WASHINGTON, D.C. — When Covid-19 shut down city operations in March 2020, people were told to stay at home. For some people without their own homes to shelter in, the dilapidated building of the Harriet Tubman Women’s Shelter — located in Ward 6 just behind the D.C. Jail on the former D.C. General Hospital campus — has been providing up to 130 beds for single women during the pandemic.
The building is situated in a bleak landscape, with abandoned buildings and torn-up side roads surrounding the shelter.
Crowded, low-barrier shelters like Tubman — open to any unhoused people — are the only spaces provided by the D.C. Department of Human Services that are available to unhoused pregnant women in their first or second trimester who do not already have minor children. According to the head of the agency’s Family Services Administration, Rachel Pierre, three-quarters of complaints DHS received from the shelter system between October of 2019 and March 2021 came from women clients at low-barrier shelters.
Pregnant women in their second or third trimester without minor children cannot access a private space in a family shelter because D.C.’s Homeless Services Reform Act has, since 2005, defined a “family” as someone with a minor or dependent child, or “a pregnant woman in her third trimester.” Yet adverse pregnancy outcomes for mothers and their babies are influenced by the conditions pregnant women experience from the first trimester — which means that the third trimester is far too late to begin providing specialized services.
Sheltering in place at a low-barrier shelter is not appropriate for an expectant mother in any trimester, advocates say. It’s difficult to maintain 6 feet of distance. You cannot control how much other people will clean or whether they will wear masks. And there is very little privacy for medical needs like telehealth prenatal visits.
“We’re being told in the pandemic to stay in your home, don’t interact with strangers, limit your exposure with others,” says Amber Harding, staff attorney with the Washington Legal Clinic for the Homeless. “But the family shelter process forces people to stay with others and have contact with strangers or they won’t be found eligible.”
Despite the city’s various efforts to prevent homelessness, the barrier to single, pregnant women seeking adequate shelter during their first two trimesters has yet to be formally addressed.
Housing is prenatal health care
Housing for pregnant women is critical to maternal and infant health. Research shows that adverse environmental conditions, like being unhoused or living through a pandemic, can have a negative effect on pregnancy. Dr. Siobhan Burke, OB-GYN at Unity Health Care, D.C.’s largest health care provider for people experiencing homelessness, says that the stress and lack of healthy food access that accompanies houselessness can lead to problems with fetal growth.
D.C. fares worse than the national average when it comes to maternal and infant mortality rates, and in particular with Black maternal mortality rates (Black women are four to five times more likely to die because of pregnancy or childbirth than white women). According to the United Health Foundation, the maternal mortality rate in D.C. was 35.6 per 100,000 live births in 2019, compared with 29.6 nationally. The rate for Black women was 71 deaths per 100,000 live births in D.C., compared with 63.8 nationally. According to the CDC’s most recent data, the city’s infant mortality rate was 7.8 per 1,000 births, compared with 5.8 nationally.
In 2018, the District’s Child Fatality Review Committee reviewed the records of 33 infant deaths by natural causes in 2017 and found that all had been born prematurely (in the second trimester) and weighed less than the expected birth weight for their gestational age. Homelessness was identified as a common “environmental risk factor” for the mothers whose infants died in 2017. (The other three factors identified by the committee were histories of domestic violence, abuse or neglect, and mental health issues.) The Office of the Chief Medical Examiner stated that, while it recognizes the general negative impact of a mother’s housing insecurity on infants, it does not keep track of a mother’s housing status when assessing infant deaths.
Even an estimate of how many pregnant women experience houselessness in their first and second trimesters each year is hard to come by, given a lack of public data.
Obstructing access to family shelters
Even pregnant women in their third trimester or who already have minor children encounter obstacles to accessing family shelters, and often poor conditions and harassment by staff once they are admitted.
At a March 1 D.C. Council oversight hearing on the Department of Human Services, Susan Gallucci, executive director of women’s health and pregnancy empowerment nonprofit The Northwest Center, expressed grave concerns about the treatment of expectant mothers at the Virginia Williams Family Resource Center as well as at low-barrier shelters.
“From what I’ve been told by the women that we serve, the intake process has become more like an interrogation and less like questions for an intake,” Gallucci told the council. “There has been an increase in complaints about the way in which a woman has been treated. Their requirements appear to have become more and more stringent and create additional barriers for pregnant women and families experiencing homelessness to find a safe, stable shelter.”
As reported previously by Street Sense Media, a homeless mother testified at a 2019 oversight hearing that she was denied family shelter access three times during hypothermia season in spite of having a 5-year-old son with her. She was only allowed access on her fourth attempt because she was accompanied by a lawyer. Once housed at the shelter, she said, “I was constantly harassed by staff and told that I was going to be terminated because … I wasn’t in my third trimester. And also because my doctor had pen-wrote-in my due date and put the signature beside there.”
When the Homeless Services Reform Act was amended in 2017, growing to 85 pages from its original 39 pages, the detailed update increased scrutiny to prevent families who were last housed outside of the District from entering D.C.’s family shelters. Every family applying for shelter is required to be screened first for eligibility for the Homelessness Prevention Program, which provides limited cash assistance and counseling to help stabilize homeless families, so they can stay with other family members or friends instead of entering the family shelter system.
In her testimony, Gallucci spoke about the “stringent” requirements that she believes are intended to discourage pregnant women from applying for shelter, such as the necessity to present current D.C. identification as proof that they are eligible for low-barrier shelter. “I spoke with a pregnant woman who had been living with her grandmother and then went to Virginia Williams when her grandmother passed away — and then was told that she had to obtain a copy of her deceased grandmother’s lease in order to receive services,” Galluci shared.
Even if they get to a family shelter in their third trimester, women may not get the services — or respect — that they need and deserve, said Taylar Nuevelle, founder of Who Speaks for Me?, a D.C.-based advocacy nonprofit focused on justice for women, girls, and LGBTQ people impacted by trauma.
“No one really cares,” she said. “Once the women get to the family shelter, there’s this push like they’ve overstayed their welcome as opposed to, ‘Take your time. It’s a pandemic.’ And when they go from low-barrier shelters to family shelters, they have a lot of catching up to do. They need help with making sure they have their WIC [food stamps for Women, Infants, and Children] and housing. Most of these women don’t have jobs. And if they do, they have to pay for child care, baby clothes, and they have to pay for cell phones. That’s why many of them don’t have phones.
“There’s a lack of respect for the trauma of being homeless and pregnant,” Nuevelle added.
Waiting for change
Ward 1 Councilmember Brianne Nadeau heads the Committee on Human Services, which oversees the operations of the Department of Human Services. She is focused on early interventions to prevent homelessness, but also has been working on possible policy changes that would provide solutions for unhoused pregnant women, including access to family shelters.
Nadeau, a mother herself, indicated that she’s on board with enacting changes, but did not give a timeline of when she would introduce legislation. “Our pregnant mothers need as much support as we can get them here in the District. So if that means that we need to reexamine the policy when they’re eligible for family shelter, I’m happy to do it. But I also just want to be mostly focused on how we’re getting them the right services,” Nadeau said in an interview.
“Ideally you can help them permanently before they give birth,” she added. “You want that mom to not be worrying about her housing when she has a newborn.”
Pierre echoed Nadeau’s sentiments about the value of getting women access to interventions earlier in their pregnancies. She pointed to nonprofit programs such as Project Connect through Catholic Charities and the Homelessness Prevention Program through Community of Hope as alternative services available to pregnant women experiencing homelessness in the District.
Yet without understanding the scope of the problem for unhoused women, the situation cannot be adequately addressed. The annual “Point-in-Time Count” of people experiencing homelessness in D.C. does not report how many women surveyed were pregnant. (The Department of Human Services did not respond in time for publication by The DC Line and Street Sense Media to questions about how pregnancy among low-barrier shelter residents is tracked.) The only data point available to assess how many expectant mothers are in need is the number of people who receive services from the Virginia Williams Family Resource Center, which does not include anyone in their first or second trimester.
In the meantime, advocates like Nuevelle are fighting to fill the gaps where D.C.’s provisions for unhoused pregnant women fall short. On many Saturday afternoons, you can find Nuevelle and a couple of dedicated volunteers outside of the Tubman shelter. She keeps returning despite run-ins with shelter staff and security enforcing rules that restrict donations of personal items and visitors. Nuevelle questions these rules and challenges staff to do more to help residents find permanent housing and get the personal items they need.
Like clockwork, when the women living in the shelter notice Nuevelle’s car pull up to the parking lot across the street on a Saturday afternoon, they line up to receive coats, boots, toiletries, socks, hand sanitizer and, perhaps, some hope.
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Candace Y.A. Montague (she/her) is a freelance journalist in Washington, DC. She covers health, racial and social justice, and gender inequality for local and national publications. Follow her on Twitter @urbanbushwoman9