Pregnancy: Distrust, Trauma, and a Door for Opportunities

Hello everyone, my name is Fern and I currently serve as an All-Love Coordinator at the San Francisco Department of Public Health (SFPDH) Whole-person Integrated Care (WPIC). WPIC’s goal is to bring together primary care, urgent care, and behavioral health services to facilitate city-wide care coordination to help improve health outcomes for people experiencing homelessness.

Around 70% of people who experience homelessness are cis-male; however, populations with other gender identities are disproportionately affected by the syndemic problems of HIV, STIs, and poor pregnancy outcomes. The All-Love Program thus started to focus on serving the unique and challenging social and medical needs of people experiencing homelessness who identify as women, trans and non-binary, pregnant individuals, and postpartum individuals, many of whom have been mistreated by the medical system.

One of the All-Love efforts I am mainly involved with is called Pregnant People Loss to Follow-Up, where we identify and connect people experiencing homelessness with high-risk pregnancies and their partner with prenatal care and STI treatments, specifically syphilis treatment. This is a city-wide effort between various organizations including the University of California San Francisco, Zuckerberg San Francisco General Hospital, SFDPH Maternal, Child and Adolescent Health, Epiphany Center, and Compass Family Services.

Syphilis in pregnant people became the focus of the SFDPH because of a sharp rise in syphilis cases in reproductive-age women. Congenital syphilis is easily preventable by treating pregnant people. However, untreated syphilis during pregnancy can lead to various morbidities for the newborn or even death.

Many pregnant people are deterred from care due to various reasons, including a lack of transportation, substance use disorder, mental health issues, and notably the distrust in the medical system and sexual trauma they may have experienced. To meet the patient where they are at, I also joined the care team on the Street Outreach Services (SOS) van to connect pregnant people who have been lost to follow-up with the prenatal care and treatment they need. Treating each patient with compassion, respect, a trauma-informed approach, and without judgment of their substance use reduces the associated stigma and helps instill trust between the care team and the patients we serve.

Pregnancy also becomes a time of opportunity for many to get support for other medical and social needs such as substance use disorder treatment, behavioral health services, and housing services. This can help them move toward supporting a healthy family in the future and breaking out of the cycle of homelessness. We treat people with the principle that everyone deserves the chance to have a family and get the reproductive health care they need regardless of their race, ethnicity, socioeconomic status, or substance use history.