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Prenatal care for homeless women

Elizabeth Liveright, MD
Section Editor
Vincenzo Berghella, MD
Deputy Editor
Vanessa A Barss, MD, FACOG


Homelessness is defined by the United States Department of Health and Human Services (HHS) as "an individual without permanent housing who may live on the streets; stay in a shelter, mission, single room occupancy facilities, abandoned building or vehicle; or in any other unstable or non-permanent situation" [1] Homelessness disproportionately affects women and children: women represent approximately 80 percent of adults in homeless families in the United States [2]. Homeless women are at higher risk of having chronic illnesses, infectious diseases, substance abuse problems, mental illness, and being a victim of sexual or domestic violence than women who are not homeless [3,4]. They are also less likely to have insurance, social support, income, or access to preventive health services [5]. Persons who experience homelessness may be less likely to engage in the health care system due to challenging relationships with care providers, inconvenience, cost, and a perceived lack of compassion and discrimination on the part of the providers [6]. Senior members of the health care team are particularly responsible for educating house staff and students on how to appropriately care for this vulnerable group of women.

Attention to the following principles is likely to improve results when providing care for homeless people [7]:

Outreach to engage those in need of health care services

Respect for each patient, regardless of circumstances

Cultivation of trust and rapport between the health care provider and patient

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Literature review current through: Nov 2017. | This topic last updated: Nov 16, 2017.
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  1. National Health Care for the Homeless Council. What is the official definition of homelessness? https://www.nhchc.org/faq/official-definition-homelessness/ (Accessed on November 16, 2017).
  2. United States Department of Housing and Urban Development. The 2008 annual homeless assessment report to Congress. HUD, Washington, DC, 2009. http://www.hudhre.info/documents/4thHomelessAssessmentReport.pdf (Accessed on November 17, 2017).
  3. Cheung AM, Hwang SW. Risk of death among homeless women: a cohort study and review of the literature. CMAJ 2004; 170:1243.
  4. Zlotnick C, Zerger S. Survey findings on characteristics and health status of clients treated by the federally funded (US) Health Care for the Homeless Programs. Health Soc Care Community 2009; 17:18.
  5. American College of Obstetricians and Gynecologists. Committee on Health Care for Underserved Women. Committee opinion no. 454: Healthcare for homeless women. Obstet Gynecol 2010; 115:396.
  6. Nickasch B, Marnocha SK. Healthcare experiences of the homeless. J Am Acad Nurse Pract 2009; 21:39.
  7. McMurray-Avila, M, Gelberg, L, Breakey, WR. Balancing act: Clinical practices that respond to the needds of homeless people. http://aspe.hhs.gov/homeless/symposium/8-Clinical.htm (Accessed on September 08, 2010).
  8. Bloom KC, Bednarzyk MS, Devitt DL, et al. Barriers to prenatal care for homeless pregnant women. J Obstet Gynecol Neonatal Nurs 2004; 33:428.
  9. Scappaticci A, Blay S. Homeless teen mothers: social and psychological aspects. J Public Health 2009; 17:19.
  10. Cutts DB, Coleman S, Black MM, et al. Homelessness during pregnancy: a unique, time-dependent risk factor of birth outcomes. Matern Child Health J 2015; 19:1276.
  11. Richards R, Merrill RM, Baksh L. Health behaviors and infant health outcomes in homeless pregnant women in the United States. Pediatrics 2011; 128:438.
  12. Jasinski, JL, Wesely, JK, Mustaine, E, Wright, JD. The experience of violence in the lives of homeless women: A research report. University of Central Florida, Orlando FL 2005. http://www.ncjrs.gov/pdffiles1/nij/grants/211976.pdf (Accessed on November 17, 2017).
  13. Killion CM. Special health care needs of homeless pregnant women. ANS Adv Nurs Sci 1995; 18:44.
  14. Crawford DM, Trotter EC, Hartshorn KJ, Whitbeck LB. Pregnancy and mental health of young homeless women. Am J Orthopsychiatry 2011; 81:173.
  15. Gelberg L, Leake BD, Lu MC, et al. Use of contraceptive methods among homeless women for protection against unwanted pregnancies and sexually transmitted diseases: prior use and willingness to use in the future. Contraception 2001; 63:277.
  16. http://www.homelesshub.ca/resource/homeless-young-women-and-pregnancy-pregnancy-hostels-single-homeless-people (Accessed on November 16, 2017).
  17. Finer LB, Henshaw SK. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sex Reprod Health 2006; 38:90.
  18. Ventura, SJ, Martin, et al. Births: Final data for 1999. Natl Vital Stat Rep 2001; 49:1.
  19. Gelberg L, Lu MC, Leake BD, et al. Homeless women: who is really at risk for unintended pregnancy? Matern Child Health J 2008; 12:52.
  20. Kennedy S, Grewal M, Roberts EM, et al. A qualitative study of pregnancy intention and the use of contraception among homeless women with children. J Health Care Poor Underserved 2014; 25:757.
  21. Haley N, Roy E, Leclerc P, et al. Characteristics of adolescent street youth with a history of pregnancy. J Pediatr Adolesc Gynecol 2004; 17:313.
  22. Beal AC, Redlener I. Enhancing perinatal outcome in homeless women: the challenge of providing comprehensive health care. Semin Perinatol 1995; 19:307.
  23. Little M, Shah R, Vermeulen MJ, et al. Adverse perinatal outcomes associated with homelessness and substance use in pregnancy. CMAJ 2005; 173:615.
  24. Stein JA, Lu MC, Gelberg L. Severity of homelessness and adverse birth outcomes. Health Psychol 2000; 19:524.
  25. Paterson CM, Roderick P. Obstetric outcome in homeless women. BMJ 1990; 301:263.
  26. Council on Community Pediatrics. Providing care for children and adolescents facing homelessness and housing insecurity. Pediatrics 2013; 131:1206.
  27. Salit SA, Kuhn EM, Hartz AJ, et al. Hospitalization costs associated with homelessness in New York City. N Engl J Med 1998; 338:1734.
  28. Roberts SC, Pies C. Complex calculations: how drug use during pregnancy becomes a barrier to prenatal care. Matern Child Health J 2011; 15:333.
  29. Allen DM, Lehman JS, Green TA, et al. HIV infection among homeless adults and runaway youth, United States, 1989-1992. Field Services Branch. AIDS 1994; 8:1593.
  30. Texas Health and Human Services Commission, Case Management Optimization. Best Practices and Emerging Trends in Case Management. http://www.hhsc.state.tx.us/about_hhsc/reports/CaseManagement_BestPractices.pdf (Accessed on September 27, 2010).
  31. American Nurses Association. Code of ethics for nurses 2001. Available at http://www.nursingworld.org (Accessed on September 27, 2010).
  32. Texas State Board of Social Worker Examiners. Title 22 (Examining Boards), Texas Administrative Code, Part 34, Chapter 781. Rules Relating to the Licensing and Regulation of Social Workers. Available at http://www.dshs.state.tx.us/socialwork/sw_rules.pdf (Accessed on September 27, 2010).
  33. Smid M, Bourgois P, Auerswald CL. The challenge of pregnancy among homeless youth: reclaiming a lost opportunity. J Health Care Poor Underserved 2010; 21:140.
  34. National Health Care for the Homeless Council. Healing Hands: Tools to help clinicians achieve effective discharge planning. http://www.nhchc.org/wp-content/uploads/2011/10/Oct2008HealingHands1.pdf (Accessed on November 17, 2017).