Perceptions of Provider Inquiry Regarding Housing Status Among Pregnant Women Experiencing Housing Instability

Objective: To explore and describe perceptions of provider inquiry regarding housing status among pregnant women experiencing housing instability.

Design: Secondary qualitative analysis using analytic expansion.

Setting: In-person and online interviews in the Mid-Atlantic and Washington, DC, region.

Participants: English-speaking women who were pregnant or gave birth within the past year, were 18 years or older, and were experiencing housing instability (N = 14).

Methods: We undertook a secondary analysis of primary data collected via semistructured interviews in the mid-Atlantic and Washington, DC, region between February 2020 and December 2021. These data were part of a primary study in which we explored the effect of housing and health during pregnancy and the postpartum period, barriers and facilitators to health care, and social support. In this secondary analysis, we used reflexive thematic analyses to interpret interpretations and discover themes.

Results: Fourteen participants answered the question regarding provider inquiry. Nine participants (64%) expressed no inquiry about their housing status and reported that visits were too short or focused more on fetal health. Many participants shared that they received limited provider support with housing challenges. Disclosing housing status depended on the patient-provider relationship and belief in the provider's ability to help and support. Three overarching themes emerged: Provider Inquiry About Housing, The Value of Relationships, and Improving Access to Housing Support and Services.

Conclusion: The current service delivery model for pregnant women does not adequately address social determinants of health. Future researchers should focus on the intersection of pregnancy and housing instability to determine whether restructuring of policy and practice is needed. Nurse-midwives and other maternity care providers can be key points of contact in facilitating housing support for pregnant women with unstable housing status.