Living on the streets of San Francisco brings undoubtable hardships for its 7499 homeless residents (ASR). Now imagine the additional pressure of being seven months pregnant and waiting to gain access to one of San Francisco’s scarce emergency family shelter beds: this is the bleak reality for many pregnant homeless women in San Francisco today, and by extension their unborn children. Despite San Francisco being the wealthiest urban area in America (US Census Bureau) and priding itself on being a city of progressive values, homeless pregnant women find themselves sleeping in doorways and tent encampments. A shocking lack of adequate shelter, and timely, accessible healthcare means that homeless women are birthing premature babies alone in the Golden Gate Park on damp December nights, and in Muni bus shelters as commuters look on in shock (Elle, J; Graff, A).
Figures from the Department of Public Health show that between 2010 and 2015, the number of pregnant women in San Francisco who identify as homeless rose seventy-six percent. Inadequacies in the city’s emergency housing policy leave this most vulnerable group of mothers homeless throughout most of pregnancy, if not their entire pregnancy. In their 2017 report, the Department of Homelessness and Supportive Housing acknowledge that there are simply not enough resources to offer housing opportunities to all families that meet their criteria. In particular, we see pregnant women with no other children slipping through the cracks in the system. The current guidelines set out by the Department of Homelessness and Supportive Housing mean that pregnant women without any accompanying minors are ineligible to receive family housing before the third trimester of pregnancy.
The only exception is if the mother’s pregnancy has been deemed and certified by a physician to be “high-risk”, and even then, she must be at least five months pregnant. Given that homeless pregnant women are significantly less likely to have a regular source of adequate prenatal care than their housed counterparts, potential problems in pregnancy are often not screened for and identified early on (Doskoch, P; Richards, R et.al; Teruya, C. et.al). What’s more, even after qualifying for an emergency family shelter, the average wait is 121 days which means that by the time most women have been able to access family emergency shelter, they have already given birth (Friedenbach and Schmalz). The alternative facing these women is to either simply remain on the street, or to line up every day for the chance of a bed in a regular adult shelter. Adult shelters might seem like a reasonable option, but they offer large communal sleeping environments with no specialized care for pregnant women, and no guarantee that a bed for the night will even be secured at the end of a long wait.
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Furthermore, statistics from the Family & Youth Services Bureau highlight why adult shelters present such an unappealing prospect for most homeless women: the sad reality is that the vast majority of homeless women are victims of domestic violence (70%) or sexual abuse (50%) which makes staying in a shelter with unknown men an unappealing and scary prospect, especially while pregnant. As the program director, Kristen Keller, at San Francisco nonprofit Compass Family Services puts it, “We are in this situation where [the] reality is we don’t have enough shelter for pregnant women who are developing a fetus, which is the essential time to have safe shelter…” (qtd. in Waxmann). With the current lack of capacity in San Francisco shelters and government housing, it is understandable why people might assume that the city’s current Rapid Rehousing initiative is the answer. This program sends homeless and low-income families out of the city to where housing is more affordable and supports them by paying the rent for a limited time to give them the chance to get back on their feet.
However, research by UCSF highlights that the rapid rehousing policy has a number of unintended negative consequences such as the destruction of social networks, and the underminement of the health and wellbeing of pregnant women and their babies by creating barriers to medical care which all lead to worsening health outcomes. Moreover, when the complicated issue of homelessness and rehousing is compounded by pregnancy, the limited-time nature of the support offered means that women are once more facing instability not long after their baby has been born, only this time in an unfamiliar city. In an evaluation of San Francisco’s Homelessness Prevention and Rapid Rehousing Program, pregnant recipients of the Rapid Rehousing initiative commented that the length of assistance was not long enough. One said, “You need stability, if after 18 months you have to move, then you’re in danger, at risk again.” Another commented that she needed “…more time—18 months it’s not enough, especially for a woman who’s pregnant—after one year, the baby is just born.”
Program staff were particularly disparaging about Rapid Rehousing, emphasizing that essential networks are destroyed when people are displaced, “…all the case management in the world is not going to replace this network. You’re destroying communities. Rapid Rehousing destroys the communities that people rely on when they’re poor.” (qtd. in McCoy-Harms et.al) The positive influence of safe, consistent housing during pregnancy, and the negative consequences of instability and displacement cannot be underestimated. Jessica Wolin, associate director of community practice for the Health Equity Institute reveals “In San Francisco, preterm birth rates are highest for women who are homeless and who live in single-room occupancy hotels and public housing,” (qtd. in Viani). In fact, research shows that homeless pregnant women living in San Francisco experience twice the rate of premature birth when compared to pregnant women living in standard housing, with as many as one in every five pregnant homeless women giving birth prematurely (California Department of Public Health).
