A mother's choice

Roxann Ray gave birth to her daughter Gracie last week. Gracie is Ray's second chance at motherhood. She was first pregnant in 2013 until miscarrying at five months. The heartbreak of the miscarriage caused Roxann to alienate herself from her family and spiral into drug and alcohol abuse. She eventually became homeless, she said.

"The reason I was out there on the streets was because of losing the first baby," she said. "I just went crazy ... I was drinking and getting high and stuff like that."

Ten months ago, Ray learned she was pregnant again.

"I found out I was pregnant when I was doing drugs and stuff ... I don't know what I was thinking, I'm glad I went to jail."

Shortly after finding out she was pregnant, Ray served 19 days in jail for drug possession. After jail, she spent two months in rehab.

"In order to make sure my baby was okay," she said. "I had to go to rehab because I didn't want to lose the baby."

Ray says that Gracie's father is still living on the street and addicted to drugs with no intention of changing his ways. She didn't want the baby exposed to his lifestyle, so once she was released from rehab, Ray found a new home in His Nesting Place, a faith-based maternity home in Long Beach. She'd wanted to get help sooner, she said, but life got in the way.

"I had options," she said. "I could've went to my mom's, but I didn't. I could've went to a shelter, but I didn't. I could've done a lot of things and I didn't. Drugs and alcohol and that life is what keeps you out there."

Not every woman in Roxann's position has options. Those that do usually don't know about them.

According to the Los Angeles Department of Public Health's Mommy and Baby Project, an estimated 3.3 percent of women were homeless during their last pregnancy. Completely omitted from the Los Angeles Homeless Services Authority's Greater Los Angeles Homeless Count, it's a community that is underrepresented in studies and insufficiently served in outreach. While there are organizations in the greater Los Angeles area attempting to lend a hand to these women, a combination of strict restrictions and deep-rooted stigmas often prevent them from taking it.

A fear of doctors

Brett Feldman is the Director of Street Medicine at the Keck School of Medicine at the University of Southern California and serves as the Vice Chair of the Street Medicine Institute. Street medicine is an emerging field that tailors healthcare to the homeless.

"You can probably imagine, it's very scary for them to be pregnant," Feldman said. "And a lot of them are still actively involved in using drugs and you know, don't really know where to go and have a lot of trauma even with the healthcare system because they know when they try to engage in the system, they're going to be met with hostility."

In Feldman's experience the circumstances surrounding a homeless pregnancy are often traumatic in nature, abortions are rarely performed at all, let alone safely. He believes that it's the sense of shame that leads many women to feel that they have no other choice but to take matters into their own hands.

"The overwhelming majority of patients that I've had that are homeless and pregnant were not interested in abortion," he said. "Now I've heard of some that have had their boyfriends go in with a hanger and abort the baby ... I want to say there's [been] three abortions and it's all been like that. They were not going to a clinic."

Even when homeless women seek professional attention, the interaction can often be strained.

"People are very concerned about the baby and what kind of environment the baby is going to grow up in," Feldman said. "Sometimes if we're not careful that can reflect on the mother feeling like she's a bad mother."

There are clinics in the area that understand the mother's fears and attempt to serve the pregnant homeless in an approachable and empathetic manner. Talitha Phillips is the CEO of Claris Health, which provides physical and psychological care to women regardless of economic status.

"Our model is not just the physical but also the psychosocial," she said. "We believe that those [are] important. So there needs to be an opportunity for women to know that they can process through things, that there is support before, during and after, regardless of what they choose."

Stacy Williams, the outreach manager for Claris Health, has found that the clinic's integrated services are especially helpful to this population of women.

"A lot of times when a woman is pregnant and homeless if there's any mental health issues, she is reluctant to take any medication for that, being pregnant," Williams said. "And so often then, mental health issues are exasperated and maybe harder to control, and I think that combination of mental health and not being able to take medication makes it more challenging than to reach that population and to house them and to get them into services."

Too few housing options

A review of housing options in the greater Los Angeles area revealed that, while there are a number of public homeless shelters in the area, most do not cater to the needs of pregnant women and new mothers.

Rita Haddad, the housing coordinator for SHIELDS For Families, which primarily serves substance abuse and mental health clients in South Los Angeles, outlined the requirements for her agency.

"They have to show that they're going to be able to sustain themselves so they're going to be working," she said. "They have to have some type of income so that when we take them on. You have to be approved and part of that approval process is there has to be income coming in. You have to show that you're going to be able to sustain and pay the rent."

For public health agencies, a newly passed law expands family housing to include pregnant women. Previously, a woman had to be in her third trimester to be considered for family housing, according to Melina Ramirez, of the Welcome Baby Project, Maternal and Child Health Access.

Some of the most readily available housing is through private faith-based organizations, funded by church and community donations. The specialized care that these Christian homes provide does come with stricter prerequisites.

Religion for a roof

Faith-based housing offers another option.

Learn more →

Learn More →

At Tender Life Maternity Home in Ventura, in addition to the basics required for public homes, residents must have no other children, a clean criminal record, 90 days sobriety, proof of legal status, and other requirements.

Lauren Stockton is the Housing and Case Manager at Tender Life. Once homeless and pregnant herself, Stockton said she believes that the various prerequisites are not ideal but serve a purpose, especially regarding sobriety.

"A lot of times when people come into programs right off the streets, just now getting off drugs, they're not ready to live that lifestyle of letting go of the drugs or the addiction," she said. "So it can kind of cause problems if we bring people in who are still fully drug addicted and not ready to let it go."

Jaclyn Ware is a resident at Tender Life, her only stable housing in the last four years outside of sober living homes. As with Roxann Ray, Ware's pregnancy was the turning point she needed to seek help.

"For me, it took being pregnant to really like, you know, 'This isn't just about me anymore. I've gotta get my stuff together,'" she said, "Because otherwise I was fearing that they'd take my child away."

Ware was more than willing to fulfill requirements such as the 90 days of sobriety for the chance at a better life.

"You use this kind of opportunity to get to get back on your feet instead of getting comfortable back in your ways. So and that's what I like, I've been benefiting from this place."

The final decision

Regardless of shelter, pregnant mothers must make many decisions, including whether or not to raise her child.

Celeste Liversidge is the founder of Tru Adopt Law, a nonprofit law firm that represents expectant parents rather than adoptive parents. A portion of her clients are homeless women. Whether the mother chooses adoption or not, Liversidge says that social workers help to facilitate the decision.

"Hospital social workers can be very instrumental," she said. "It's very tricky with social workers, because their job is to protect their patients which are both the child and the mother at that point."

Depending on the woman's history, the Department of Child and Family Services is sometimes called to intervene.

Nayat Mutafyan is the Child Services Administrator for the Child Welfare Health Services section of the Department of Child and Family Services.

"Some [hospitals] offer services without even us getting involved," Mutafyan said. "And sometimes they would have to prepare a referral within which a social worker would get assigned and would go out and investigate. Every situation is different and again if the hospital is reporting it, the hospital usually does the main risk assessment."

Mutafyan clarifies that it depends on the situation, not stereotypes, as to whether they interfere.

"Just because you're homeless doesn't mean that you're neglecting your child," she said. "Or you will be neglecting your child. And that was what I was going to say is that homelessness in and of itself does not mean that the department will get involved. You know, that doesn't justify our involvement in and of itself."

If a woman chooses adoption during her pregnancy, matching the baby with a family is a detailed process for which the birth mother has considerable input, according to Liversidge.

"Once she's made an adoption decision, that's a huge step for her," Liversidge said. "Instead of saying 'Here choose from these people' we say 'Tell us what is important to you' ... So you’ve got to help them step back and try to discover those things within themselves because they're not walking in the streets thinking about why education is important to them. They're thinking about 'How am I gonna eat? Where am I going to sleep tonight?'"

According to Liversidge, there are 200,000 to 250,00 families nationwide waiting to adopt. Additionally, about 85 to 90 percent of adoptions are open, meaning that the child is able to know and develop a relationship with its birth mother. Despite the encouraging statistics, homeless women fear rejection.

"They conclude on their own that there are no adoptive parents that would want to adopt their child because the child has been exposed to drugs in utero, or may have a genetic propensity toward mental illness, but that is absolutely not true," she said. "There are adoptive parents for any child that is out there, that are willing, not just willing but enthusiastically willing to adopt. It's pretty amazing to see ... But that is part of that stigma; 'no one is going to want my baby.' That couldn't be further from the truth. We have never not been able to find adoptive parents for a child, regardless of the challenges."

Liversidge hopes that the vulnerability of their situation doesn't keep homeless women from exercising their right to determine their own destiny as well as accepting the support available to them.

"There's hope," she said. "There are a lot of people that care about this population."

Roxann Ray shares this optimism despite the unideal circumstances of her pregnancy. Since Gracie was born just a day after Ray's own birthday, she considers her a daughter a late 40th birthday gift.

"It's what I've been waiting for, to have a baby," she said. "It's time to do everything I said I was going to do."