Distance matters

Geographic barriers to long-acting reversible and permanent contraception for homeless women Veterans

Bibliographic Data

ID20408491
AuthorsLori M Gawron (0000-0003-4431-9729, Informatics, Decision Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA, corresponding author), Warren Pettey (0000-0002-4436-3319, University of Utah), Warren B P Pettey (Informatics, Decision Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA), Andrew Redd (0000-0002-6149-2438, VA Salt Lake City Healthcare System), Andrew M Redd (Informatics, Decision Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA), Ying Suo (0000-0002-3563-5300, Informatics, Decision Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA), David K Turok (0000-0002-6289-0542, Departments of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, USA), Adi V Gundlapalli (0000-0002-7423-7903, Informatics, Decision Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA)
Year2019
Volume28
Issue2
Pages139-148
Publication date2019-07-03
Open AccessNo
TypeARTICLE
VenueJournal of Social Distress and the Homeless (JOURNAL)
Journal identifiersISSN: 1053-0789 • E-ISSN: 1573-658X
PublisherInforma UK Limited (PUBLISHER • GB)
DOI10.1080/10530789.2019.1619242
PMID31656390
OpenAlexW2945256224
LanguageEN
Citations received2
References cited23

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

Environmental health · Family medicine · Family planning · Logistic regression · Population · Unintended pregnancy · Demography · Food Security and Health in Diverse Populations · Homelessness and Social Issues · Medicine · Migration, Health and Trauma · Gerontology

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