The Challenges of Pregnancy in Homeless Women


Dr. Kecia Gaither

“Homeless mothers have less prenatal care, are more likely to be underweight or obese, and are more likely to have substance abuse problems.”


Pregnancy rates are higher among homeless women than among housed women. But not surprisingly, the stress of homelessness has significant negative effects on the health of pregnant women and their babies. “Homeless mothers have less prenatal care, are more likely to be underweight or obese, and are more likely to have substance abuse problems,” says Maternal Fetal Medicine Specialist, Dr. Kecia Gaither. “Their babies have lower birth weights, longer hospital stays, and are more likely to need neonatal intensive care. Ensuring adequate care for these women is a challenge for clinicians and social service providers.”

The Importance of Prenatal Care
Almost a third of the millions of women who give birth each year have some kind of pregnancy-related complication. With adequate prenatal care, potential complications can be detected early and the risk reduced. Without care, an issue that could have been successfully dealt with can have serious consequences for both mother and child. Health care providers can also educate women on the importance of good diet and nutrition and other healthy habits important for them and their babies. For women who have pre-existing physical or mental health conditions or substance abuse problems – all of which are prevalent among the homeless – pre-natal care is even more important. “Many homeless women, especially those who are chemically dependent, avoid seeking medical care for fear that their babies may be taken away from them,” says Dr. Gaither. “In many communities, social service organizations provide outreach programs for homeless women and are skilled at building trust to ensure that the women get the care they need.”

The Dangers of Under- and Overweight
Both very low body weight and obesity are risk factors in pregnancy. Underweight women are likely to give birth to underweight babies who are at greater risk of several serious complications. Obese women are at increased risk of conditions associated with high blood pressure, such as pre-eclampsia and gestational diabetes, and often have very large babies, which can complicate delivery. “All homeless women are at risk of under-nourishment,” says Dr. Gaither, “but this problem is even more acute for those who are pregnant. Both under- and overweight pregnant women may unavoidably have poor eating habits and limited access to healthy foods. Education is critical to help them learn what to eat and how to gain access to healthy foods and prenatal vitamins.”

The Challenge of Substance Abuse
Prenatal exposure to alcohol is the leading preventable cause of birth defects in the United States. Smoking during pregnancy dramatically increases the risk of stillbirth, premature delivery, and low birth weight. And street drugs – especially heroin and illicitly obtained prescription opioids – increase the risk of miscarriage, stillbirth, preterm labor, and problems with the placenta. “Babies whose mothers used highly addictive drugs may be born addicted to those drugs and suffer debilitating withdrawal after birth,” says Dr. Gaither. “But quitting addictive drugs suddenly can also cause devastating problems for the baby. Women who are addicted must get treatment that gradually reduces their dependency in a way that is safe for themselves and their babies. This is a particularly complex challenge for pregnant homeless women. They must seek help from a community health center or recovery program.”

“Clinicians and social services providers who work with homeless pregnant women must gain the mother's trust and emphasize concern for the baby's health, not condemnation of her behavior,” says Dr. Gaither. “She needs to know that services are available to help her learn how to care for the child, train for a job, and most important, find a place to live. With strong motivation and support, she can raise her child in a loving, stable, and healthy environment.”

Kecia Gaither, MD, MPH, FACOG, a perinatal consultant and women’s health expert, is a double board-certified physician in OB/GYN and Maternal-Fetal Medicine in New York City. Dr. Gaither is Director of Perinatal Services at NYC Health + Hospitals/Lincoln, Bronx, New York.

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