgh Access Practice primary care service, Edinburgh, UK
  3. 3Medical School, The University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Katie Eirian Hawkins, Usher Institute, The University of Edinburgh, Edinburgh EH8 9YL, UK; katiehawkins{at}nhs.net

Abstract

Background Of the 70 000 people experiencing homelessness in Scotland, at least 40% are women. Little is known about their contraceptive usage. Most pregnancies in homelessness are unintended and children are usually looked after in the care system.

Methods A case note review of women’s current contraceptive usage in a primary care service serving women experiencing homelessness in Edinburgh, Scotland. The service electronic database was searched for keywords relating to contraception to determine current usage, but also reproductive health, wider demographics and previous pregnancies.

Results Of 174 women (16–55 years), 75 (43%) were recorded as using a contraceptive method. 49 (28%) were using long-acting reversible contraception (LARC), most of which was the contraceptive implant. However, 6/41 (15%) of the most effective LARC (intrauterine contraception and implant) was being used beyond its’ expiry date. 34 (20%) had no mention of contraceptive use in their medical record and 32 (19%) were not using contraception despite being sexually active. 6 (3%) had been hysterectomised/female sterilisation. 26 (15%) were not sexually active. 179 of the 233 (77%) children mentioned in women’s electronic records were recorded as being looked after out with their care. 138/174 (79%) had current/previous drug or alcohol misuse. 100/174 (57%) had a history of domestic violence or abuse. 22/174 (13%) were involved/had been involved in sex work.

Conclusions Primary care services need to give greater attention to the contraceptive needs of homeless women to empower them to become pregnant when the time is right for them and prevent the consequences of unintended pregnancy and homelessness.

  • long-acting reversible contraception
  • family planning service provision
  • general practice
  • hormonal contraception
  • implants
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Footnotes

  • Twitter @drkatieh

  • Contributors KEH conceived the idea of the study. EM-J helped design the study along with KEH. KEH and EM-J decided how the data would be anonymised and handled. EM-J performed the case note review and collated the data. EM-J collated the data for the results table from the notes review. KEH wrote the introduction. Methods and results were written by authors. Guidance regarding interpretation of results was sought from SC. Discussion was written by KEH. SC and SM proofread the paper prior to submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved as service evaluation as per the University of Edinburgh’s ethical requirements, written in conjunction with the National Research Ethics Service of the Health Research Authority of Scotland. No modification of investigation, treatment or other aspects of clinical practice was involved. The dataset was anonymised, and the code for each patient was kept in the practice computer system rather than with the dataset, to ensure confidentiality.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. Relevant data are included in the article.

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