A policy that failed to prioritize pregnant women who are homeless for shelter and housing before their third trimester is changing, San Francisco Department of Homelessness and Supportive Housing director Jeff Kositsky told an audience last week.
The announcement caused surprise and confusion among nonprofits and advocates, however, who say they have received mixed messages from city officials and were told as recently as this week that no change in policy was planned.
Advocates have been working for years to persuade city officials to prioritize homeless women for shelter and housing services early on in their pregnancies. Currently, The City prioritizes homeless mothers for emergency services in their seventh month of pregnancy, or fifth month if the pregnancy is high risk.
For more than two years, health experts and advocates have been working to gain access to services for pregnant mothers much sooner, but say they have faced pushback from The City’s Department of Homelessness and Supportive Housing.
On Wednesday, however, during a panel discussion on San Francisco’s homelessness crisis held at the Temple Emanu-El, the department’s director, Jeff Kositsky, announced that The City is changing course.
“Now, anybody who is pregnant can get into the shelter system immediately and without having to wait, and will then eventually get access into the housing system,” said Kositsky.
“I don’t know why the policy was the way it was before, but that’s not the way it is now,” he added, indicating that the “third trimester” policy had finally been changed.
That was news to community stakeholders and even some city leaders, who said that they were informed by Kositksy in writing and at a hearing of the Local Homeless Coordinating Board (LHCB) earlier this week that the policy would remain as is.
“It’s been a muddle of confusion, with [the department] only giving stuff in writing that demonstrated that they did not change the policy,” Jennifer Friedenbach, executive director of the Coalition on Homelessness, told the San Francisco Examiner on Saturday.
According to Friedenbach, Kositsky’s verbal announcement at the Temple came a day after the “homeless department released verbally and in writing that pregnant people still have to wait until [the] third trimester for family shelter and housing.”
On Twitter, Friedenbach said that it is critical for homeless pregnant women, who have an almost 20 percent preterm birth rate, to be stabilized within their first trimester.
“Just last week one of our moms went through a devastating stillbirth. She’s trying to figure out what to do with her [baby’s] body. Her doctor said it was likely the stress of being homeless,” Friedenbach wrote in a tweet, adding that this year, 18 women so far have given birth in shelters.
She said that organizations and service providers advocating for the policy change have met with the department as well as the mayor’s office on several occasions in recent months to discuss the issue.
“The mayor said ‘yes’ in an initial meeting, then we had a meeting with the mayor and providers. Our understanding was that they also said ‘yes,” said Friedenbach, who described the policy change as what should be “low-hanging fruit.”
“Then, later in meeting with HSH to lay it out, their staff said ‘no,’ then they put it in writing twice,” she said.
Friedenbach said that written communications indicating that the policy would stay the same were put out by the department and at a LHCB hearing on Tuesday. A document containing policy definitions of homelessness distributed at the LHCB hearing showed that the policy pertaining to pregnant homeless women had not been tweaked.
A spokesperson for the department denied that a written communication was issued, but also declined to comment on whether or not a policy change had taken place by press time.
Friedenbach isn’t alone in her confusion.
“We have been told that they want to make a change but we haven’t seen enough forward movement,” said Shanell Williams, a City College of San Francisco Trustee and Community Engagement Director of the California Preterm Birth Initiative (CPBI).
Williams said that over an almost two-year period, the Benioff Community Innovators project — spearheaded by a number of public health experts and service providers like the Homeless Prenatal Program, CPBI and others — assessed the impacts of inadequate housing on birth outcomes.
One of the recommendations that came out of the assessment was to prioritize homeless pregnant women for services immediately.
“I think that everyone sees the need for this to change. We are, at this point, waiting for HSH to let us know how they will address the needs of this population when it comes to housing support — it’s been one message after another and now there is a lot of confusion among providers,” said Williams.
Last month, a resolution introduced by Supervisor Matt Haney urging HSH to “implement urgent policy changes to serve pregnant individuals” as well as to prioritize families living in single room occupancy hotels and doubled up for housing and services, passed at the full board of supervisors. The resolution directs the department to pursue policy changed “in coordination with” the board.
“Shelter and services should be provided to pregnant women from the moment they become pregnant, not late in their term,” Haney told the Examiner during an interview in September. “They often are put on a waiting list, meaning they could have the baby while in a shelter or navigation center and still be waiting to be placed in family shelter or housing.”
Haney’s resolution also urges the department to close a loophole in the family shelter system that excludes families living in SROs or substandard conditions from consideration for shelters or housing because they are technically housed. The Examiner has previously reported on the issue.
“These are vulnerable families living in tiny apartments that are overcrowded. They should be on the pathway to more stable and adequate housing situations,” said Haney.
Haney indicated last month that he received a commitment from the department to address both issues. But on Saturday, he said he was no longer clear about where things stood.
“They were dragging their feet on it and going back and forth, despite the fact that we thought we had a commitment and it was clearly the right thing to do,” he said.