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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Housing Instability: Pregnancy.

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Strategy. Policy and System Level Changes. (Pregnancy)

Approach. Adopt housing stability policies to improve health outcomes for women and children across the lifespan.

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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 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...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

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. Search similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of policymakers, public officials, and community leaders partnered with Title V 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)

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 practical 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)

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. (Measures ripple effect and alignment impact of housing policies on other systems) Number of communities that experience significant reductions in adverse birth outcomes as a result of comprehensive housing stability policies and system changes. (Assesses population health and impact of policy change)

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 fair reproductive outcomes as a core goal and value. (Measures centering fairness 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, fairness-oriented discourse) Percent of pregnant and parenting individuals 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) Percent of communities that demonstrate sustained shifts, such as systemic bias and economic exploitation, as a result of transformative housing and social policies. (Assesses long-term, structural impact of initiative)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. 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.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.