Women in the Shadows: Women unwilling or unable to access prenatal care

1. Women in the Shadows: Women unwilling or unable to access prenatal care Streetworks Streetworks, Edmonton

2. Who are the women we are talking about? • Women involved in the street • Working in the sex trade • Women using illicit drugs • Women with multiple Children’s Services involvement • Women with criminal justice system involvement • Highly stressed, undernourished, homeless • Women with preexisting health problems (HIV, mental health, other STIs) Streetworks, Edmonton

3. What are the problems? • A large number of women are not accessing prenatal care (an alarming number of babies with congenital syphilis) • A large number of women are pregnant and homeless • Poor data/surveillance of the numbers of women who are in the situation • Lack of street-friendly resources • Lack of understanding of the street realities in the health care system and discriminatory profiling • Children’s Services policies that do not support marginalized women • Lack of housing • ?Other Streetworks, Edmonton

4. Streetworks’ project – Women in the Shadows • Funding obtained by STI Centre through PHAC. Worked in partnership. • Hired 2 outreach workers from the community, and 1 nurse (in the first year). Physician services available about one half day per week. Streetworks, Edmonton

5. Streetworks’ project – Women in the Shadows • Pregnancy outreach workers connected with the women, built trust, learned basic prenatal functions – preg tests, testing for STIs, fetal heart rates, weights, fundal heights etc. • Not about diagnosis – about engaging mom with the pregnancy Streetworks, Edmonton

6. Why are women of Edmonton’s inner city not accessing prenatal care? Streetworks, Edmonton

7. Why are women of the inner city not accessing prenatal care? • Fear of having Children’s Services become involved and losing custody of the child (major reason). • Being afraid of which other health issues they will discover about themselves through prenatal screening • Extreme guilt about where they are and what they are doing Streetworks, Edmonton

8. Why are women of the inner city not accessing prenatal care? • Fear of stopping drug use, as it has been how they have coped with current and past abuses and stress • Being homeless, which means that other survival priorities take precedent (food, clothing, shelter), and other barriers exist (transportation, communication) Streetworks, Edmonton

9. Why are women of the inner city not accessing prenatal care? • Previous negative experience with a health care provider (from physicians to receptionists) and lack of understanding by health care personnel about the realities of street-involved lives • Fear of judgment by mainstream service providers (race, age, income, addictions etc.) • Lack of knowledge about pregnancy issues and the importance of prenatal care Streetworks, Edmonton

10. Why are women of the inner city not accessing prenatal care? • Lack of proper ID, Alberta Health Care Number, and other important paperwork (Medicentres require picture ID, pharmacists require AHC, for example) • Feeling hopeless, frightened, isolated, stressed, abandoned, lost and discriminated against • Fear of law enforcement (current warrants) • Domestic violence situations Streetworks, Edmonton

11. What are some of the pregnancy/parenting issues women face? Streetworks, Edmonton

12. Pregnancy/parenting issues • Misinformation of healthcare personnel • Harsh responses • Misinformation • Concerns not heard • High level of judgment • May use others’ ID, healthcare number • Unequal application of standards of parenting Streetworks, Edmonton

13. Pregnancy/parenting issues • Women blamed for difficulties with children • No closure when children apprehended • Post-partum depression often missed, mixed in with grief from loss of child, and increased drug use. Streetworks, Edmonton

14. Addictions • There are different drug effects on a fetus. What are some of the commonly held beliefs? • What are some things to remember when working with women who use drugs during pregnancy? Streetworks, Edmonton

15. Addictions • Understand that addictions are not logical. • Coping skills may include drugs; more stress = more drugs. • Not having illicit drugs does not mean the addiction is gone. • Track marks do not mean current drug use – may not have anything to do with current situation. • Withdrawal is painful and can cause irrational behaviour Streetworks, Edmonton

16. Addictions/Drug Use • The awareness that a mom who has used drugs does not mean she will be a “bad” mom. • Many drug using moms are not suspected of doing so. • The most dangerous drugs during pregnancy are alcohol and tobacco. • The term “crack babies” is being proven to be unfounded. Streetworks, Edmonton

17. Drug Use • Stress, poor nutrition, lack of sleep, lack of social support networks etc. can be responsible for many symptoms previously attributed to drug use. • Breastfeeding has been found to be helpful for babe’s withdrawal (if HIV -) • Moms on methadone are to be congratulated, not vilified • Pregnancy can be a time for change • Women want to keep their babies Streetworks, Edmonton

18. Drug Use • Some mom is better than no mom Streetworks, Edmonton

19. Future • A new pregnancy project will be starting later in June. Includes 2.4 outreach workers, 1 Social Worker, 1 nurse/midwife. • Same general format as before but more opportunities to connect with and support more women, as well as advocate more strongly for systemic change. Streetworks, Edmonton

20. Questions? Karen Turner – kturner@boylestreet.org Marliss Taylor – mtaylor@boylestreet.org Streetworks, Edmonton