• Megan S Orlando, Anusha M Vable, Kelsey Holt, Erin Wingo, Sara Newmann, Bradley J Shapiro, Deborah Borne, Eleanor A Drey, and Dominika Seidman.
• Departments of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA.
• Am. J. Obstet. Gynecol. 2020 Dec 1; 223 (6): 892.e1-892.e12.

BackgroundAdverse reproductive health outcomes are well documented among people experiencing homelessness or housing instability. Little is known about abortion outcomes among this population.ObjectiveThis study aimed to investigate the relationship between housing status and abortion outcomes and whether gestational age mediates this relationship.Study DesignOur sample comprised 1903 individuals who had abortions at an urban clinic in San Francisco, CA, from 2015 to 2017. We defined homelessness or housing instability as a binary exposure, which included staying outside, with friends and/or family, or in a tent, vehicle, shelter, transitional program, or hotel. We evaluated gestational duration of ≥20 weeks as a mediator variable. Our primary outcome was any abortion complication. Logistic regression models were adjusted for age, race, substance use, mental health diagnoses, and previous vaginal and cesarean deliveries.ResultsApproximately 19% (n=356) of abortions were among people experiencing homelessness or housing instability. Compared with those with stable housing, people experiencing homelessness or housing instability presented later in pregnancy (mean gestational duration, 13.3 vs 9.5 weeks; P<.001) and had more frequent complications (6.5% vs 2.8%; P<.001; odds ratio, 2.2; 95% confidence interval, 1.2-3.9). Adjusting for race, substance use, mental health diagnoses, and previous cesarean deliveries, individuals experiencing homelessness or housing instability were more likely to have abortion complications (odds ratio, 2.3; 95% confidence interval, 1.3-4.0). However, the relationship was attenuated after adjusting for gestational duration (odds ratio, 1.4; 95% confidence interval, 0.7-2.6), suggesting that gestational duration mediates the relationship between housing status and abortion complications.ConclusionPatients experiencing homelessness or housing instability presented later in gestation, which seems to contribute to the increased frequency of abortion complications.Copyright © 2020 Elsevier Inc. All rights reserved.

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