Most of us have seen a pitiful sight, either in photographs or in reality: a homeless mother and one or more young children, sitting in a doorway, wrapped in blankets against the cold, with their few possessions next to them in a shopping cart. We don't know what brought this little family to this situation, but we can guess that domestic violence, abuse, and/or dire poverty played some major roles in their history. For days or weeks, they may fend for themselves, but eventually they may find a place in a public shelter. There they will be warm and fed, but their lives will be very different than what they might choose if they could have their own homes.
Have you ever thought what it would be like to be in a homeless shelter with your young children? Or to be pregnant and homeless? If you haven't-- and most of us don't---let me ask you to consider how you would manage to answer some practical questions, if you found yourself in this position.
1. How would you find a place where you could put your baby down to crawl or toddle?
2. What would you do if you or your child needed a snack and it wasn't a regular meal or snack time?
3. Who would take care of your other children when you went to the hospital to give birth?
4. How would you manage to establish your relationship with your new baby?
5. How would you help your children cope with the traumas of leaving a familiar home and dealing with an unfamiliar shelter crowded with other distressed families?
6. How would you manage your relationships with your children, knowing that they will need to be in group care while you receive job training and eventually go to work-- while you are still living at the shelter?
7. How would you help foster your children's relationships with their father, grandmother, or other family members, when you would usually be able to receive visitors only in the public area of the shelter-- if it has such an area?
One program that works to help homeless families solve these and many other problems is the Homeless Health Initiative run by Children's Hospital of Philadelphia (www.chop.edu/about/chop-in-the-community/ homeless-health-initiative). Yesterday I heard Karen Hudson, HHI Program Leader, and her staff discuss their services and the ways they try to help homeless families answer the questions above. Clearly, the most important resources the HHI staff brought to families in shelters were imagination and empathy-- imagination to figure out innovative ways to solve problems within severe limits, and empathy to understand how homeless parents and babies experience their situations.
An unusual and valuable service offered by HHI is the contribution of lactation consultant Meki Davis, who works with pregnant women and new mothers to encourage breastfeeding. Rates of breastfeeding are low among women who are poor, less educated, or of African-American ethnicity (and while anyone could end up in a homeless shelter nowadays, those characteristics are frequent among homeless populations). Meki's work with mothers-to-be is especially important because attitudes and choices about breastfeeding really need to be established before the baby is born. For young women who find breastfeeding culturally foreign-- who have never seen women who looked like them nursing their babies-- attitude change can be especially important. As a nursing mother herself, Meki makes an excellent role model who can discuss the real challenges of breastfeeding (what about the baby's teeth?!).
One difficulty Meki must deal with is the fact that baby formula is given to mothers free under the WIC (Women, Infants, and Children) federally-supported nutrition program. Although this makes a wonderful resource for HIV-positive mothers, for sick babies who are not strong enough to nurse, and under some other circumstances, the availability of the free formula to all qualified families does suggest that formula-feeding is the "normal" thing to do, the best way to feed your baby. One of Meki's jobs is to educate mothers-to-be on the ways in which breastfeeding is superior to formula-feeding in most cases. She does this by providing information about the lower risk of sudden infant death syndrome (SIDS) among breastfed babies and the reduced levels of breast and ovarian cancer among women who have breastfed. Because these mothers have to anticipate that they will be required to be away from their babies for work or school, they also need information about pumping milk-- including the fact that some insurance companies will provide breast pumps for mothers' use.
Shelter programs need to and do offer parenting education and guidance. An understanding of the role of attachment in children's lives is an important part of such programs. Mothers need to know that their relationships with their children are generally more important than "parenting skills". But life in the shelter creates unusual problems for these relationships. Mothers are responsible for their children all the time, unless the mother is in a required activity and the child is in group care. There are no dads, grandmas, or babysitters to give a break or to take older children out while Mom has time to snooze with baby. In addition, many homeless mothers suffer from depression which is not helped by their surroundings and confused futures. These mothers need both guidance about developing good relationships with children, and confidence that the relationships can be maintained while the mothers go to work or school-- difficult and contradictory problems that require the energies of the mothers and of shelter staff and programs like HHI.
As one HHI staff member remarked, "all these mothers deserve to be Mother-of-the-Year"-- and I'd say that HHI deserves to be Program-of-the-Year too. By the way, for readers in the Philadelphia area, the web site mentioned earlier gives information about volunteering for this program.