Prenatal care for the underserved is a national concern, especially among homeless women likely to experience barriers to care during pregnancy. Inadequate prenatal care confers increased risk for gestational complications and unfavorable postnatal outcomes, including prematurity and low birth weight. Yet while many studies delineate the prevalence and health consequences of inconsistent prenatal care in the homeless and underserved, few explore the women’s experiences or identify perceived needs within this population.

This study explored both positive and negative experiences with prenatal care and pregnancy among Philadelphia’s pregnant homeless women with the intention of designing effective interventions to increase the consistency and to improve the quality of care. Study participants were recruited from Philadelphia’s primary intake shelter for women and children, and were individually interviewed about their pregnancies and prenatal care experiences. Interviews were digitally recorded, transcribed, and reviewed for thematic elements. Nine women were interviewed in total.

Self-identified barriers undermining consistent prenatal care included issues with insurance, lack of transportation to appointments, and negative experiences with prenatal care during previous pregnancies. While some women reported rewarding relationships with their prenatal care providers, many expressed a need for education regarding exercise, diet, and stress-reducing practices for both expecting and breastfeeding mothers. Women also expressed interest in support groups, parenting classes, and therapy sessions as venues to share their stories and to learn from others. These insights inspired several initiatives at Eliza Shirley House for Women through JeffHOPE, Jefferson’s medical student-run free clinic, including designing educational materials and classes, and providing family therapy sessions.