Lack of Prenatal Care Puts Them Behind Before They Get Started : Babies Born to the Homeless Consigned to a Bleak Life

Spent vials on the sidewalks attest to a robust trade in crack. Prostitutes turn tricks in the stairwells. Robberies, beatings and even killings are everyday risks. In the hostile environs of New York’s hotels for the homeless, hundreds of expectant mothers mark time.

These women face double jeopardy as they fend for a place to live while new, luckless life grows inside them.

Their babies die at twice the rate of other infants born in the city. Those who live often are underweight, behind even before they get started, and many never catch up. Many of these women are unaware that medical help is available or are ignorant of the need for it.

The typical homeless pregnant woman is 27, single and has two or three children already. She has welfare checks to fetch, apartments to hunt and meager meals to cook on a hot plate. The routine priorities come before their own nutrition, vitamins, rest or hygiene.

“These are high-risk pregnancies,” said Dr. Philip Brickner of St. Vincent’s Hospital, which offers free care to the pregnant homeless. “Without prenatal care, there’s a relatively high risk of a premature baby or a damaged baby, both of which lead to enormous (medical) expense.”

Social ‘Time Bomb’

“It’s a time bomb,” said Dana Hughes, a senior specialist with the Children’s Defense Fund in Washington, D.C. “The baby born to a homeless woman is at tremendous disadvantage if it happens to survive.”

Dabbing at tears with toilet paper, hotel resident Juanita Williams talked about a daughter born to her in December. She was busy with her other children and neglected to get prenatal care. The little girl, her 10th child, was born with spina bifida, a congenital defect of the nervous system that doctors say can be caused by drug or alcohol abuse early in pregnancy.

“I wonder if she’d be OK if I would have gotten better care. I was on the run so much,” the 42-year-old mother said. “This is not living. I don’t even know if it’s surviving. It’s no place to raise a child. You have to take it one day at a time and pray you get out of this hell.”

Efforts of city, state and volunteer agents to reach these fragile tenants are complicated by their numbers. In five years, the homeless population has exploded and overwhelmed a stopgap shelter system that scatters them all over the city. In that wave came scores of pregnant women.

New York has 28,000 homeless people, according to the city’s Human Resources Administration, and it spends $312 million, about 6% of its $4.9-billion annual budget, to care for them. The city doesn’t know how many of the homeless women are pregnant, but the Legal Aid Society and the Coalition for the Homeless estimate the number at between 500 and 800.

Mothers Go to Hotels

Because the city doesn’t have enough private rooms in its 29 shelters, most get emergency housing in one of 55 hotels. Some are filled to capacity with welfare dependents, while others are shared with tourists. Officials acknowledge that the hotels make rotten shelters. They say the city hopes to get out of them by 1993.

Since 1986, New York has been under court order not to house pregnant women or mothers with newborns in barracks-style shelters, where they might be exposed to contagious ailments such as measles and respiratory infection.

Advocates of the homeless had argued that such women should have private rooms. They didn’t bargain for the wretched conditions in welfare hotels.

Four people may share a room as small as 9-by-12-feet, furnished with two bunk beds but lacking chairs or a table for meals. Paint is peeling from the walls and ceilings. Food is strung on ropes to keep it away from rats and roaches.

Not all bathrooms are private. Afraid their children may catch a disease or be molested in a communal toilet, some mothers teach youngsters to relieve themselves in plastic potties or empty cans.

‘Cure Worse Than Disease’

“The city’s cure is perhaps worse than the disease,” said Arthur Fried of the Legal Aid Society.

Nevertheless, some homeless women, desperate to escape congregate shelters and knowing that pregnant women get private rooms, offer to buy urine from pregnant women. The city uses a urine test to verify pregnancy, and a positive result can get a woman a room alone instead of a crowded floor.

“One girl said she’d pay me $5 for a sample of my urine because she wanted a private room. She was strung out on drugs and she wanted to do them in privacy,” said Tracie Dillard, 22, who, at eight months pregnant, was staying at a city shelter in Brooklyn.

Urine sales do occur, city officials said, but follow-up pregnancy tests have not found any cheaters.

“I’m sure it’s happened,” said Gail Gordon, first deputy administrator of adult services for the Human Resources Administration. “But it’s not the norm. If it did happen--my goodness, how sad!”

Medically and financially, being homeless and pregnant produces a harsh principle of pay-now-or-pay-more-later.

Higher Infant Mortality

Infants born to residents of welfare hotels had a death rate of 25 per 1,000 births, according to a 1984 study of the city’s Health Department. That’s more than double the overall rate in the city and 2.5 times higher than the national mortality rate of 10 per 1,000 births.

Without prenatal care, newborns are at least three times more likely to weigh less than 5 pounds, which means that they will need follow-up medical care, according to the Children’s Defense Fund.

Prenatal care, in which an expectant mother’s pulse, blood pressure, weight and nutrition are regularly checked, costs $800 to $1,200. A month’s stay under neonatal intensive care can cost $300,000.

Marjorie Gish, a registered nurse at the Lamb’s Church prenatal care clinic, said the plight of homeless and pregnant women reminded her of her Peace Corps days in a Mayan village in Belize, where the women walked barefoot through open pigsties and bathed in a stream.

There, however, the village chief ordered pregnant women to get regular checkups--a power that no authority wields in the largest city of the world’s wealthiest nation.

Third World Comparison

“Care was more readily available in (Belize). The homeless and pregnant in New York are probably worse off than the women receiving care in Third World countries,” she said.

The children who survive have scant prospects for a normal life.

“They are the closest things you can find to refugee populations in underdeveloped countries,” said Dr. Irwin Redlener of New York Hospital, which provides pediatric care for the homeless through the sponsorship of singer Paul Simon and New York Yankees slugger Don Mattingly.

“They are disenfranchised, cut off and undernourished. A lot of kids are not going to recover from the psychological trauma,” Redlener said.

“You end up with a lost generation of children,” said Stephen Banks, a lawyer with the Legal Aid Society.

The average homeless, pregnant woman is a high school dropout carrying her third or fourth child. Of all homeless expectant mothers, 67% are black and 27% are Latino. Like all homeless people, they qualify for Medicaid.

Patricia Smith, four months pregnant, has an 8-year-old daughter and a 6-month-old son. Everyone in her family has asthma. She had just spent three nights in three different hotels.

‘There’s No Bottom’

“I’m a walking zombie,” said Smith, 37, who was clutching a dog-eared prayer book to her bosom. “It’s like you’re falling and there’s no bottom and there’s nothing to catch on to.

“It makes me feel like I’m a failure. People treat you like you’re nothing,” she said. “I’m always petrified. I’ve chased rats as big as alley cats away from my children--but I have no place else to go.”

Frustrated social workers offer prenatal care, but the women don’t actively seek it. Some skip sessions to keep other types of Medicaid appointments, which can take two weeks to reschedule. Others loathe standing in line for hours and filling out forms at hospital clinics.

“We knock on doors in the hotels,” said Barbara Conanan, director of the homeless project at St. Vincent’s Hospital, which has a van to drive patients to clinics or gives them transit tokens to make it easier to get care.

“You have to reach out. Some don’t understand the need for prenatal care. Many of them never sought it for their other children. There’s a real lack of education,” Conanan said.

City Pilot Program

In a pilot program, a team from Bellevue Hospital identifies and registers pregnant women at the Prince George Hotel. The city then pays their way to and from the hospital for checkups.

In addition, the city’s Department of Health has clinics inside three hotels, which offer convenience but lack amenities such as private exam rooms.

The state Bureau of Reproductive Health also operates a medical van that dispenses prenatal care at five sites.

Living in a hotel may sound cozy, especially when a room costs taxpayers an average $2,000 a month or $23,725 a year. That’s enough to rent a spacious apartment or make a down payment on a house. Half the bill is paid by the federal government; the other half is split between the city and state.

In New York, however, the money most commonly pays for space in warehouses of despair such as the Martinique, Prince George, Holland and Allerton hotels. Expectant mothers and children are especially vulnerable in these hostile incubators.

Drug dealers recruit homeless children as lookouts and couriers, according to City Council’s Select Committee on the Homeless. Other kids sit in hallways at night while their mothers trade sex for crack, hotel residents said.

Prostitutes in Business

Some hotels are brothels, the committee said. By day, hookers rent rooms by the hour. When business drops off at night, the homeless move back in. The beds are called hot sheets because nobody stays on them for long.

Jacqueline Macklin, 31, a hotel resident since 1984, sent her 11-year-old twin daughters to live in Philadelphia with their grandmother in 1987, after they saw a security guard shot dead by another guard in the Holland Hotel.

“There’s nothing a kid doesn’t see in here,” said Macklin, who said she is a recovering crack addict.

“It’s a picture of the worst of our civilization,” said Robert Hayes, founder of the Coalition for the Homeless.

“It’s an abandonment of the most fragile people to the most devastating of environments--and then we wonder why these kids are so irreparably harmed,” Hayes said. “It’s insane as well as cruel to leave a woman in a situation that will result in a sick baby.”