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Homelessness in Canada

As discussed in my previous posts, individuals who experience homelessness evidently face numerous struggles. Being a woman and living on the streets have additional hardships. Navigating womanhood with a roof over our head is a journey in itself, doing that without a home just adds to the physical and psychological health burden. This is a reminder to be kind and empathetic to everyone because anyone can end up in a situation like this. Everyone has their own struggles and they deal with a lot more than we can realize. We can never know someone's story just by looking at an individual. Canada is widely known as a developed country. Citizens of this country are able to enjoy many perks and have numerous resources and opportunities available in order to sustain themselves. While Canada is known as this amazing developed country, there are many issues the country still has to improve on, and putting an end to homelessness should take a much greater priority. This population faces countless amounts of disparities, especially the women. Homelessness exists everywhere, not just in Toronto where it is visible. Numbers and statistics of homelessness in urban areas are usually more readily available and talked about but rural communities see this issue as well (Schiff, J. W., 2016). Homelessness being an issue to this extent proves how much more serious and important addressing this issue is and the need for implementing plans to eradicate homelessness in a developed nation like Canada.  

Comment below some additional disparities that come to mind when you think about women experiencing homelessness.

References:

Schiff, J. W., Schiff, R., & Turner, A. (2016). Rural Homelessness in Western Canada: Lessons Learned from Diverse Communities. The Homeless Hub. https://www.homelesshub.ca/resource/rural-homelessness-western-canada-lessons-learned-diverse-communities

Gif link: https://images.app.goo.gl/s7CevsX7RiXLQTmK6

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Pregnancy while experiencing homelessness

While the idea of pregnancy - bringing new life into the world - is a great privilege and can be an exciting time for many people, it is universally known just how hard pregnancy really is. Morning sickness, excessive hormones, and drastic changes to the body are all difficult things expecting mothers have to experience. With these changes come many new adjustments to a person's daily life in order to make the journey a little more tolerable and comfortable. Individuals who have the financial ability can purchase maternity clothes, medications for the pain, and buy food to satisfy the pregnancy's food cravings. Those with a stable home can rest comfortably when tired, sleep comfortably in their own bed every night and get the rest needed while being pregnant. These examples of making adjustments to daily life are not possible for the women experiencing homelessness. Individuals experiencing homelessness already have a long list of hardships they have to overcome each day such as finding a place to sleep for the night. Being homeless has numerous other struggles and being pregnant while in that situation makes everything much more difficult. From a health perspective, since STIs are more prevalent in the homeless population, if an expecting mother is carrying STIs, complications can occur for the fetus as well. STIs can be transmitted from mother to baby (vertical transmission) and that can result in adverse effects such as prematurity, a low-birth-weight of baby, stillbirth, and more (WHO, 2022). Pregnancy complications are more likely for homeless women as well as higher injury and physical risks. Other health effects include behavioral ones such as depression and anxiety (Clark, R. E., 2019). Below are links to two news articles that covered the lived experience of pregnant women who are experiencing homelessness in the GTA. They are short reads (approximately 3 mins each); take a look as it can help offer a little more perspective of their experience. 

Homeless and pregnant in Toronto: 1 woman tells her story. CBC. https://www.cbc.ca/news/canada/toronto/homeless-pregnant-1.3717484

Opinion | Homeless and pregnant: responding to a crisis. Hamilton Spectator. https://www.thespec.com/opinion/contributors/2022/05/24/homeless-and-pregnant-responding-to-a-crisis.htm

References:

Clark, R. E., Weinreb, L., Flahive, J. M., & Seifert, R. W. (2019). Homelessness Contributes To Pregnancy Complications. Health Affairs, 38(1), 139-146,146A-146C. https://doi.org/10.1377/hlthaff.2018.05156

Dunlop, M. (2016, August 17). Homeless and pregnant in Toronto: 1 woman tells her story. CBC. https://www.cbc.ca/news/canada/toronto/homeless-pregnant-1.3717484

Vaccaro, M., Hamilton, Y., & Uppal, M. (2022, May 24). Opinion | Homeless and pregnant: responding to a crisis. Hamilton Spectator. https://www.thespec.com/opinion/contributors/2022/05/24/homeless-and-pregnant-responding-to-a-crisis.html

WHO - Torgovnik, J. (2022, August 22). Sexually transmitted infections (STIs). World Health Organization (WHO). https://www.who.int/news-room/fact-sheets/detail/sexually-transmitted-infections-(stis)

Image link: https://images.app.goo.gl/WgxTBtmKwvC1ZgqUA

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Women's Health - Menopause

Along with the abundance of stress of living without a fixed address, an additional difficulty in life women have to face is menopause. With the end of menstruation, a major shift in life, this can be the beginning of a whole set of problems for women that experience homelessness in Toronto. Night sweats, brain fog, and hot flashes all correspond to menopause. It is a natural stage of a women’s life which marks the end of their reproductive years occurring in their late forties or fifties (Sinai Health). The hardships that women would have to go through with already being homeless and on their menopause is insurmountable. In addition to the struggles of being homeless, the psychological and physical effects a woman that is going through their menopause certainly amplifies any negative emotion that they are feeling and results in irritability, mood swings, and depression (NIH). It is a transition in a women’s life stage that requires constant monitoring and attentiveness which women experiencing homelessness do not have the luxury to receive. This opens up gateways of new inner struggles which many women experiencing homelessness specifically cannot face themselves and causes derogatory thoughts, affecting them mentally in a negative manner. A large sum of individuals who have experienced homelessness have either serious mental health illness or substance abuse disorders (Pita M., 2014). People that have experienced homelessness in their lives are most likely to develop some sort of mental health illness throughout that specific period of their life. In comparison, women who experience menopause while being homeless is much more prone to develop even more serious mental health illnesses and would be at a higher significant disadvantage physically and mentally compared to the average person with little to no help provided for them.

References:

NIH - What Is Menopause? | National Institute on Aging. (2021, September 30). National Institute on Aging. https://www.nia.nih.gov/health/what-menopause

Piat, M., Polvere, L., Kirst, M., Voronka, J., Zabkiewicz, D., Plante, M., Isaak, C., Nolin, D., Nelson, G., & Goering, P. (2015). Pathways into homelessness: Understanding how both individual and structural factors contribute to and sustain homelessness in canada. Urban Studies (Edinburgh, Scotland), 52(13), 2366-2382. https://doi.org/10.1177/0042098014548138

Sinai Health - About Menopause —. (n.d.). Mount Sinai Hospital. https://www.mountsinai.on.ca/care/womens-unit/menopause-clinic/about-menopause

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Gynecological health

Safe sex is not very common for the homeless population. They do not always have the means to purchase condoms or have condoms readily available when engaging in sexual activities. Other barriers include partners not wanting to use condoms (Adedze, M., 2022). Such practices can lead to STIs (as mentioned in a previous post) as well as unplanned pregnancies. Women experiencing homelessness often have a high rate of unintended pregnancies. Contraceptives to prevent pregnancies are also not widely available to this population (Corey, E., 2020). Terminating a pregnancy comes with many challenges and medical attention is crucial for abortions to ensure it is done is a safe and timely manner (Wenzel, S. L., 2001).

Engaging in sexual practices evidently, comes with many responsibilities. Although it is everyone’s own responsibility to take the necessary precautions, people experiencing homelessness are not able to do so due to the lack of knowledge and access. With their living conditions, precautionary measures or getting educated on such topics is not their main priority. As a woman who is capable of creating life, it is very important to take care and pay attention to reproductive health in order to one day have a baby. Homeless women experience an increased vulnerability to reproductive health. This is because their health is already threatened by their living situation and they are not always able to seek their necessary health care services (Wenzel, S. L., 2001). Another common complication they might miss is abnormal breast conditions. For example, lumps in breasts are usually early indicators of breast cancer but that can easily go unnoticed for these women unfortunately (Wenzel, S. L., 2001). A reproductive disorder that people experiencing homelessness may not be aware of but may suffer from is endometriosis, which can be very painful.

References:

Adedze, M., Osei-Yeboah, R., Morhe, E. S. K., & Ngambouk, V. P. (2022). Exploring sexual and reproductive health needs and associated barriers of homeless young adults in urban ghana: A qualitative study. Sexuality Research & Social Policy, 19(3), 1006-1019. https://doi.org/10.1007/s13178-022-00724-9

Corey, E., Frazin, S., Heywood, S., & Haider, S. (2020). Desire for and barriers to obtaining effective contraception among women experiencing homelessness. Contraception and reproductive medicine, 5, 12. https://doi.org/10.1186/s40834-020-00113-w

Wenzel, S. L., PhD., Andersen, R. M., PhD., Gifford, Deidre Spelliscy,M.D., M.P.H., & Gelberg, Lillian,M.D., M.S.P.H. (2001). HOMELESS WOMEN'S GYNECOLOGICAL SYMPTOMS AND USE OF MEDICAL CARE. Journal of Health Care for the Poor and Underserved, 12(3), 323-41. https://doi.org/10.1353/hpu.2010.0797

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Sexual health

As a part of the vulnerable population, homeless women are exposed to challenges around the integrity of their bodies and health (Barbosa, N. G., 2022). Sex/intercourse is a natural part of most living things life whether it be for the purposes of reproducing or pleasure. People experiencing homelessness share the same desires but this can get particularly dangerous if safe sex practices are not maintained. Young adults of the homeless population tend to engage in sexual activies earlier in life, have multiple partners, and have unprotected sex due to many reasons (Adedze, M., 2022). This opens up numerous opportunities for them to be at risk of contracting sexually transmitted infections (STIs). In fact, homeless people have an increased risk of contracting STIs (Stockwell, S., 2015). These bodily infections can be very harmful, especially to women. Bacterial infections such as gonorrhea and syphilis can increase the risk of acquiring HIV (human immunodeficiency virus) which is a virus that attacks the body's immune system. In the homeless population, HIV is a major cause of morbidity & mortality (Marshall, B. D., 2016). HPV (human papillomavirus) can cause genital warts and/or cervical cancer (CDC). Some more examples include genital herpes, chlamydia, bacterial vaginosis, and hepatitis. For a population whose priorities do not include visiting the doctor's office to receive routine check-ups and medications, contracting such STIs can lead them to live very uncomfortable/painful lives while the infection causes detrimental harm to their bodies. For example, lots of STIs can also lead to infertility later in life as well (CDC). While sex may be a voluntary and pleasurable act for many, a lot of the times, living on the streets can push people to trade sex for shelter or survival (Adedze, M., 2022). This unfortunate scenario can result in individuals having to live with a physical illness for the rest of their lives.  Attached below is an infographic from the Public Health Agency of Canada (PHAC) which shows the rates of chlamydia, gonorrhea & syphilis infections in Canada. You may also click the image to visit the website. To learn more about STIs, link the CDC link below.

Refernces:

Adedze, M., Osei-Yeboah, R., Morhe, E. S. K., & Ngambouk, V. P. (2022). Exploring sexual and reproductive health needs and associated barriers of homeless young adults in urban ghana: A qualitative study. Sexuality Research & Social Policy, 19(3), 1006-1019. https://doi.org/10.1007/s13178-022-00724-9

Barbosa, N. G., Hasimoto, T. M., Michelon, T. M., Carvalho Mendes, L. M., Gustavo Gonçalves dos Santos, Juliana Cristina dos Santos Monteiro, & Gomes-Sponholz, F. A. (2022). Attention to Women’s sexual and reproductive health at the street outreach office. International Journal of Environmental Research and Public Health, 19(17), 10885. https://doi.org/10.3390/ijerph191710885

Marshall, B. D., Elston, B., Dobrer, S., Parashar, S., Hogg, R. S., Montaner, J. S., Kerr, T., Wood, E., & Milloy, M. J. (2016). The population impact of eliminating homelessness on HIV viral suppression among people who use drugs. AIDS (London, England), 30(6), 933–942. https://doi.org/10.1097/QAD.0000000000000990

Sexually Transmitted Diseases - Information from CDC. (n.d.). CDC. https://www.cdc.gov/std/default.htm

Stockwell, S., Dean, G., Cox, T., Tweed, M., Poole, J., Hume, G., Nicolson, S., & Hutchinson, L. (2015). P224 The sexual health of the homeless – an outreach sexual health screening project. Sexually Transmitted Infections, 91(Suppl 1), A90-A90. https://doi.org/10.1136/sextrans-2015-052126.268

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Life as a woman (continued)

As discussed previously, menstruation is a challenging part of life and it being a taboo topic does not help make the situation any better. In many cultures and even in different societies, speaking about menstruation is often stigmatized and seen as “shameful”. Stigma is defined as something that sets you apart from others or the ”norm” in the sense that you have a defect. The stigma around menstruation evidently has a negative effect on “women’s self-esteem, body image, self-presentation, and sexual health” (Johnston-Robeldo, I., 2013). It is absurd to think that a common and natural process of being human is seen that way. Unfortunately, this stigma does exist and the homeless population experience that as well. Menstruation stigma and shame is even more intense for people who experience homelessness (Sommer, M., 2020). They are unable to properly clean themselves and their blood-soiled clothing which often leads to them feeling ashamed to go near people, creating barriers in their daily activities of living due to embarrassment. Additionally, with this stigma, many may even feel ashamed to ask for menstrual hygiene products. Many do not want to disclose their menstrual status just to ask for pads or tampons and having to do so just to meet a basic need contributes to more feelings of shame and embarrassment (Sommer, M., 2020). These additional barriers and lack of menstrual hygiene adds to their anxiety as well (Maroko, A., 2021). An already stigmatized population - those who experience homelessness - have to face even more stigma just because they are females. I would imagine they do not feel great having to deal with any of this and that this has a negative impact on their self-confidence; all resulting from things they have no control over. 

References:

Johnston-Robledo, I., Chrisler, J.C. The Menstrual Mark: Menstruation as Social Stigma. Sex Roles 68, 9–18 (2013). https://doi-org.ezproxy.lib.ryerson.ca/10.1007/s11199-011-0052-z

Maroko, A. R., Hopper, K., Gruer, C., Jaffe, M., Zhen, E., & Sommer, M. (2021). Public restrooms, periods, and people experiencing homelessness: An assessment of public toilets in high needs areas of Manhattan, New York. PloS one, 16(6), e0252946. https://doi.org/10.1371/journal.pone.0252946 

Sommer, M., Gruer, C., Smith, R. C., & Maroko, A. (2020). Menstruation and homelessness: Challenges faced living in shelters and on the street in new york city Pergamon. doi:10.1016/j.healthplace.2020.102431

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Life as a woman

Arguably, being a female already comes with challenges that males do not have to worry about. I am sure it is common knowledge that when females reach puberty, they start menstruating. It is hard to navigate what works for your cycle (learning to properly use sanitary products, choosing the sanitary products that work best), having a supply of such products, dealing with PMS - headaches, nausea, cramps, hormonal changes and so much more. It is a difficult and constant cycle. When an individual who has a home, is feeling unwell due to period cramps, they have the luxury to return/stay home to rest. They can take a break and rest in their comfortable bed with a roof over their head or take a nice hot shower/bath to soothe the pain. Anyone with a uterus and menstruation cycle can agree how necessary and helpful just doing these simple things can be during an already difficult and annoying time of the month. Homeless women do not have that luxury and do not have a place to escape to in order to try to be comfortable during this hormonal time. Menstrual hygiene is also something they lack.

Maintaining personal hygiene is already difficult while living on the streets and managing a blood flow on top of that only adds to the challenges (Sommer, M., 2020). They do not readily have access to sanitary products such as pads or tampons. They do not have a definite private place to clean themselves with soap and water while they are bleeding for those 5-7 days. Public restrooms or food establishments restrooms are not always accessible and open for use. They usually have to collect their blood with toilet tissue, socks, rags or perform other unsanitary menstrual hygiene practices. Aside from it being a nuisance to deal with, these unsanitary practices can lead to health issues such as reproductive tract infections and increased risk of “HIV, HPV and/or poor pregnancy outcomes” (Boden L., 2021). Along with all the other diseases and infections homeless individuals are exposed to, the women of this population have this additional risk they have to worry about. The mental health impacts of menstruation will be discussed in the next post. 

References:

Boden, L., Wolski, A., Rubin, A. S., Oliveira, L. P., & Tyminski, Q. P. (2021). Exploring the barriers and facilitators to menstrual hygiene management for women experiencing homelessness. Journal of Occupational Science, ahead-of-print(ahead-of-print), 1-16. https://doi.org/10.1080/14427591.2021.1944897

Sommer, M., Gruer, C., Smith, R. C., & Maroko, A. (2020). Menstruation and homelessness: Challenges faced living in shelters and on the street in new york city Pergamon. doi:10.1016/j.healthplace.2020.102431

Image link: https://images.app.goo.gl/x9dnhyBwRF8dQU489

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Hello & Welcome!

Homelessness is an unfortunate situation many individuals are faced with even in a developed nation like Canada. It continues to be a growing issue especially in the city of Toronto, Ontario. When in a state where they have no place to call home, there are numerous things they are being deprived of and they still have to get by with almost nothing. The homeless population is already robbed of one of the basic necessities of life - shelter. Along with that, another basic need of survival is food and oftentimes the homeless do not have food to eat either. If we look at the indicators set out in the quality of life framework for Canada, it is evident that the homeless population experience a very poor quality of life. The conditions and environment in which they exist are also very poor as can be concluded when looking at the social determinants of health (SDH). Individuals experiencing homelessness have serious health consequences (Clifford, B., 2019). One group of people that suffers the most and is more vulnerable among the homeless population are the women (Barbosa, N. G., 2022). This blog will explore and deconstruct the disparities faced by the women in Toronto who survive without a home, their overall health but specifically their sexual as well as their reproductive health. Additionally, shed light on pregnancies in the homeless population and the increased hardships they experience trying to bring new life into the world. Along with the challenges that come with being an expecting mother and carrying a baby, see how different it is to experience that without shelter.

References:

Barbosa, N. G., Hasimoto, T. M., Michelon, T. M., Carvalho Mendes, L. M., Gustavo Gonçalves dos Santos, Juliana Cristina dos Santos Monteiro, & Gomes-Sponholz, F. A. (2022). Attention to Women’s sexual and reproductive health at the street outreach office. International Journal of Environmental Research and Public Health, 19(17), 10885. https://doi.org/10.3390/ijerph191710885

Clifford, B., Wilson, A., & Harris, P. (2019). Homelessness, health and the policy process: A literature review. Health Policy (Amsterdam), 123(11), 1125-1132. https://doi.org/10.1016/j.healthpol.2019.08.011