Women’s Health in Utah’s Homeless Population | Categories Health Disparities in Special Populations | DOI: 10.26054/0K37YFD98Z

The U.S. Department of Housing and Urban Development defines “Homeless” as “individuals and families who lack a fixed, regular, and adequate nighttime residence” and those “who are fleeing, or are attempting to flee, domestic violence… or other dangerous or life-threatening conditions that relate to violence against the individual or a family member” (State of Homelessness Executive Committee, 2015). A person is deemed chronically homeless if she or he remains homeless longer than one year or has four episodes of homelessness in a three-year time period, and if she or he has a disabling condition (HUD, 2007).

Women and families are the fastest-growing segment of the homeless population, as calculated with a Point-In-Time (PIT) count (ACOG, 2013). Risk factors for women becoming homeless include: extreme poverty, affordable housing shortage, inadequate social support, substance abuse, mental illness, and history of violence (Comprehensive Report on Homelessness State of Utah, 2016). In fact, domestic and sexual violence is the leading cause of homelessness for women and families, and over 92% of homeless mothers “have experienced severe physical and/or sexual abuse” in their life (The Characteristics and Needs of Families Experiencing Homelessness, 2011). 73% of homeless persons have unmet health needs; and women, in particular, lack preventative care such as prenatal care, mammograms and Pap smears (Baggett, O’Connell, Singer, & Rigotti, 2010).

Partly due to this lack of access, 30% of the care provided by homeless clinics to women is for chronic diseases (ACOG, 2013). This results in lower prioritization of reproductive planning; and although most homeless women have access to contraception, often they are provided methods with high-failure rates, putting them at high risk for unintended pregnancy and poorer obstetric outcomes.

In the mid 1980s, Salt Lake revitalized their downtown by demolishing and redeveloping many Single-Room Occupancy Hotels (SROs). The SROs were home to the city’s lowest-income residents who often worked within walking distance. When the SROs were destroyed in the early 2000’s, about 1,000 residents were left homeless and jobless. Prior to this, Utah homelessness was temporary; however, now it can be permanent and often intergenerational (http://fourthstreetclinic.org/history/). As of 2016, 2,807 individuals remained homeless in Utah at a given point-in-time (Comprehensive Report on Homelessness State of Utah, 2016).

Since 2009, Utah has received national recognition for its reduction in homelessness. Unfortunately, some of this decline is secondary to changing definitions of what constitutes homelessness and how rates of homelessness are reported. From 2007 to 2016, the total number of homeless individuals in Utah decreased by 6.8%, compared to a national 15% reduction; and from 2011 to 2016, the number of homeless individuals in families decreased by 8%, compared to a national decrease of 16% (see figure 1) (PIT and HIC Data Since 2007, 2018). Yet between 2011 and 2016 there was been a significant reduction in the number of individuals in Utah affected by chronic homelessness compared to national reductions, particularly those individuals that are unsheltered (see Figure 2).

Figure 1. Utah's trends in select homeless populations from 2007-2016
Figure 1. Utah’s trends in select homeless populations from 2007-2016. Source: 2007-2016 PIT Counts by State. U.S. Department of Housing and Urban Development, Homeless Point-in-Time Count Data
Figure 2. Utah's reductions in chronic homelessness compared to the national trends between 2011 and 2016
Figure 2. Utah’s reductions in chronic homelessness compared to the national trends between 2011 and 2016. Source: 2007-2016 PIT Counts by State. U.S. Department of Housing and Urban Development, Homeless Point-in-Time Count Data



This reduction in chronic homelessness was largely attributable to the rapid re-housing programs and provision of permanent supportive housing for select individuals. The majority of these services are provided by the Road Home, Utah’s largest homeless shelter. Demonstrating ongoing commitment to maintaining these services, in 2016, the Housing and Homeless Reform Initiative (H.B. 436) was passed, appropriating $27 million over three years to focus on the needs of homeless sub-populations such as families and victims of domestic violence (Comprehensive Report on Homelessness State of Utah, 2016).

In addition to rapid re-housing, Utah’s homeless population has increasing access to primary care. The Fourth Street Clinic, in downtown Salt Lake City, serves over 5,000 homeless patients annually ( http://fourthstreetclinic.org/history/). In 2017, there were over 25,000 visits and 35% of the patient population was female. In 2015, the University of Utah Department of Obstetrics and Gynecology began staffing a women’s health clinic within the Fourth Street Clinic. This clinic provides essential women’s healthcare needs, including treatment for cervical dysplasia, urinary incontinence and contraceptive counseling and provision. By increasing homeless Utahns’ access to primary care, Fourth Street is a major contributor to ending homelessness, promoting community health, and achieving health care savings.

While homelessness is decreasing, largely due to improving homeless assistance, this system cannot fix the affordable housing crisis. Housing is still unaffordable to a large number of Americans, and this lack of affordable housing is the leading cause of homelessness among families with children (The Characteristics and Needs of Families Experiencing Homelessness, 2011; State of Homelessness Executive Committee, 2015). The housing crisis continues to worsen, and assistance programs need to help maintain housing stability when possible. Most important, policy makers in Utah need to prioritize investment in affordable housing, while continuing to provide rapid re-housing and access to primary care for homeless Utahns.

References

  • American College of Obstetricians and Gynecologists (ACOG. (2013). Health Care for Homeless Women.
  • Baggett, T. P., O’Connell, J. J., Singer, D. E., & Rigotti, N. A. (2010). The unmet health care needs of homeless adults: a national study. Am J Public Health, 100(7), 1326-1333. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2882397/pdf/1326.pdf.
    doi:10.2105/ajph.2009.180109
  • The Characteristics and Needs of Families Experiencing Homelessness. (2011). Retrieved from iles.eric.ed.gov/fulltext/ED535499.pdf
  • Comprehensive Report on Homelessness State of Utah. (2016). Retrieved from https://jobs.utah.gov/housing/scso/documents/homelessness2016.pdf
  • Homeless Point-in-Time Count Data. (2016). Retrieved from https://www.hudexchange.info/resource/3031/pit- and-hic-data-since-2007/
  • State of Homelessness Executive Committee. (2015). Retrieved from https://www.hud.gov/sites/documents/PIH2013-15HOMELESSQAS.PDF. Accessed April 29, 2019
  • U.S. Department of Housing and Urban Development (HUD) Office of Community Planning and Development, Office of Special Needs Assistance Programs (2007). HUD’s Homeless Assistance Programs. Defining Chronic Homelessness: A Technical Guide for HUD Programs. Retrieved from https://files.hudexchange. info/resources/documents/DefiningChronicHomeless.pdf. Accessed April 29, 2019

Citation

Benson AE & Gawron L. (2019). Women’s Health in Utah’s Homeless Population. Utah Women’s Health Review. doi: 10.26054/0K37YFD98Z.

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Ashley E. Benson, MD

Maternal-Fetal Medicine Fellow, Department of Obstetrics and Gynecology, University of Utah

Lori Gawron, MD

Department of Obstetrics and Gynecology, Division of Family Planning, University of Utah