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Am Fam Physician. 2006;73(9):1655

The American College of Obstetricians and Gynecologists (ACOG) Committee on Health Care for Underserved Women has released recommendations to improve health care of homeless women. The recommendations were published in the August 2005 issue of Obstetrics & Gynecology.

Approximately 3.5 million Americans are homeless, and one third of these persons are women. Homelessness increases the risk of injury and illness and results in high rates of mortality. More than two thirds of homeless mothers have mental illness, and posttraumatic stress disorder, substance abuse, and depression are significantly more common in homeless women than in other populations. About 26 percent of homeless women report having “survival sex,” and almost two thirds reported using no method of contraception despite having sex at least once per week. Homeless women, especially those with mental illness, have about a 10 percent greater chance of being raped than the general population. Pelvic inflammatory disease affects 28 percent of homeless women, and 60 percent have had at least one sexually transmitted disease (STD). Pregnancy rates are higher among homeless women, and these women have significantly higher rates of adverse birth outcomes than the general population.

In the past year, nearly 25 percent of homeless persons who needed medical attention were unable to obtain health care, and homeless women are less likely to have mammography and Papanicolaou tests than the general population. To implement obstetric and gynecologic care guidelines recommended by the ACOG, the committee suggests that communities develop organized services directed specifically to the homeless population. The committee recommends the following actions to improve health care for homeless women:

  • Provide unbiased care for homeless women in individual practices.

  • Volunteer to provide health care services at homeless shelters and soup kitchens. Adherence to treatment is enhanced when medical care is coupled with services to meet the survival needs of patients. Care should not be withheld because of concerns about lack of adherence.

  • Seek donations of medications from pharmaceutical companies for use in homeless clinics and shelters.

  • Work with local hospitals and clinics to implement health care programs for the homeless.

  • Work with medical schools and residency programs to encourage modification of the educational curriculum to increase awareness of the problems associated with homelessness and to involve medical students and residents in care for homeless persons as part of their training.

  • Assess current community programs for homeless persons and advocate for improved coordination of services between these programs and other special programs (e.g., prenatal care, immunization, tuberculosis treatment, STD clinics, mental health care, housing and legal aid).

  • Advocate for professional liability protections for physicians who volunteer their services to the homeless.

  • Encourage federal, state, and local governments to provide adequate funding for the provision of comprehensive health care services, including mental health treatment for all homeless persons.

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