PITCH: How do homeless women conceptualise access to and experience of antenatal and postnatal care in Sheffield?

Problem

Prevalence of temporary accommodation use has increased by 63% since 2010, reflecting a national housing crisis and a growing issue of homelessness. In the homeless population, smoking, mental health problems and alcohol and drug use are significantly higher than the average UK population. This, paired with their vulnerable housing situation puts this population at risk of blood born viruses (BBV), foetal alcohol syndrome, neonatal abstinence syndrome (NAS), and postnatal depression among other issues. Homeless women have high pregnancy rates but removal of their children is common.

Women who present late to antenatal services are more likely to have low educational attainment, smoke and to experience significant socioeconomic deprivation and a lack of social support. Barriers to antenatal care, in women of low socioeconomic status, include feeling undervalued and judged by healthcare professionals, lack of access to services, and failure to understand information issued. There are no UK studies relating to homeless women’s attitudes and access to antenatal services but data from other countries indicates that they do not receive adequate perinatal care. Overall these indicators suggest that homeless women in the UK may be missing out on vital perinatal health care, particularly given their multiple health needs.

The aim is to qualitatively examine the perspectives of homeless women on, and lived experiences of antenatal and postnatal care in the North of England.

Approach

A scoping literature review was used to develop a topic guide. Semi-structured interviews are ongoing, with service users of a Sheffield based homeless project, who have experienced at least one self reported pregnancy confirmed by a healthcare practitioner. Interviews will continue until data saturation,. Data will be transcribed and thematic analysis undertaken with independent verification of emergent themes.

Findings

Preliminary findings highlight the extent of the influence of addiction to alcohol and other substances on the behaviour of the women, and the turbulence in their lifestyles. Perceived ‘norms’ in terms of personal safety, social support and stability appear to significantly alter the women’s health seeking behaviour, reducing their ability to recognise events or circumstances that endanger them or their child. This is partially due to the close-knit nature of the homeless community; in socialising predominantly with each other the community has created a micro-environment that extends through to their social media usage. The majority of what they see and hear online, and in person comes from other members of the community and therefore societal norms are disregarded or unknown.

Consequences

The study will highlight the lived experience of homeless women through pregnancy and delivery. It will examine their perceived access to and experiences of perinatal care and provide insight into their knowledge and understanding of pregnancy, as well as recommendations in how to optimise this care in future.