Impact of homelessness on pregnant mothers and their families Assessment Answer

Introduction

This essay will demonstrate the critical connection between homelessness and public health and midwives' vital role in tackling this social issue. The lack of a stable, consistent, and sufficient place to live at night is known as homelessness, and it is a complex problem with wide-ranging effects (Substance Abuse and Mental Health Services Administration (SAMHSA), 2023). People who are homeless have significant obstacles when it comes to accessing healthcare, being more vulnerable to infectious diseases, and having poorer outcomes for the health of mothers and children (Bedmar et al., 2022). As the primary caretakers for women during pregnancy, labour, and the postpartum period, midwives have a crucial role in aggravating the healthcare inequalities experienced by individuals who lack permanent housing. 

This essay will explore the various facets of homelessness, delving into its root causes, health ramifications, and the unique challenges confronted by pregnant individuals navigating unstable living conditions. Emphasis will be placed on the imperative for midwives to comprehend and actively address this issue. Homelessness, given its profound impact on health disparities, necessitates a comprehensive healthcare approach. Positioned as maternal and infant welfare advocates, midwives possess a unique capacity to contribute to a compassionate, equitable, and all-encompassing healthcare response.

Supporting statistics

Survey responses from midwives in the UK underscore the staggering prevalence of various forms of homelessness among pregnant women. An overwhelming 99.7% of midwives acknowledged encountering pregnant women who were homeless in the past six months, illustrating the pervasive nature of this issue. Furthermore, a substantial 96.7% reported instances where pregnant women were perceived to be at risk of homelessness, emphasising the urgency of intervention and support. Disturbingly, 97% of midwives had witnessed pregnant women forced to endure overcrowded or otherwise unsuitable living conditions, highlighting the detrimental impact on maternal and fetal well-being (Royal College of Midwives (RCM), 2019). The challenges extend to pregnant women seeking refuge in hostels, shelters, or temporary accommodations, with 99% of midwives encountering such situations.

Additionally, the distressing phenomenon of sofa-surfing, where pregnant women lack a stable place to stay and move between acquaintances, was observed by 97% of midwives. Perhaps most alarmingly, 81% of midwives had encountered pregnant women experiencing street homelessness, exposing these vulnerable individuals to extreme risks and hardships. These stark statistics emphasise the critical need for comprehensive and targeted support systems as midwives navigate the complex landscape of homelessness to ensure the well-being of pregnant women and their unborn children (RCM, 2019).

Impact on Maternal Health

Pregnant people are affected dramatically by the severe effects of homelessness on maternal health. Pregnancy difficulties are greatly increased among homeless women due to their increased susceptibility to high-stress levels, poor nutrition, and restricted access to prenatal care (Ervin et al., 2022). A 2019 study by McGeough et al. found that compared to their housed peers, pregnant women who are homeless are more likely to give birth early and have babies with low birth weights. These unfavourable results highlight the critical need for comprehensive, coordinated treatment to meet the particular difficulties faced by pregnant homeless people. Midwives are essential in reducing these hazards as the primary caregivers during pregnancy. Social determinants of health and medical demands must be taken into consideration when coordinating treatment for expectant mothers living in unstable housing. The cyclical nature of homelessness makes it difficult to provide care that is both accessible and consistent (DiTosto et al., 2021). This means working with other organisations to establish a caring and supportive atmosphere for pregnant people experiencing housing instability and adopting creative approaches to service delivery.

Challenges in Coordinating Care

Collaboration between shelters, social services, and community organisations is necessary to coordinate care for pregnant homeless people (NICE, 2022). However, practical cooperation is frequently impeded by systemic hurdles. For example, research by Gongora-Salazar et al. (2022) identifies major barriers to information use and access, operational difficulties, and resource limitations as hurdles in integrated care. The fragmented structure of these systems may result in gaps in care, limiting midwives' attempts to offer comprehensive and ongoing assistance. In addition, midwives encounter difficulties in managing the multifaceted requirements of homeless pregnant women, which encompass everything from jobs and housing to mental health and drug abuse concerns (McGeough et al., 2020). Strong teamwork with social workers, mental health specialists, and housing organisations is essential to address these issues successfully. 

Homelessness and Infant Health

Beyond pregnancy, homelessness has an impact on the growth and health of the unborn child. According to The Queen's Nursing Institute (n.d.), babies delivered to homeless moms may be more susceptible to respiratory problems, infectious infections, and developmental delays. Furthermore, compared to babies born to moms who were housed, infants born to homeless mothers had greater hospitalisation rates and were more likely to suffer from respiratory disorders (Holden et al., 2023). Midwives must address these issues through close postpartum supervision, thorough prenatal education, and support programs.

Working together with paediatricians and social workers is crucial to ensuring that homeless families receive continuous treatment. But when midwives collaborate with other organisations, they run across obstacles. For example, social workers frequently deal with a lot of work, tight budgets, and limited time (Mattison et al., 2021). According to the National Health Service (NHS) report, there is a growing need for mental health treatments, which frequently leads to extended wait times and fewer resources (House of Commons Library, 2023). Given that improving the health of mothers and infants is a shared objective, midwives must push for more funding and improved lines of communication.

Psychosocial Impact on Wider Family

The psychological effects of homelessness ripple throughout the family, impacting spouses' and other kids' well-being. Family members' mental health is impacted by the atmosphere of stress and uncertainty that homelessness brings (Anderson et al., 2021). Midwives need to have a family-centred approach, taking into account the whole family. To address the emotional toll of homelessness, collaboration with mental health providers and family support agencies becomes essential. Furthermore, Josheh et al.'s research from 2023 highlights the necessity of integrated and community participation for homeless families, pointing out that both parents—especially single mothers—and their kids are more likely to experience mental health problems. Midwives can address the wider effects of homelessness on the wellbeing of the entire family by providing more thorough and effective care by acknowledging the linked issues families experience (NICE, 2022).

Addressing Barriers to Prenatal Education

Grand-Guillaume-Perrenoud et al. (2022) state that although prenatal education is essential for mother and infant health, homeless people frequently encounter obstacles in their quest to access these resources. By customising instructional materials to meet the specific needs of this demographic, midwives can effectively overcome these hurdles. Collaboration with community organisations becomes vital to delivering accessible and culturally sensitive education (Jones et al., 2017). To enable pregnant women who are homeless to make decisions about their own and their children's health, educational barriers must be removed (Nelipovich et al., 2022). Research from the National Institute for Health and Care Excellence (NICE) emphasises the necessity of providing pregnant people facing homelessness with focused and readily available support (UK, 2022). By working together, midwives, community organisations, and educational institutions can close the access gap to prenatal education, enabling expectant mothers to make better decisions about their health (Behruzi et al., 2017).

Advocacy for Systemic Change

Midwives are uniquely positioned to support systemic change since they advocate for the health of mothers and infants. Midwives can become more effective advocates by analysing the obstacles and difficulties in care coordination. According to Rayment-Jones et al. (2020), this could entail advocating for legislative changes that address the socioeconomic determinants of health, increasing financing for supportive services, and improving coordination between social services and medical organisations. To address the health needs of pregnant women who are homeless, for example, the NICE underlines the necessity of a collaborative and multidisciplinary approach (NICE, 2022). Understanding that homelessness is a systemic issue motivates midwives to take the initiative to promote long-lasting change. Promoting more funding, better channels of communication, and legislative changes will help homeless pregnant people feel more supported, which will ultimately benefit the moms, babies, and extended families.

Conclusion

In summary, this essay has shed light on the complex relationship between public health and homelessness, highlighting midwives' critical role in resolving this widespread social issue. Pregnant women are disproportionately likely to be homeless, as seen by the startling data from a UK midwives' survey. This highlights the critical need for focused interventions and support networks. The effects on maternal health are significant, as poor housing puts expectant mothers at higher risk of problems. As the primary caregivers, midwives are essential in assisting with the intricate task of arranging care for pregnant homeless people.

Nevertheless, they run into structural obstacles that complicate cooperation with other agencies. Moreover, the repercussions of homelessness on the health of infants and the more prominent families require a comprehensive approach to midwifery care. Advocating for systemic change and developing specialised educational practices are necessary to address these issues. Midwives can support a more compassionate and equitable healthcare response by pushing for improved collaboration methods, additional resources, and regulatory reforms. By promoting systemic change, midwives work to improve the health of homeless mothers and their children, providing access to stable housing and comprehensive care.

References

Anderson, M., Hazel, A., Perkins, J. M., & Almquist, Z. W. (2020). The Ecology of Unsheltered Homelessness: Environmental and Social-Network Predictors of Well-Being among an Unsheltered Homeless Population. International Journal of Environmental Research and Public Health, 18(14), 7328. https://doi.org/10.3390/ijerph18147328

Bedmar, M. A., Bennasar-Veny, M., Artigas-Lelong, B., Salvà-Mut, F., Pou, J., Capitán-Moyano, L., García-Toro, M., & Yáñez, A. M. (2022). Health and access to healthcare in homeless people: Protocol for a mixed-methods study. Medicine, 101(7). https://doi.org/10.1097/MD.0000000000028816

Behruzi, R., Klam, S., Dehertog, M., Jimenez, V., & Hatem, M. (2017). Understanding factors affecting collaboration between midwives and other health care professionals in a birth center and its affiliated Quebec hospital: A case study. BMC Pregnancy and Childbirth, 17(1), 1-14. https://doi.org/10.1186/s12884-017-1381-x

DiTosto, J. D., Holder, K., Soyemi, E., Beestrum, M., & Yee, L. M. (2021). Housing instability and adverse perinatal outcomes: A systematic review. American Journal of Obstetrics & Gynecology MFM, 3(6), 100477. https://doi.org/10.1016/j.ajogmf.2021.100477

Ervin, E., Poppe, B., Onwuka, A., Keedy, H., Metraux, S., Jones, L., Sandel, M., & Kelleher, K. (2022). Characteristics associated with homeless pregnant women in Columbus, Ohio. Maternal and Child Health Journal, 26(2), 351-357. https://doi.org/10.1007/s10995-021-03227-y

Gongora-Salazar, P., Glogowska, M., Fitzpatrick, R., Perera, R., & Tsiachristas, A. (2022). Commissioning [Integrated] Care in England: An analysis of the current decision context. International Journal of Integrated Care, 22(4). https://doi.org/10.5334/ijic.6693

Grand-Guillaume-Perrenoud, J. A., Origlia, P., & Cignacco, E. (2022). Barriers and facilitators of maternal healthcare utilisation in the perinatal period among women with social disadvantage: A theory-guided systematic review. Midwifery, 105, 103237. https://doi.org/10.1016/j.midw.2021.103237

guideline NG214, N. I. C. E. (2022). Integrated health and social care for people experiencing homelessness. Methods.

Holden, K. A., Lee, A. R., Hawcutt, D. B., & Sinha, I. P. (2023). The Impact of Poor Housing and Indoor Air Quality on Respiratory Health in Children. Breathe, 19(2). https://doi.org/10.1183/20734735.0058-2023

House of Commons Library. (2023). Mental health policy and services in England. https://commonslibrary.parliament.uk/research-briefings/cbp-7547/

Jones, E., Lattof, S. R., & Coast, E. (2017). Interventions to provide culturally-appropriate maternity care services: Factors affecting implementation. BMC Pregnancy and Childbirth, 17(1), 1-10. https://doi.org/10.1186/s12884-017-1449-7

Joseph, N., Burn, A. M., & Anderson, J. (2023). The impact of community engagement as a public health intervention to support the mental well-being of single mothers and children living under housing insecure conditions–a rapid literature review. BMC Public Health, 23(1), 1866. https://doi.org/10.1186/s12889-023-16668-7

Mattison, C., Bourret, K., Hebert, E., Leshabari, S., Kabeya, A., Achiga, P., Robinson, J., & Darling, E. (2021). Health systems factors impacting the integration of midwifery: An evidence-informed framework on strengthening midwifery associations. BMJ Global Health, 6(6). https://doi.org/10.1136/bmjgh-2020-004850

McGeough, C., Walsh, A., & Clyne, B. (2020). Barriers and facilitators perceived by women while homeless and pregnant in accessing antenatal and or postnatal healthcare: A qualitative evidence synthesis. Health & Social Care in the Community, 28(5), 1380-1393. https://doi.org/10.1111/hsc.12972

Nelipovich, S., Kotagiri, N., Afreen, E., Craft, M. A., Allen, S., Davitt, C., & Diehr, S. (2022). Impact evaluation of patient-centered, community-engaged health modules for homeless pregnant women. WMJ, 100.https://wmjonline.org/wp-content/uploads/2022/121/2/99.pdf

Rayment-Jones, H., Silverio, S. A., Harris, J., Harden, A., & Sandall, J. (2020). Project 20: Midwives’ insight into continuity of care models for women with social risk factors: What works, for whom, in what circumstances, and how. Midwifery, 84. https://doi.org/10.1016/j.midw.2020.102654

Royal College of Midwives (RCM). (2019). Dispatches and RCM find that 99.7% of midwives have seen mothers who were homeless over the past six months. https://www.rcm.org.uk/media-releases/2019/november/dispatches-and-rcm-find-that-997-of-midwives-have-seen-mothers-who-were-homeless-over-the-past-six-months/

Substance Abuse and Mental Health Services Administration (SAMHSA). (2023). SOAR definitions of homelessness and at risk of homelessness. https://soarworks.samhsa.gov/article/definitions-of-homelessness#:~:text=The%20definition%20of%20those%20who,not%20meant%20for%20habitation%2C%20or

The Queen’s Nursing Institute. (n.d). The impact of homelessness on babies and their families. https://www.qni.org.uk/wp-content/uploads/2016/09/homelessness_babies_families.pdf

UK, N. G. A. (2022). Evidence review for views and experiences of health and social care for people experiencing homelessness. https://www.ncbi.nlm.nih.gov/books/NBK579614/

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