During the COVID-19 pandemic, the number of pregnant people experiencing street-level homelessness has been steadily increasing in Hamilton, Ontario. In our community, we have also seen a number of critical incidents for pregnant people experiencing homelessness, including people without shelter going into labour in public spaces and drop-in programs, miscarriages without having had access to prenatal care, and the devastating impacts of stillbirths and child apprehension at birth can have on people’s well-being. 

 YWCA Hamilton, the Community Research Platform (McMaster University) and the Community-University Policy Alliance on Gender-based Homelessness (McMaster University School of Social Work) convened a ‘Call to Action’ focusing on the intersection of reproductive health care, pregnancy and homelessness. We brought over 50 community partners together for a half-day session to learn from the voices of lived experience, hear from clinical care providers and engage in a process to inform local systems planning. 

We began our May 13th 2021 event with Medora Uppal (Director of Operations at the YWCA of Hamilton and co-chair of the Women’s Housing Planning Collaborative of Hamilton) sharing the impetus for the Call to Action. In doing so, Medora reflected on some of the complex and tragic situations that have occurred in our community for pregnant people experiencing homelessness. Furthermore, Medora encouraged community partners to use this forum as a way to re-consider the ways they prioritize supporting pregnant people within their organizations to ensure access to basic needs; safe shelter and permanent housing; and low-barrier reproductive health information, support and care.

Mary Vaccaro (PhD candidate, McMaster University School of Social Work) then gave a presentation that consolidated findings from a consultation process with people in Hamilton who have lived experience of pregnancy and homelessness. The findings that emerged from consultations with people who have lived experience highlighted three key themes: 

1. Access to basic needs (including information about reproductive choices, low-barrier reproductive and prenatal health care, a place to rest post-abortion or post-miscarriage, and access to temporary shelter and permanent housing with on-site supports).

“I did not know I was pregnant but went to the hospital and they told me I had miscarried and to just “go home”. But I didn't really have anywhere to go to rest, so that was not good. I never had any access to someone to talk to anyone. I just had to accept that what happened was because of my lifestyle but I did not have anyone or anything during that time.” - 29 years old, 15 years of homelessness 

2. Supports (from someone who ‘gets it’ - non-judgemental, trauma-informed care and peer-support options, a ‘one-stop shop’ for information, support and care relating to reproductive health and pregnancy, practical support including transportation to appointments, a systems navigator, and advocacy particularly with child welfare organizations and housing providers)

“There needs to be more women’s health clinics - ‘one-stop shops’ – there is no program where women could get all of the information they need in one spot, including access to birth control, abortion, help after a miscarriage. If you are pregnant, you need healthy meals, vitamins, somewhere to live and support from people who know what you are going through. There needs to be a place where there is no judgement. Around Barton or King St. - locate it where women are doing sex work.” - 30 years old, 12 years of homelessness 

3. Care (a sense of community, a sense of connection and someone checking in!) 

“I spent all my time just trying to get to the prenatal appointments and fighting CAS - but what would have happened if I had a home? Help to me means people coming and checking on me, making sure I am doing okay - help with getting an apartment, help with setting up the apartment, help with getting what I needed for the baby - help with someone coming to help with the baby once and a while so I can have a break because I have no supports. Let me have a chance to walk out of the hospital with my baby.”- 43 years old, 15 years of homelessness

We then heard from Dr. Robin Lennox (MD), Lisa Nussey (RM) and Chelsea Futers (RM) about existing opportunities and gaps in clinical services for pregnant people experiencing homelessness in Hamilton. Our clinical care providers shared their intentions to develop an outreach midwifery program that would offer pregnant people experiencing homelessness client-centred care from a trauma-informed and harm-reduction lens. They are continuing to seek funding to operate this kind of midwifery outreach program in our community. 

Following the presenters, community partners worked in small groups to engage in a participatory systems planning process. The organizers of the ‘call to action’ analyzed the data collected and developed eight key recommendations. A working group has been formed of emergency shelter and housing providers, health care providers, decision-makers, and people with lived experience to help advance these recommendations into action in our community. 

Key Recommendations

1. A Commitment to Truth and Reconciliation

Supports must be mobilized immediately to ensure access to Indigenous-specific health care, housing and legal advocacy for people experiencing pregnancy and homelessness. 

There is a need for the community to work together to redress the overrepresentation of Indigenous children in the care of the child welfare system. 

2. Ensure that pregnant people (and people who have either recently terminated or lost a pregnancy) are not being turned away from accessing a bed within emergency shelters 

Recognizing that shelters in the women’s sector are almost always operating at or above capacity, there is a need for dedicated beds, or a systems-wide policy ensuring pregnant people (and people who have recently terminated or lost a pregnancy) are prioritized for shelter space in Hamilton. 

3. Prioritize access to permanent housing for pregnant people through existing Housing First programs, and through housing waitlists

Without permanent housing, health outcomes decline and there is an increased risk of child apprehension. There is a need to prioritize pregnant people through existing Housing First programs and on housing waitlists (including waitlists for access to housing and local non-profit housing providers). 

4. Dedicate funding for a Pregnancy Outreach Worker to improve system navigation for people experiencing homelessness and pregnancy

There is a need to fund a dedicated outreach worker who can assist with systems navigation and provide practical support for pregnant people experiencing homelessness, addiction and mental health concerns. 

5. Develop service pathways for accessing reproductive health care during pregnancy for people experiencing homelessness (including access to abortion and support after a miscarriage)

While there are a lot of clinical services available in Hamilton, there is a need to develop comprehensive and low-barrier service pathways that outline how to access the reproductive health care services available (including contraception, abortion, abortion care, post-miscarriage and pre/post-partum supports). 

6. Bring reproductive health care services into spaces that people experiencing homelessness access

 As a way to build trust, familiarity and reduce barriers to access, there is a need to bring reproductive health care service providers directly to people experiencing pregnancy and homelessness in low-barrier drop-in spaces.

7. Supportive housing developed for people who need support to parent (thinking about what exists in the young parent sector)

A longer-term vision involves developing supportive housing specifically for people who require on-site supports in their housing during pregnancy, post-partum and parenting. 

8. ‘One-stop shop’ for reproductive health care

This kind of service could be operated as a drop-in space and could offer access to reproductive health care, support, information, referrals and education for people experiencing pregnancy, homelessness and people who face barriers to accessing healthcare services.  

If you are interested in learning more about our Call to Action in Hamilton, or you are interested in developing a similar Call to Action in your own community - please contact Mary Vaccaro at vaccarm@mcmaster.ca