Tuesday, November 19 2019

Why should homeless service providers care about maternal health and mortality?

Megan VeithBy Megan Veith, JD, Policy & Research Associate

pregnant woman sitting on a benchHomeless service providers should care about maternal health and mortality because stabilizing pregnant and postpartum moms in housing not only improves their housing outcomes but may also contribute to better maternal health outcomes.

MaternalHealth calloutAccording to the most recent report by the Washington State Maternal Mortality Review Panel, the maternal mortality rate for pregnancy-related deaths was 11.2 deaths per 100,000 live births in 2014-16. Among these deaths, 60% were preventable. The panel’s priority recommendation in preventing pregnancy-related deaths is addressing social determinants of health and social inequities. Strategies include prioritizing funding for housing and addressing the housing crisis to ensure women and children have access to safe, affordable, and stable housing during and after pregnancy. 

The panel also recommends applying a racial equity lens to policies, programs, and resource decisions. This is especially important because we know that people of color are overrepresented in the homeless population and have disparate maternal health outcomes. In the state of Washington alone, the rates of homelessness and maternal mortality for American Indian and Alaska Native families are nearly 7x greater than the rate for white women and their families. 

Another recommendation is to improve and expand the Health Care Authority’s Maternity Support Services (MSS). MSS is a program covered under Medicaid that helps pregnant women in low-income households get the health and social services they need. Eligibility is not based on housing status, but on Medicaid enrollment and pregnancy. The Maternal Mortality Review Panel recommends that the Health Care Authority extend MSS for women to one year postpartum, provide more MSS blocks of time for each participant, and improve reimbursement rates so MSS slots can be expanded across Washington. 

Building Changes actively supports MSS as an opportunity to improve patients’ health and housing outcomes. In 2016, we established the Perinatal Housing Grant project in Pierce County. The goals of the project were to support positive health outcomes for pregnant and post-partum women and their children under MSS, and to house families experiencing homelessness or at-risk of homelessness by training MSS caseworkers in Diversion. The project ends this fall and a final report will be released in 2020. Preliminarily, we are hearing from MSS support staff that this project has helped streamline processes for patients to obtain housing, helped patients avoid costs of eviction and moving, helped cover patients’ rent during unpaid parental leave gaps, and encouraged patients to self-advocate. We’ve also learned that cross-sector work like this between health and housing can reduce trauma and save time and money.

We thought it was a win-win solution to help empower and collaborate with the MSS providers to address housing issues directly with their clients.
—Emily Mirra, Building Changes

In referencing the importance of this project grant and MSS, Building Changes’ program lead Emily Mirra stated, “We learned from the MSS provider community that many of them are working with families who are experiencing homelessness or unstably housed. MSS staff had limited resources to help families with housing and were unclear how to connect them to the homeless response system. We thought it was a win-win solution to help empower and collaborate with the MSS providers to address housing issues directly with their clients, as we know that safe and stable housing is a crucial part of a healthy environment for growing families.” 

Over the next few years, Building Changing will be focusing more on this intersection between maternal health and housing. Building off the Perinatal Housing Grant, as well as recommendations from the Maternal Mortality Review Panel, we are starting a research, policy, and advocacy project to improve and expand MSS to better serve patients experiencing homelessness or at-risk of homelessness. The project will involve provider surveys, patient interviews, statewide MSS site visits, as well as state comparison research. We will then use that research to advocate in Olympia for improving and expanding MSS to better support positive housing outcomes. 

We are excited about this work and believe it is important because as the Panel put so well, “[h]ealth inequities affect everyone, including families and communities. When people of childbearing age experiencing poverty, trauma, homelessness, violence, maltreatment, and other adverse experiences within community environments, the lifelong health and wellbeing of the entire family can be negatively impacted.”