The Extent, Nature and Impact of Homelessness on Pregnant Women and Their Babies

by Dr Freda Haylett, Professor Suellen Murray, Dr Juliet Watson and Dr Jacqui Theobald

This article was originally published in Parity magazine. Learn more about Parity magazine including how to access full editions.

Pregnant women and homelessness

This article discusses the findings of two studies conducted by researchers at RMIT University and La Trobe University during 2017–18 and 2019–20, funded by Launch Housing and the Lord Mayor’s Charitable Foundation respectively.

In total, the research involved in-depth interviews with 14 women with recent experience of pregnancy and homelessness in Victoria and interviews and focus groups with 41 practitioners from 27 health, homelessness and related services. Most services were in Victoria, including those from regional and rural areas, with one from interstate that had been identified as an example of good practice.

Using these studies and an updated review of relevant literature, this article focuses on three critical components of pregnancy and homelessness: what is known about extent of the problem in Australia; the impacts of homelessness on pregnant women and their babies; and the gendered experiences of homelessness, including the harms of a “gender-neutral” approach to supporting pregnant and parenting homeless women.

Counting Homeless Pregnant Women

There is not a lot known about the number of pregnant women who are homeless in Australia, and this represents a significant gap in knowledge that could be used to inform social and health policy and service delivery. In the United States and the United Kingdom, some attempts have been made to identify the extent of pregnancy among the homeless population.

In the US, for example, one study estimated that one in five homeless women are pregnant at any given time, almost twice the rate of the general population. Similarly, a London study found almost a quarter of young homeless women were pregnant. Other research uncovered even higher rates of pregnancy among homeless women, finding that while 10 per cent of women in the US were pregnant in 2009, 50 to 60 per cent of homeless women were pregnant.

However, our research found that pregnancy status was not routinely and consistently collected by homelessness agencies in Victoria, which would enable researchers to begin to estimate the extent of pregnancy among homeless women in this state. Where data is being collected, it tends to be by specialist homelessness and health services who work specifically with women. In addition, sometimes these data are difficult to enumerate because they are embedded in case notes rather than in a formal system where they can be readily accessed. Figuring out a way to aggregate this data between and across health and homelessness sectors would significantly improve the accuracy of this information.

To identify the number of pregnant women seeking housing support in Victoria, two snapshot surveys were undertaken in 2017 at Launch Housing and the Salvation Army Crisis Services Network. Reflecting international data, these surveys found that the percentage of pregnant women who were homeless was higher than that among the wider population of Australian women.

Even so, such data only include those women who seek support from services or, if they do, disclose their pregnancy. There is, then, likely to be a population of pregnant women experiencing homelessness who remain invisible to services. Our research found that sometimes women do not disclose pregnancy because they fear this would make them less likely to be housed. They may be excluded from access to short-term crisis accommodation because they will need to move when their baby is born, which highlights a troubling disincentive in the system for women to disclose their pregnancy early on to support workers. Some women also fear that making services aware of their pregnancy could lead to their baby’s removal by Child Protection, a finding also noted in other studies.

The Impact of Homelessness on Women and Babies

Babies born to homeless women are at higher risk of birth complications, and longer-term medical complications are more prevalent among this group of children, including ongoing behavioural and emotional problems caused by the effects of maternal stress in utero. A recent study in the US found a 73 per cent higher risk of low birth weight or preterm birth among infants born to mothers who experienced homelessness or threatened eviction, while infants had an increased risk of requiring a stay in a neonatal intensive care unit.

Our research also uncovered experiences of serious health complications during pregnancy such as gestational diabetes, preeclampsia and very low blood pressure. The women were required to manage these conditions in circumstances not conducive to rest and recuperation, and where access to necessities such as adequate nutrition was difficult to obtain.

An important aspect of having stable, secure housing is that women can prepare for the birth, both psychologically and practically. Having a safe place means that a woman can consider what motherhood will entail and can acquire the material goods needed to care for her baby, such as clothing and equipment. However, many of the women we interviewed did not have this opportunity to prepare for the birth due to the dangerous and precarious nature of their circumstances, such as living in a car, rough sleeping or couch surfing, where they were exposed to violence and other hazards to their health and that of the baby.

When women are not stabilised in housing early in their pregnancy, it undermines the relationship between mother and baby during the critical early stages.

Gendered Experiences of Homelessness

Gender inequality impacts pregnant women in a multitude of ways that increase their risk of homelessness. One of the key hurdles pregnant homeless women face as they navigate support services is “gender blindness”, wherein their distinct needs as women are often overlooked and, while not necessarily intentional, a normative masculine (and white) model of service delivery is standardised. Consequently, policy and practice responses to homelessness have been criticised for being “gender-neutral”, relying on a “one-size-fits-all” approach despite there being “gender-specific processes and practices involved in the navigation of poverty, violence, and social exclusion”.

Gender-based violence, in particular, is a significant factor in women’s homelessness, and pregnancy is known to be a risk factor for the onset or an increase in family violence; it is a key reason why women seek homelessness support. In Victoria in 2016–17, 40 per cent of clients (or nearly 115,000 people) seeking assistance from homelessness services were experiencing family violence. Our research also unearthed incidents of gender-based violence with most of the women interviewed having experienced family violence, sexual assault or child abuse in their past, and for many it had directly caused or contributed to a worsening of their homelessness circumstances.

Pregnant women need safe, long-term housing

Our research found that pregnant homeless women are a largely unrecognised and highly vulnerable group. They have specific and complex needs that require greater attention and specialised responses from homelessness and housing services.

The lack of reliable data on the numbers of pregnant homeless women makes it difficult to provide appropriate and targeted service responses meaning their unique needs, as distinct from men’s, can be overlooked. This has implications not only for women but also for their babies as there are serious physical and psychological effects for both mother and baby in failing to provide safe, long-term housing.

This article was originally published in Parity magazine. Learn more about Parity magazine including how to access full editions.