Maternity Homes: Reverse Morbidity with Hope

This is the presentation I gave at the Research Summit of the International Institute for Bioethics and Patient Care Advancement, modified slightly for this venue.

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I am currently involved in the preliminary efforts to open a maternity home in my community and I would like to explain that I am taking that particular step because maternity homes are among the best remedies to the profound needs of special pockets of the female patient population—namely, racial minorities, adolescents, and the urban poor. (For the sake of brevity, I will only speak about a smaller group made up of adolescent women who are impoverished and among the country's larger racial minorities: non-Hispanic black and Hispanic.)

First, some numbers from 2009, the most recent year that the CDC provides birth and pregnancy rates. Of every 1000 women between ages 15 and 19 in this country, 39 give birth to a child. This number is not evenly distributed among the various racial groups in the US. Of 1000 Hispanic teens, 70 give birth; of blacks, 59 do; of whites, only 25.

Birth rates are not the same as pregnancy rates, since some pregnancies end in abortion or miscarriage. Pregnancy rates are not available for 2009, but if rates have remained relatively stable since 2005 (the latest year the CDC provides), then we can estimate even more distressing statistics: the differences between racial groups are even more pronounced, and the abortion ratios are probably also skewed, as high as 50% among black adolescents compared to maximums of 43% in whites and 36.5% among Hispanics.


Distressing numbers mirror distressing trends that anyone observes driving through inner cities. I am from a city of population 1.2 million, 23% of which is made up of residents below the poverty level in 2009. Growing up, I associated apartments, 75% of which are rented by individuals below the poverty line, with family problems, low education, crime, street drugs, teen pregnancy, and a cycle of poverty. (Find your city's data here.)

Credit: greenkozi

My casual observations are supported by public health studies, among them a 2008 study tracking families across three generations which found that low socioeconomic status predicts harsh parenting and behavioral problems in children. Moreover, a 2005 paper correlated neighborhood physical disorder (generally characterized by disrepair, low amount of greenery, etc) with crime and teen births in Pittsburgh. Everything in the environment of the urban poor—from the neighborhood to the relationships—points to what this 2005 study calls “a general sense of powerlessness.”

The effects of this personal and social depression touches OB/GYNs and other clinicians in prenatal clinics, emergency rooms, and labor and delivery wards. The morbidity directly tied with poverty and its effects is enormous. I looked at the list of delivery room morbidity from our lecture on the topic and crossed off the items not related to poverty. Some of the ones I was left with are obvious (hypertension, drug and alcohol abuse, history of previous infant with jaundice, respiratory distress, or anemia, poor fetal growth, etc), but I’ll highlight a few because of their prevalence or preventability:

1. Incompetent cervix, linked with surgical abortions, which (as we have seen) are higher among minority groups.
2. Abnormal position, often preventable with regular prenatal care.
3. Infection, which (if not sexually transmitted) may be due to inadequate vaccination of the mother or (if sexually transmitted) an effect of inadequate gynecological care or poor sex education.
4. Congenital malformations, the neural tube variety being tied directly to poor supplementation, perhaps resulting from poor prenatal care or unplanned or unwanted pregnancy.
5. Maternal diabetes, causing macrosomia, leading to a large for gestational age infant with glucose imbalance. The baby’s size predisposes him to injury during childbirth, which can be serious; the glucose imbalance predisposes him to infection and jaundice.

So what can be done about this situation? My conclusions, unsurprisingly, echo what the weeklong IBPCA Distinguished Lecture Series has emphasized. Dr. Daniel Daly, referring to Cardinal Bernardin’s A Consistent Ethic of Life, emphasized that our duty to protect life extends to every moment of our fellow man’s time on this earth. Dr. Martha Shuping, Dr. John Bruchalski and Kristan Hawkins have emphasized the important of forming, deepening, and maintaining relationships to work with and for the vulnerable persons we want to protect.

I took this picture. The sky looks so hopeful...

In addition to IBPCA lecturers, independent research highlights the importance of relationships in a young girl's reproductive decisions. In 2011, family communication initiatives were shown to be very effective ways to delay first sexual intercourse; also in 2011, involvement of the fathers of babies carried by teens was found to improve fetal outcomes; and in 2006, home-based mentoring programs were proven effective in delaying second births among adolescent mothers. The relationships a young girl has with her parents, significant other, and mentors can help her flourish when they are marked by significant investment of time and care.

But when a girl finds herself pregnant without strong relationships, she needs help. She often find them in Pregnancy Resource Centers (PRCs), so well detailed in the Family Resource Council’s document A Passion to Serve: How Pregnancy Resource Centers Empower Women, Help Families and Strengthen Communities.

Another source of empowerment is maternity homes, housing establishments that offer help to women facing crisis pregnancy and homelessness. A 2005 report on maternity homes of the Department of Health and Human Services found that maternity homes across the country offer many services; this list makes clear that such homes undo or prevent the morbidities reviewed earlier. Especially note that they offer:

1. Classes in parenting skills and life skills like banking—to mothers and fathers.
2. Education: some maternity homes are also charter schools and can help young mothers complete their high school curriculum or earn a GED.
3. Mental health services and case management, offering individual professional care.
4. Referrals for substance abuse and prenatal care (and, in my experience of several homes, strict rules about making appointments and staying substance- and alcohol-free).

This important work can break this general, overwhelming powerlessness by investing in women and families, the time befitting their transcendent value.

I hope I have helped you to share my perspective on women’s health: I see parts of the female patient population that are vastly underserved. The morbidity that presents in the clinic cannot be treated without addressing the deeper effects of powerlessness—financial poverty, crime and violence, substance abuse, neighborhood safety, poor education, and family struggles. Maternity homes are a powerful tool to address these deep problems. They foster a sense of hope, found and strengthen relationships, and provide material, mental, social, and spiritual aid.