Transcript Pregnancy and Hard to Reach Populations in Edmonton

Women in the Shadows:
Women unwilling or unable to
access prenatal care
Streetworks
June 2011
Streetworks, Edmonton
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Who are the women we are
talking about?
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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)
June 2011
Streetworks, Edmonton
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What are the problems?
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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
June 2011
Streetworks, Edmonton
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Streetworks’ project – Women
in the Shadows
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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.
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Streetworks’ project – Women
in the Shadows
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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
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Why are women of
Edmonton’s inner city not
accessing prenatal care?
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Streetworks, Edmonton
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Why are women of the inner city
not accessing prenatal care?
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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
June 2011
Streetworks, Edmonton
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Why are women of the inner city
not accessing prenatal care?
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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)
June 2011
Streetworks, Edmonton
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Why are women of the inner city
not accessing prenatal care?
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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
June 2011
Streetworks, Edmonton
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Why are women of the inner city
not accessing prenatal care?
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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
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Streetworks, Edmonton
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What are some of the
pregnancy/parenting issues women
face?
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Pregnancy/parenting issues
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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
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Pregnancy/parenting issues
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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.
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Addictions
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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?
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Addictions
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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
June 2011
Streetworks, Edmonton
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Addictions/Drug Use
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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.
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Streetworks, Edmonton
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Drug Use
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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
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Drug Use
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Some mom is better
than no mom
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Future
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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.
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Streetworks, Edmonton
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Questions?
Karen Turner – [email protected]
Marliss Taylor – [email protected]
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