{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T19:37:17Z","timestamp":1784230637220,"version":"3.55.0"},"reference-count":37,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2023,1,1]],"date-time":"2023-01-01T00:00:00Z","timestamp":1672531200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100012297","name":"society of family planning","doi-asserted-by":"publisher","award":["(Phase 1) grant, 2017"],"award-info":[{"award-number":["(Phase 1) grant, 2017"]}],"id":[{"id":"10.13039\/100012297","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Womens Health (Lond Engl)"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Women experiencing homelessness with substance use disorders face unique and intersecting barriers to realizing their reproductive goals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>This study explored the reproductive aspirations of this population, as well as the barriers to accessing reproductive services from the perspectives of affected individuals, and the healthcare providers who serve them.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>This mixed-methods study included surveys and interviews with women experiencing homelessness with substance use disorders and healthcare providers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We conducted surveys and semi-structured interviews with women recruited from opiate treatment programs and homeless encampments in San Francisco, California in 2018. We also conducted interviews and focus groups with healthcare providers in reproductive health and substance use treatment settings. Interviews were recorded, transcribed, and coded. Descriptive statistics of survey results were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Twenty-eight women completed surveys, 96% of whom reported current substance use. Ten women participated in interviews. One-third (9\/28) reported desiring pregnancy in the next year; over half (16\/28) reported they would be somewhat or very happy to learn they were pregnant. A majority used no contraception at last intercourse (14\/28). Twenty-six healthcare providers participated in interviews (n\u2009=\u200915) and focus groups (n\u2009=\u20092). Patients and providers identified similar barriers to care access, including discrimination, logistical and financial challenges, and delayed pregnancy awareness. While providers proposed solutions focused on overcoming logistical challenges, patients emphasized the importance of transforming the healthcare environment to treat patients affected by substance use and homelessness with dignity and respect.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Women experiencing homelessness with substance use disorders face intersecting and compounding barriers to accessing reproductive health services. For patients, the impact of stigma and bias on treatment experiences are particularly salient, in contrast to logistical barriers emphasized by providers. Improving access will require structural and individual-level solutions to address stigma and create person-centered, trauma-informed, and respectful care environments.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17455057231152374","type":"journal-article","created":{"date-parts":[[2023,2,22]],"date-time":"2023-02-22T03:44:46Z","timestamp":1677037486000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":12,"title":["Patient and provider perspectives on barriers and facilitators to reproductive healthcare access for women experiencing homelessness with substance use disorders in San Francisco"],"prefix":"10.1177","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1787-2417","authenticated-orcid":false,"given":"Christina N","family":"Schmidt","sequence":"first","affiliation":[{"name":"School of Medicine, University of California San Francisco, San Francisco, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin E","family":"Wingo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology & Reproductive Services, University of California San Francisco and San Francisco General Hospital, San Francisco, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara J","family":"Newmann","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology & Reproductive Services, University of California San Francisco and San Francisco General Hospital, San Francisco, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah E","family":"Borne","sequence":"additional","affiliation":[{"name":"San Francisco Department of Public Health, San Francisco, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brad J","family":"Shapiro","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominika L","family":"Seidman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology & Reproductive Services, University of California San Francisco and San Francisco General Hospital, San Francisco, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,2,22]]},"reference":[{"key":"bibr1-17455057231152374","unstructured":"The U.S. Department of Housing and Urban Developement. The 2020 annual homeless assessment report (AHAR) to congress, https:\/\/www.huduser.gov\/portal\/sites\/default\/files\/pdf\/2020-AHAR-Part-1.pdf"},{"key":"bibr2-17455057231152374","doi-asserted-by":"publisher","DOI":"10.1080\/03630242.2010.532754"},{"key":"bibr3-17455057231152374","doi-asserted-by":"publisher","DOI":"10.1300\/J013v40n02_06"},{"key":"bibr4-17455057231152374","doi-asserted-by":"publisher","DOI":"10.1080\/03630242.2011.649829"},{"key":"bibr5-17455057231152374","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpag.2015.07.003"},{"key":"bibr6-17455057231152374","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2004.041608"},{"key":"bibr7-17455057231152374","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2022.306915"},{"key":"bibr8-17455057231152374","doi-asserted-by":"publisher","DOI":"10.1353\/hpu.2014.0079"},{"key":"bibr9-17455057231152374","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2015.05.023"},{"key":"bibr10-17455057231152374","doi-asserted-by":"publisher","DOI":"10.1111\/ajad.12582"},{"key":"bibr11-17455057231152374","unstructured":"Rountree J, Hess N, Lyke A. Health conditions among unsheltered adults in the U.S. California Policy Laboratory, 2019, https:\/\/www.capolicylab.org\/wp-content\/uploads\/2019\/10\/Health-Conditions-Among-Unsheltered-Adults-in-the-U.S.pdf"},{"key":"bibr12-17455057231152374","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003666"},{"key":"bibr13-17455057231152374","doi-asserted-by":"publisher","DOI":"10.1186\/s40352-015-0015-5"},{"key":"bibr14-17455057231152374","first-page":"1","volume":"9","author":"Terplan M","year":"2015","journal-title":"Subst Abuse"},{"key":"bibr15-17455057231152374","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000000991"},{"key":"bibr16-17455057231152374","doi-asserted-by":"publisher","DOI":"10.1016\/j.whi.2016.09.002"},{"key":"bibr17-17455057231152374","doi-asserted-by":"publisher","DOI":"10.1016\/j.chiabu.2018.01.026"},{"key":"bibr18-17455057231152374","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2019.107652"},{"key":"bibr19-17455057231152374","doi-asserted-by":"publisher","DOI":"10.1016\/j.whi.2010.02.003"},{"key":"bibr20-17455057231152374","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003750"},{"key":"bibr21-17455057231152374","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-020-8353-1"},{"key":"bibr22-17455057231152374","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2021.08.012"},{"key":"bibr23-17455057231152374","doi-asserted-by":"publisher","DOI":"10.1016\/S0010-7824(01)00198-6"},{"key":"bibr24-17455057231152374","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2015.04.008"},{"key":"bibr25-17455057231152374","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2018.03.015"},{"key":"bibr26-17455057231152374","doi-asserted-by":"publisher","DOI":"10.1363\/psrh.12134"},{"key":"bibr27-17455057231152374","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000004255"},{"key":"bibr28-17455057231152374","doi-asserted-by":"publisher","DOI":"10.1136\/bmjsrh-2020-200799"},{"key":"bibr29-17455057231152374","doi-asserted-by":"publisher","DOI":"10.1007\/s11135-017-0574-8"},{"key":"bibr30-17455057231152374","unstructured":"Applied Survey Research. 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What is trauma-informed care? https:\/\/socialwork.buffalo.edu\/social-research\/institutes-centers\/institute-on-trauma-and-trauma-informed-care\/what-is-trauma-informed-care.html (accessed 21 September 2022)."},{"key":"bibr36-17455057231152374","unstructured":"Centers for Disease Control and Prevention. Six guiding principles to a trauma-informed approach, 2022, https:\/\/www.cdc.gov\/cpr\/infographics\/6_principles_trauma_info.htm (accessed 21 September 2022)."},{"key":"bibr37-17455057231152374","unstructured":"Ginwright S. The future of healing: shifting from trauma informed care to healing centered engagement, 2018, https:\/\/ginwright.medium.com\/the-future-of-healing-shifting-from-trauma-informed-care-to-healing-centered-engagement-634f557ce69c (accessed 21 September 2022)."}],"container-title":["Women's Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/17455057231152374","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/17455057231152374","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/17455057231152374","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T08:25:43Z","timestamp":1777710343000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/17455057231152374"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1]]},"references-count":37,"alternative-id":["10.1177\/17455057231152374"],"URL":"https:\/\/doi.org\/10.1177\/17455057231152374","relation":{},"ISSN":["1745-5057","1745-5065"],"issn-type":[{"value":"1745-5057","type":"print"},{"value":"1745-5065","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1]]},"article-number":"17455057231152374"}}