Distance matters: geographic barriers to long-acting reversible and permanent contraception for homeless women Veterans

ABSTRACT

Women Veterans who experience homelessness are at high risk of unintended pregnancy and adverse outcomes. Contraception could mitigate risks, yet access barriers exist across the Veterans Health Administration (VHA). We identified all US women Veterans, age 18–44y with evidence of homelessness in VHA administrative data between fiscal years 2002–2015, in order to document the geographic distribution of ever-homeless women Veterans in relation to VA Medical Centers (VAMCs) and assess geographic associations between long-acting reversible contraceptives (LARC) or permanent contraception (PC) use. We calculated VAMC travel distance from last known ZIP Code. We used multivariate logistic regression models to explore contraceptive method associations. We included 41,722 ever-homeless women Veterans; 9.2% had LARC exposure and 7.5% PC. We found 29% of ever-homeless women Veterans resided >40miles from the nearest VAMC and increasing drive distance was negatively correlated with contraceptive exposure, especially for Veterans residing >100miles from a VAMC. Increasing distance to the nearest VAMC results in a geographic barrier to the most effective contraceptive options for women Veterans. The VHA is uniquely positioned to leverage its rural and homeless healthcare expertise to address geographic barriers and integrate comprehensive contraceptive services into established programs for high-risk Veterans.

KEYWORDS:

• Homelessness
• Veterans
• reproductive health
• travel distance
• contraception

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Lori M. Gawron is an Assistant Professor of Obstetrics and Gynecology and VA Gynecology Section Chief.

Warren B.P. Pettey is a VA Affiliate Investigator and Data Scientist in the Division of Epidemiology.

Andrew M. Redd is a VA Affiliate Investigator and Assistant Professor of Epidemiology.

Ying Suo is a VA Data Manager.

David K. Turok is an Associate Professor of Obstetrics and Gynecology and Family Planning Division Chief.

Adi V. Gundlapalli is Professor of Internal Medicine and VA Core Investigator.

Additional information

Funding

This work was supported by Eunice Kennedy Shriver National Institute of Child Health and Human Development: [Grant Number IK12HD085816]; Eunice Kennedy Shriver National Institute of Child Health and Human Development: [Grant Number K24HD087436]; Health Services Research and Development: [Grant Number IIR 12-084]; Health Services Research and Development: [Grant Number I50HX001240].