Women and Homelessness: A Health Overview

Peggy Maguire and Kristin Semancik

European Institute of Women’s Health

Women and their children are the fastest growing group within the homeless community. Yet, there is a lack of information on and understanding of homeless women and families, particularly about their health status and healthcare needs, facing many health inequities and challenges that must be addressed through targeted policy and programming.

Homeless women have higher levels of ill health and injury than housed women. Even among the homeless population, women have worse health than do men. When faced with homelessness, women often neglect their health, Finding housing, food and clothing for themselves and, in many cases, for their children become the priorities.  Common health problems, such as a colds and chronic diseases, that are treated or managed in the housed population are often worse among homeless people. The average age of death for homeless women is only forty-three years old. 1,2,3,4

Chronic diseases are disproportionately common and more severe among the homeless population, especially those in non-sheltered environments. Respiratory diseases, including tuberculosis, are common among homeless people, compounded by late diagnosis, lack of treatment adherence and drug-resistant strain development. Chronic conditions, like diabetes, can be undiagnosed and untreated for prolonged periods of time.  Sexually transmitted infection (STI) rates are high among homeless women with estimates of six in ten homeless women infected with an STI. Homeless women are at particularly increased risk to contracting HIV/AIDS.5,6,7

In addition, homeless women have higher levels of stress, smoking, sleep deprivation, exhaustionon and poor nutrition compared to women with housing, thereby increasing their vulnerability to and their risk of disease and ill health. Homeless women and their children have less access to good nutrition and consume higher amounts of unhealthy food than those who are housed. Poor nutrition increases the risk of health conditions, including chronic disease and poor oral health, and affects children’s development. A top cause of homelessness for women and families is domestic and sexual violence, a topic explored in greater detail in other articles in this edition of the newsletter, has large implications for both physical and mental health.8,9,10,11

A complex interconnection exists between homelessness, abuse, mental health and general health. Many women who were abused as children subsequently suffer from low-self-esteem and mental health problems, which often leading to abusive relationships during adulthood and elevated risks of homelessness. Consequently, one in five women who suffered from pervasive abuse are homeless, twenty times more likely than those who have not been extensively abused. This intersectionality of abuse, vulnerability and homelessness has large adverse implications for both mental and physical health and requires careful policy and programming that provides not only recovery, but also much-needed stability and security. 12

Homeless women, like men, have higher rates of mental health issues compared to the general population. About three-quarters of homeless women suffer from a mental illness and about two-thirds have attempted suicide. Many homeless women have post-traumatic stress disorders after experiencing sexual, physical and other forms of abuse. Substance abuse is higher among homeless women than housed women, though the estimated rates of substance abuse among homeless women largely vary in studies.13,14

Homeless individuals disproportionately lack regular healthcare services compared to the general population. Thus, aaccess to healthcare services can be a major issue, including access to routine screening and treatment programmes like prenatal care, mammograms and Pap testing. Homeless women often do not seek medical attention at an early stage of ill health and wait until the condition worsens. Therefore, homeless women are less likely to obtain needed healthcare services than women with housing. Consequently, women who are homeless find themselves in the emergency department of hospitals more often than housed women.15,16

1 Gillian Silver and Rea Panares. 2000. “The Health of Homeless Women: Information for State Maternal and Child Health Programs.” Women’s and Children’s Health Policy Center, John Hopkins University, School of Public Health. http://www.jhsph.edu/research/centers-and-institutes/womens-and-childrens-health-policy-center/publications/homeless.PDF.

2 American College of Obstetricians and Gynecologists. 2013. “Health care for homeless women.” Committee Opinion No. 576. Obstetrics & Gynecology, 122: pp936–940. http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Health-Care-for-Homeless-Women.

3 The Ontario Women’s Health Council. 2002. The Health Status of Homeless Women: An Inventory of Issues. http://ywcacanada.ca/data/research_docs/00000274.pdf.

4 Katharine Sacks-Jones. 2016, April 16. “Without secure housing, how can vulnerable women begin to rebuild their lives?” The Guardian. http://www.theguardian.com/housing-network/2016/apr/13/housing-vulnerable-women-homeless-mental-health.

5 Silver and Panares. 2000. “The Health of Homeless Women.”

6 American College of Obstetricians and Gynecologists. 2013. “Health care for homeless women.”

7 The Ontario Women’s Health Council. 2002. The Health Status of Homeless Women: An Inventory of Issues. http://ywcacanada.ca/data/research_docs/00000274.pdf.

8 Mary Anne Drake. 1992. “The nutritional status and dietary adequacy of single homeless women and their children in shelters.” Public Health Reports, 107(3): pp.312-319.

9 Silver and Panares. 2000. “The Health of Homeless Women.”

10 The Ontario Women’s Health Council. 2002. The Health Status of Homeless Women.

11 American College of Obstetricians and Gynecologists. 2013. “Health care for homeless women.”

12 Sacks-Jones. 2016, April 16. “Without secure housing, how can vulnerable women begin to rebuild their lives?”

13 Silver and Panares. 2000. “The Health of Homeless Women.”

14 The Ontario Women’s Health Council. 2002. The Health Status of Homeless Women.

15 Silver and Panares. 2000. “The Health of Homeless Women.”

16 American College of Obstetricians and Gynecologists. 2013. “Health care for homeless women.”

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