“I Was Treated Differently”: Reproductive Health Care Experiences Among Women With Recent Experiences of Incarceration, Homelessness, And/Or Substance Use in a Medically Underserved Area in the Southwestern US

<b>Background:</b> Women with upstream social determinants of health, particularly those with recent experiences of incarceration, homelessness, and/or substance use, encounter a series of barriers in accessing health care services and consequently face poor sexual and reproductive health outcomes. Driven by a community concern for increasing rates of syphilis and congenital syphilis among women who are structurally disadvantaged, this study focuses on their experiences with reproductive healthcare access across healthcare settings.<b>Research Design and Study Sample:</b> This community-based <i>pláticas</i> (conversational) research project gathered 12 in-depth interviews and <i>testimonios</i> (testimonies) with women who reported a criminalized upstream barrier (incarceration, homelessness, and/or substance use) in a small city in the southwestern U.S. - most of whom identified as Latina/Hispanic.<b>Analysis and Results:</b> Using a grounded analysis and drawing upon Chicana feminist methodologies, this study identifies four major themes: (1) homelessness and economic vulnerabilities, (2) incarceration and health care, (3) drug use, provider stigma, and motherhood, and (4) desired changes to the healthcare experience.<b>Conclusion:</b> Results highlight the need for economic and transportation supports, community-based preventive services as alternatives to incarcerated healthcare, along with more compassionate and structurally competent provider-patient dialogue.