Healthcare experiences of homeless pregnant women

Objective: to understand healthcare experiences from the perspective of women who are or were pregnant while in homelessness. Methods: qualitative study based on Heideggerian phenomenology adapted to the field of health. There were ten participants. The technique of phenomenological interview and a semi-structured instrument were used. The comprehensive analysis methodically followed the stages of phenomenological reduction, construction, and destruction. Results: the existence of pregnant homeless women represents difficulties, discrimination, violence, prejudice, racism, and vulnerability. It is a violation of human dignity, revealing specificities and nuances of the triad women-maternity-street. Conclusion: the research made it possible to understand that healthcare, from the perspective of women who are pregnant while homeless, offers risks both to the mother and to the child. Both the self-care and the healthcare offered by health workers and services is precarious and has weaknesses, being different from any type of care that could be understood as solicitous, zealous, and concerned. Descriptors: Empathy; Women; Pregnancy; Homeless Persons. RESUMO Objetivo: compreender a vivência do cuidado à saúde, na ótica de mulheres que gestam e/ou gestaram em situação de rua. Métodos: estudo qualitativo que se fundamentou à luz da fenomenologia heideggeriana, adaptada à área da saúde. Participaram dez depoentes. Aplicaram-se a técnica de entrevista fenomenológica e um instrumento semiestruturado. A análise compreensiva seguiu momentos metódicos: redução, construção e destruição fenomenológica. Resultados: o existir de mulheres que gestam em situação de rua representa dificuldades, discriminação, violência, preconceito, racismo e vulnerabilidade. Configura violação da dignidade humana, desvelando singularidades e nuances da tríade mulher-maternidade-rua. Conclusão: a pesquisa possibilitou compreender que o cuidado à saúde, na ótica das mulheres que gestam em situação de rua, oferece risco para mãe e filho. É fragilizado e precário, tanto o cuidado de si, como o realizado por profissionais e serviços de saúde, o que difere do cuidado compreendido como solicitude, zelo e preocupação. Descritores: Empatia; Mulheres; Gravidez; Pessoas em Situação de Rua. *Extracted from the dissertation “Mulheres que gestam nas ruas e suas vivências de cuidado: estudo à luz da fenomenologia heideggeriana”, Universidade Estadual de Feira de Santana, 2019. 1Universidade Estadual de Feira de Santana. Feira de Santana, BA, Brazil. 2Universidade do Estado da Bahia. Salvador, BA, Brazil. Corresponding author: Keila Cristina Costa Barros Rua Monte Verde, 76, Parque Getúlio Vargas, CEP: 440076-736. Feira de Santana, BA, Brazil. E-mail: keilaccosta@hotmail.com EDITOR IN CHIEF: Ana Fatima Carvalho Fernandes ASSOCIATE EDITOR: Francisca Diana da Silva Negreiros Keila Cristina Costa Barros1 Rita de Cássia Rocha Moreira1 Mariana Silveira Leal1 Tânia Christiane Ferreira Bispo2 Rosana Freitas Azevedo2 How to cite this article: Barros KCC, Moreira RCR, Leal MS, Bispo TCF, Azevedo RF. Healthcare experiences of homeless pregnant women. Rev Rene. 2020;21:e43686. DOI: https://doi.org/10.15253/2175-6783.20202143686 Barros KCC, Moreira RCR, Leal MS, Bispo TCF, Azevedo RF Rev Rene. 2020;21:e43686. 2 Introduction Homeless people are considered to be heterogeneous; to live in extreme poverty; to have broken or fragilized family bonds; to have no conventional housing; to occupy public and degraded spaces to live and survive, permanently or not; and to resort to shelters to spend their nights(1). Healthcare to pregnant homeless women is a phenomenon that can be understood in its specificities, since a sensitive and attentive look at this group makes strategies to confront the problem a possibility, as well as healthcare practices, which are characterized by attention, responsibility, zeal, and diligence, with unique actions, considering time and space(2). The survival of women in the streets implies the use of practices that escape human dignity. Many women exchange sexual intercourse for drugs, and drug abuse is routine(3). Considering this situation, there is a perceptible possibility of pregnancy, oftentimes unwanted. These pregnant women, in most cases, have no access to prenatal monitoring, which, according to the Ministry of Health, aims, especially, to embrace the women since the beginning of her pregnancy, to guarantee that, at the end of her pregnancy, a healthy child will be born, and assure maternal and neonatal wellbeing(4). As a result, this research emerged as a possibility of pondering on possible improvements to the healthcare offered to these women. It is justified as it incorporates studies that indicate the main factors associated to their pregnancy, among which are: being homeless since an early age, being out of home for long periods of time and abandoning school, having an early start in sexual life, trading sex for money, favors, or advantages(5). Additionally, this study is validated by the scarce academic production about the subject and by the recognition that being a pregnant homeless women is a public health problem, as is the low access to prenatal care, since a study pointed out that 33.0% of homeless pregnant women only went through one prenatal consultation(6). This piece of data corroborates studies carried out in the United States, according to which the access of homeless pregnant women to the prenatal is a neglected and persistent problem(7). This study can benefit and contribute in the follow-up and supervision of the application of the policies of women’s rights in the reduction of indexes of violence, as to make possible an equal and universal access to health services. It can also offer positive contributions to the sexual and reproductive health of these women. The study can also impact in the prevention of mother and fetus morbidity and mortality and increase the capacity of the Primary Healthcare to deal with the issue, as well as to offer an effective integral coordination of care to this invisible portion of the population. Therefore, considering this existential and public health context, the following research question was elaborated: How do homeless women experience and/or experienced healthcare in pregnancy? The objective was to understand the healthcare experiences from the perspective of women who are or were pregnant while in homelessness.