Born in the shadows: Ontario’s baby secret

Hundreds of homeless births go unreported each year, experts say

Samantha was 18 and living in a shelter when she gave birth to her eldest daughter — just one of an estimated 300 babies born each year to homeless or underhoused women in Toronto. Pregnant and living between the streets and a shelter, Samantha, whose name has been changed to protect her identity, said she was scared of losing her baby before she’d even had the chance to meet her.

“I was working my hardest to get a place before I had her,” she said.

If she found a home before she gave birth, she wouldn’t have to answer questions about her living situation, she said.

It’s a common fear among pregnant and underhoused women, experts say, and not an unreasonable one.

Child protection services can become involved when there are concerns about housing, said Maritza Sanchez, executive director of Jessie’s: The June Callwood Centre for Young Women, a Torontobased resource centre for pregnant teens, young parents and their children.

That fear is one reason that the data, which relies on pregnant women and mothers identifying themselves as homeless or underhoused, has vastly underrepresented the scope of the issue in Toronto.

Now a group of front-line health workers is trying to change that.

In a commentary published this month in the journal Paediatrics & Child Health, five medical professionals from Sick Kids, an epidemiologist with Toronto Public Health and a University of Toronto medical student called for a more collaborative model of data collection to get a clearer picture of pregnancy and homelessness.

“Homelessness is so stigmatized, members of this community will often try to conceal their homeless status,” said Joyce Bernstein, one of the commentary’s authors and an epidemiologist with Toronto Public Health.

“In the case of a homeless new mother, who assumes her status will mean immediate loss of custody, there is added incentive to not disclose her homelessness,” she said.

According to Ontario’s Ministry of Health and Long-Term Care, in the past six years the number of babies born to homeless parents in Ontario each year ranged from fewer than five to eight. The numbers show there were fewer than five babies born to homeless or underhoused women in Ontario in 2011; six in 2012; six in 2013; fewer than five in 2014; six in 2015; and eight in 2016.

Those figures are based on data that is self-reported by women who give birth in hospital and collected by the Canadian Institute for Health Information, which is then provided to the health ministry. The numbers don’t include babies that may have been born in a shelter or elsewhere.

Acollaborative effort by the organization Young Parents No Fixed Address and 17 of its member agencies in Toronto has found that the numbers are much higher.

Between 2012 and 2014, the participating organizations tracked births among their underhoused clients, compared the data, and found there were roughly 300 babies born each year to homeless mothers in Toronto alone — women who may be living in detention facilities, shelters, refugee centres, couch surfing or temporarily staying with family or friends.

“We suspect that this is if anything an underestimation given the fact that it’s not an exhaustive review of all agencies serving the population,” said Dr. Ashley Vandermorris, the commentary’s senior author and a doctor with the young families program at Sick Kids. “Understanding the magnitude of this issue is the first step” toward finding solutions for families, said Vandermorris, who believes this should be an ongoing data collection effort.

The group is looking for more partners.

“Ongoing effective monitoring of this at-risk group will require assistance from the (Ministry of Health and Long-Term Care) or other established surveillance programs, as community-based networks may be affected by changes in individual agency policies, management and staffing,” the authors wrote.

A spokesperson for the Ministry of Health said the government recognizes self-reported data is “subject to bias and under-reporting.”

“The ministry is inclined to continue using this data since it is as accurate as possible and follows a standard format used by other provinces and territories as well,” a ministry spokesperson, David Jensen, said, adding that it provides a way for provinces and territories to benchmark against each other.

Data collection is just a first step, said Sick Kids’ Vandermorris, who wants to see more collaboration in the services offered to vulnerable women and their children.

“There isn’t going to be a one size fits all solution and there’s not a one size fits all entity that can support these families, it needs to come from all of us,” she said.

For Samantha, who had her second baby girl two months ago, it’s the people rooting for her who have made all the difference. Finding an apartment was a challenge, one she may have given up on without the support and advocacy of her housing worker at the time, she said.

Sanchez agrees the services and support workers available to pregnant women and mothers in vulnerable situations are important — but the issues are more complex than that, she said.

“The problem is there isn’t enough affordable housing in the city of Toronto,” she said.