Strategy. Policy and System Level Changes (Pregnancy)
Approach. Adopt housing stability policies to improve health outcomes for women and children across the life span
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Overview. Policies and systems-level changes can have a significant impact on pregnant women, especially those experiencing homelessness. By implementing policies and systems-level changes that prioritize pregnant women experiencing homelessness, communities can work towards creating a more supportive and equitable environment for maternal health and well-being. [1,2,3]
Evidence. Emerging Evidence.
Strategies with this rating typically trend positive and have good potential to work. They often have a growing body of recent, but limited research that documents effects. However, further study is needed to confirm effects, determine which types of health behaviors and conditions these interventions address, and gauge effectiveness across different population groups. (Clarifying Note: The WWFH database calls this "mixed evidence").
Access the peer-reviewed evidence
through the MCH Digital Library or related evidence source.
(Read more about understanding evidence ratings).
Source. Peer-Reviewed Literature
Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):
- Policy. This strategy helps to promote decisions, laws, and regulations that promote public health practices and interventions.
- Social Determinants of Health. This strategy advances economic, social, and environmental factors that affect health outcomes. SDOH include the conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.
Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.
Intervention Type. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).
Intervention Level. Population/Systems-Focused
Examples from the Field.
There are currently no ESMs that use this strategy. As Title V agencies begin to incorporate this strategy into ESMs, examples will be available here. Until then, you can search for ESMs that have similar intervention components in the ESM database.
Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).
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Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")
- Number of policymakers, public officials, and community leaders engaged in developing and advancing housing stability policies for pregnant and parenting women. (Assesses partner engagement and coalition-building for policy change)
- Number of public awareness and education campaigns conducted to build community understanding and support for housing stability policies benefiting pregnant and parenting women. (Shows efforts to shape public narratives and build political will for policy change)
- Number of pregnant and parenting women in stable housing who experience improved maternal and child health outcomes, such as increased prenatal care utilization, reduced maternal stress, and positive child development indicators. (Assesses health impact of housing policies)
- Number of public and private agencies and organizations that adopt and implement housing stability policies and practices tailored to the needs of pregnant and parenting women. (Shows institutionalization and spread of housing policies across sectors and systems)
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Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")
- Percent of housing stability policy proposals that are developed with substantive input and leadership from pregnant and parenting women with lived experience of housing instability. (Measures centering of impacted communities in policy design)
- Percent of policy implementation and evaluation process that include meaningful participation and power-sharing with community-based organizations representing the interests of pregnant and parenting women. (Shows community accountability in policy implementation)
- Percent of pregnant and parenting women with access to stable, affordable housing who report improvements in their physical, mental, and social wellbeing. (Measures impact of housing policies on holistic maternal health and quality of life)
- Percent of housing stability policies that demonstrate effectiveness in reducing maternal and child health disparities and advancing equitable outcomes for pregnant and parenting women from marginalized communities. (Assesses equity impact of policy changes)
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Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")
- Number of cross-sector collaboratives and coalitions formed to support comprehensive housing stability policies that address the intersecting needs of pregnant and parenting women, such as health, economic security, and social support. (Measures multi-disciplinary, integrative approach to policy change)
- Number of community organizing and mobilization efforts undertaken to build grassroots power and leadership among pregnant and parenting women working towards transformative housing policies. (Assesses community capacity building and support for policy change)
- Number of cross-sector partnerships and collaborative initiatives catalyzed by housing stability policies that work synergistically to improve maternal and child health outcomes and advance health equity. (Measures ripple effect and alignment impact of housing policies on other systems)
- Number of communities that experience significant reductions in adverse birth outcomes, child poverty, and intergenerational health disparities as a result of comprehensive housing stability policies and system changes. (Assesses population health and equity impact of policy change)
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Quadrant 4:
Measuring Quality of Effect ("How are they better off?")
- Percent of housing stability policy agendas and platforms that explicitly name and prioritize the advancement of racial, gender, and reproductive justice as core goals and values. (Measures centering of intersectional justice and equity in policy vision and discourse)
- Percent of narratives and public conversations about housing stability policies that amplify the voices, solutions, and resilience of pregnant and parenting individuals, rather than perpetuating stigma and deficit-based frames. (Shows narrative shift toward asset-based, justice-oriented discourse)
- Percent of pregnant and parenting individuals, particularly those from historically oppressed communities, who report experiencing increased agency, dignity, and support in their interactions with housing and health systems as a result of policy changes. (Measures impact of policies on shifting power and promoting reproductive and birth justice)
- Percent of communities that demonstrate sustained shifts in the structural determinants of health inequities, such as systemic bias, gender discrimination, and economic exploitation, as a result of transformative housing and social policies. (Assesses long-term, structural impact of policies on health equity and social justice)
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Note. When looking at your ESMs, SPMs, or other strategies:
- Move from measuring quantity to quality.
- Move from measuring effort to effect.
- Quadrant 1 strategies should be used sparingly, when no other data exists.
- The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.
Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.
References
[1] Himmelstein, G., & Desmond, M. (2021). Association of eviction with adverse birth outcomes among women in Georgia, 2000 to 2016. JAMA pediatrics, 175(5), 494-500.
[2] Sakai-Bizmark, R., Kumamaru, H., Estevez, D., Neman, S., Bedel, L. E., Mena, L. A., ... & Ross, M. G. (2022). Reduced rate of postpartum readmissions among homeless compared with non-homeless women in New York: a population-based study using serial, cross-sectional data. BMJ quality & safety, 31(4), 267-277.
[3] Theobald, J., Watson, J., Haylett, F., & Murray, S. (2023). Supporting pregnant women experiencing homelessness. Australian Social Work, 76(1), 34-46.
