'The chances are zero': A qualitative study on perceived susceptibility to pregnancy among women experiencing homelessness

Background: Women experiencing homelessness are at higher risk of unintended pregnancy than women stably housed. The way women perceive their susceptibility to pregnancy may contribute to effective contraceptive use. This study aimed to explore how women experiencing homelessness perceive their susceptibility to pregnancy with and without contraception from a qualitative, emic perspective. Methods: Semi-structured interviews (n = 19) were conducted from December 2019 to October 2020 among English-speaking, pregnancy-capable (i.e. not sterilised) women, aged 18-45 years, experiencing homelessness. Interview questions included perceived susceptibility to pregnancy with and without contraception, attitudes toward pregnancy, and pregnancy intention. Interviews were audio-transcribed and coded to consensus using a seven-step coding process. Themes were identified via thematic and framework analysis, stratifying participants by pregnancy desire in the next year: yes (n = 4), no (n = 9), or don't know (n = 6). Results: Seventeen women reported inconsistent or no contraceptive use. Some women found their risk of pregnancy was equal with and without contraception based on perceptions of specific contraception efficacy (e.g. condoms vs pills); fertility and fecundity concerns; and high abstinence self-efficacy themes. In stratified analysis, women who desired pregnancy or were uncertain of pregnancy desire in the next year reported similar perceived susceptibility with and without contraception, compared with women not desiring pregnancy in the next year. Conclusions: Given the need to have higher susceptibility to pregnancy without contraceptive use for consistent contraception uptake, findings may explain the lack of contraceptive behaviours and contraception preferences related to pregnancy desire.