Dr Theresa Lynch, Chair, Pregnancy and Homelessness Coalition and Sandra Morris, Senior Engagement and Strategy Manager, Birth For Humankind
This article was originally published in Parity magazine. Learn more about Parity magazine including how to access full editions.
Women and gender diverse people who are pregnant without a home have complex needs associated with intersectional experiences of economic and social disadvantage, mental ill health drug and alcohol use and violence and/or abuse. Evidence shows that large numbers of women and children are homeless as a result of escaping family violence and find themselves isolated from social and/or community supports. Their experiences of homelessness place them at further risk of violent and exploitative relationships as well as reduced access to and engagement with appropriate health services.
It is our contention that their experiences and trauma are shaped by discriminatory policies and practices across our service systems that are underpinned by established patriarchal ideas, structures and priorities and widely accepted gender stereotypes where the male experience remains the norm.
In the absence of a gender lens the distinct needs of women, gender diverse people and children are not integrated and overlooked, and their voices rarely heard. This often translates to them being denied access to early, appropriate and safe health and housing support.
The inability to access stable housing profoundly undermines pregnant women’s and gender diverse people’s ability to access pregnancy care. This can create immediate and long lasting harm to them and their child’s health and wellbeing — including increased risk of pre term birth and low birth weight, which are risk factors for life long developmental challenges. It also impacts their ability bond with and care for their baby. For many women and gender diverse people, the inability to find suitable housing prior to birth will result in the removal of their baby from their care.
In Victoria, we do not know how many homeless women and gender diverse people are pregnant at any given time, as services are not required to collect this data. (1) There is also no coordinated system wide response to ensure we are achieving the widely accepted best health and social outcomes for both the parent and infant.2 This gap in the service system is a missed opportunity to provide early intervention and best practice, wrap around care and support.
Similarly, we do not know have comprehensive intersectional demographic data about people experiencing pregnancy and homelessness that are known to impact their experiences of the maternity care system, including age, race, ethnicity, sexuality, gender identity or disability. Not understanding the extent of the problem is a significant impediment to improving services and providing best the possible outcomes for homeless pregnant women and gender diverse people and their infants in Australia.
Despite evidence of need and their vulnerability to poorer health and wellbeing outcomes pregnant women are often invisible in systems of support across the health, wealth and homelessness and housing sectors.3 They and their unborn child subsequently do not receive the level and continuity of support and care that they require. This is largely because homelessness and health professionals have a lack of understanding of how to integrate their unique needs into service delivery models and responses.
Compounding these service delivery challenges is the evidence that not all frontline workers in the homeless and housing sectors possess the skills and knowledge to work with pregnant women in effective and sensitive ways. As a result, workers may not inquire about the pregnancy or follow up appropriately. Without the integration of a ‘gender lens’ into organisational policies and practices homeless pregnant people’s needs are often not identified or assessed comprehensively, and appropriate care not provided to them.
Below are interventions that are critical for transforming the health care and social support required to improving the life outcomes for pregnant women and gender diverse birthing parents and their infants impacted by homelessness.
- Improved data collection processes to better identify the number of pregnant homeless women and gender diverse people to inform policy and service system development.
- Ensure pregnancy is considered as a critical factor for determining access to housing and support when pregnancy is first identified or disclosed.
- Identify policies and practices that apply a gendered lens to address the unique needs of pregnant women and gender diverse birthing parents when accessing housing support and health care.
- Include women and gender diverse people with lived 37 experience in the design and delivery of service models to ensure their voices and experiences are at the centre of service design.
- Strengthen cross-sector collaboration across homelessness, maternity, sexual reproductive health, drug and alcohol and child protection services.
- Streamlining and enhancing information sharing and improving system responses and referral pathways.
- Build the skills and knowledge of homelessness and housing service professionals and healthcare clinicians to develop specialist care and support for clients impacted by pregnancy and homelessness.
- Increase supply of safe and affordable long-term housing and ensure that this is the principal option offered to pregnant homeless women and gender diverse people unless it is unsuitable for their specific circumstances.
- Where long-term housing is not available, provide access to other supported housing options including specialist transitional accommodation and safe crisis accommodation.
- Improve pregnant homeless people’s access to wrap-around and continuity-of-care models in hospital and other health settings.
We recognise and applaud the recent positive changes and support of housing and health service to build on actions and programs to improve the outcomes of vulnerable women, gender diverse people and infants. However, without recognition of the pervasive and entrenched nature of patriarchal ideology and practices in service delivery models the fundamental human rights to secure, safe and appropriate housing and healthcare remain at significant risk. Therefore, it is critical that urgent action is taken to remove the barriers and to address the service gaps affecting pregnant women and gender diverse people’s capacity to access to responsive and comprehensive homelessness and clinical care.
Endnotes
1. Murray S, Theobald J, Haylett F and Watson J 2020, ‘Not Pregnant Enough?’, Pregnancy and Homelessness. Melbourne, RMIT
2. Ibid
3. Ibid.
This article was originally published in Parity magazine. Learn more about Parity magazine including how to access full editions.