Structural inequities amplify homelessness challenges for pregnant people in Washington DC

WASHINGTON — New research conducted with Washington, DC, residents who experienced homelessness during pregnancy sheds light on the intersection of homelessness, pregnancy, and racial inequities. The findings underscore the urgent need for policy and practice changes to support vulnerable populations.

The study, published May 30, 2024 in the journal Health Equity (DOI: 10.1089/heq.2023.0235), is grounded in a reproductive justice framework and delves into the lived experiences of 20 DC residents who faced homelessness while pregnant.

Homelessness during pregnancy is a symptom of broader structural inequities in access to safe and stable housing, and exacerbates adverse health outcomes for birthing people and infants. Conducted by researchers aiming for an action-oriented recommendations, the findings emphasized three key areas for policy and practice improvements:

• Timely Access to Safe Housing: One of the foremost recommendations is ensuring pregnant individuals have timely and meaningful access to safe and stable housing. The lack of secure housing not only impacts immediate health but also sets the stage for long-term challenges in child-rearing and family stability.
• Comprehensive Care Coordination: The study advocates for improved care coordination encompassing services and referrals that support physical, mental, and social well-being. Housing insecurity often intertwines with other complex needs, necessitating a holistic approach to healthcare and social support systems.
• Economic Justice and Affordable Housing: Access to a living wage and affordable housing emerged as critical components. Economic disparities, compounded by lack of affordable housing, disproportionately affect marginalized communities, amplifying the cycle of homelessness and health disparities.

The study’s lead researcher says stable housing is critical to health outcomes for the child and parents.

“Pregnant and parenting people in Washington, DC, must have a stable home as early in pregnancy as possible,” says Christina X. Marea, PhD, MA, MSN, FACNM, assistant professor of nursing at Georgetown’s School of Nursing. “That stability can improve health outcomes for birthing people and infants, support their ability to plan for the postpartum period, and enable them to enjoy this incredible life transition without the unrelenting stress and fear of homelessness.”

The study’s insights have directly influenced strategic policy and practice recommendations, paving the way for a new model of collaboration across sectors. Initiatives like the DC Calling All Sectors Initiative (CASI), spearheaded by the DC Health Office of Health Equity, exemplify the commitment to bridging structural gaps and addressing the needs of vulnerable populations.

“The perspectives of people with lived experience has led directly to new initiatives at Community of Hope to support people who are pregnant and experiencing homelessness, says Kelly Sweeney McShane, CEO at Community of Hope, a community health center and homeless services provider who supported the study. “ The perinatal period is such an important one, and stable housing and access to healthcare are important components for both parent and baby during that critical period.”

The study’s recommendations align with broader efforts to promote health equity and dismantle systemic injustices. Sustained political will and collaborative endeavors are essential to effectuating tangible improvements in housing accessibility and perinatal care.

The authors stress that as the nation grapples with ongoing challenges in housing insecurity and healthcare disparities, initiatives rooted in community based participatory research, that are intentionally informed by the lived experience of impacted residents, offer a beacon of hope for transformative change. The voices and experiences of those navigating homelessness during pregnancy serve as catalysts for a more inclusive and equitable future.

The work was supported by a grant from the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and the Pew Charitable Trusts.

C. Anneta Arno, PhD, MPH, Chief Health Equity Officer at DC Health, says, “The Office of Health Equity is appreciative of the grant, which enabled us to tangibly demonstrate the importance of proactive engagement of non-traditional partners, including impacted residents, government agencies, community-based organizations, as well as academia, to inform equity-driven collaborative practice change, by applying a health in all policies framework to address persistent structural barriers to health.”

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In addition to Marea, Arno, and McShane, collaborating researchers include Andrew Lozano, MPH, and Makeda Vanderpuije, MPH CPH,  DC Health Office of Health Equity; Kelley N. Robinson, PhD, CNM, CNE, University of Maryland; Karen Trister Grace, PhD, MSN, CNM, FACNM, George Mason University School of Nursing; and Noelene K. Jeffers, PhD, CNM, IBCLC, Johns Hopkins University School of Nursing.

The authors report having no personal financial interests related to the study.