A pregnant woman had just hada miscarriage in the toilet of her hotel room, a La Quinta Inn employee told Auburn police in April. The woman, who was three months pregnant, was whisked away to UMass Memorial Medical Center for treatment, while a firefighter stayed behind with her two other children.
It was not an unusual call for emergency responders in this Central Massachusetts town — or any of the communities where homeless and migrant families have been placed in hotels serving as shelters. The week before, emergency responders had come to La Quinta for a 22-year-old, likely pregnant, who was reporting stomach pain. The month before, they helped another woman having a miscarriage. Between September and December of last year, La Quinta staff called 911 another six times for pregnancies, records show. One woman was in labor, three had abdominal pains, one was having trouble breathing at seven months, and one was bleeding in her first month.
Behind the closed doors of hotel rooms in far-flung communities across the state are hundreds of women far from their extended families, facing the profound emotional and physical toll of pregnancy in a foreign land with no place to call home. The state’s Emergency Assistance program is explicitly designed for sheltering families with children or pregnant women, but is not equipped to handle this many families, let alone pregnancies.
Even as the shelter system exploded over the past two years with a massive influx of migrants, the state has done little to address the heightened needs of pregnant and postpartum women, from nutrition to mental health, a Globe review found.
Police and fire logs from a sample of communities with shelters reveal that many of the 911 calls are made on behalf of pregnant women — often in distress.
In addition to the more common labor and pregnancy complications, the logs include calls for miscarriages, stillbirths, and pregnant women suffering mental health crises.
Over the past two years, nearly one in nine families that sought shelter through the state’s Emergency Assistance program included a pregnant woman, according to data provided by the Massachusetts Executive Office of Housing and Livable Communities, which runs the program. That figure doesn’t include those who arrived with babies or became pregnant during their stay.
Source: Massachusetts Executive Office of Housing and Livable Communities
Many are migrants who fled Haiti, the country with the highest rates of maternal and infant mortality in the Western Hemisphere, and landed in America homeless, a risky circumstance for any pregnant woman, linked to adverse outcomes such as low birth weight infants and preterm deliveries.
Hypertension, gestational diabetes, and anemia are now common among the migrants, according to health care providers, mental health counselors, and migrant advocates. Some mothers blame their weak and insufficient breast milk and flagging energy on the unpalatablemeals they’re provided by the government-funded food vendors.
“I was just really shocked,” said Soraya DosSantos, founder of Sacred Birthing Village, a maternal support organization, who has worked with women in shelters in the New Bedford area. “I’m shocked by the condition that these families were living in, especially for the pregnant and birthing individuals and their children. Because they weren’t getting what they fully needed. Because it’s not just about a roof over their head, right?”
State officials stress that the Emergency Assistance program is charged with providing shelter — not additional support like nutrition counseling thatfederal programs provide low-income pregnant women and children.
“Emergency Assistance is a program to prevent homelessness among children, their families, and pregnant women in Massachusetts by providing them with temporary, emergency shelter and case management,” said Kevin Connor, a spokesman for the state housing agency. State staff and shelter providers work with pregnant individuals to connect them with existing programs, benefits, and services, he noted.
The state’s unique right-to-shelter law aims to keep children off the street by providing temporary housing for homeless families with children and pregnant individuals. In years past, when shelters were full, the state also turned tohotel rooms to accommodate families. But demand has grown so astronomically over the past two years — as pandemic-era eviction protections expired and more immigrants came to Massachusetts — that the state has been sheltering as many as 7,500 families at a time, the limit set by Governor Maura Healey.
Source: Massachusetts Executive Office of Housing and Livable Communities
The government had to rent out entire hotels — and then, since many accommodations lacked kitchenettes, find food contractors to provide meals. The state rushed to find vendors, offering no-bid contracts that had no requirements for nutritional value, and advocates say the vendors often serve produce-free meals, rather than the iron-rich and nutrient-filled diets pregnant and lactating mothers require.
At the same time, a lack of mental health counseling has left many postpartum mothers isolated in suburban hotel complexes, often located along highways or in office parks far from job centers, playgrounds, pharmacies, or doctor’s offices.
At some shelters, local organizations and church groups have intervened to host support groups or diaper drives. But advocates say the state must develop a more comprehensive approach to meet the burgeoning needs of mothers and children.
“There really has to be a statewide response to this instead of kind of piecemeal things,” said Dr. Roseanna Means, an attending physician at Brigham and Women’s Hospital, who has been working with homeless and pregnant women for 40 years. “This problem is not going away anytime soon. … It is a human justice and health issue that is at the heart of this.”
Eight months pregnant and in a new country, Midou, a 32-year-old mother from Haiti, is measuring life by distance.
She is holed up in an office park hotel in southeastern Massachusetts — more than 1,600 miles from her parents and extended family after fleeing violent gangs who repeatedly broke into and ransacked the clothing store she and her husband operated in Haiti.
She is more than 30 miles from her obstetrician in Roxbury, who was near her first shelter placement. Now, the trip takes an hour by Uber along congested streets and through towns with names she doesn’t recognize.
Isolated in her hotel room with her two older children and her husband, Midou’s experience is far from the normal, healthy pregnancy she expected.
Her doctor has warned that herunborn child needs to gain weight, but she finds the food at the shelter — sometimes undercooked meator cold-cut sandwiches on dry bread — difficult to consume. She is able to pick up milk, vegetables, and juice with federal benefits given to pregnant and new mothers, but it isn’t always enough. She has been diagnosed with anemia, a red blood cell deficiency, that can lead to exhaustion in a mother and, in more severe cases, cause a baby to be born preterm. Andshe can barely sleep, worried about how she and her family will make their way in this new country.
“I’m really stressed every day, more and more,” said Midou, who only gave her nickname to protect the privacy of her children and family. “I’m pregnant. I’m like in a prison.”
Massachusetts has absorbed nearly 13,000 migrant families like Midou’s over the past two years, dispersing themto live in 128 different hotels in communities all over the state, from Chelmsford to Chicopee. To protect their privacy — especially after hate groups protested at shelters that had beenidentified — the state hastried to keepthe hotel locations confidential and restricted access by the public. With the families so spread out, however, their needs remain largely unseen and health care providers and volunteers are limited in their ability to offer home visits and other help. When DosSantos volunteered to organize a moms group, she submitted a background check and other forms with the state, only to be told by the shelter provider that she’d have to pay $200 each time she used the hotel’s conference room.
“It’s not easy to get in,” added Myrtise Maurice, founder of a behavioral health organization that focuses on communities of color and tried to volunteer at a shelter. “Especially when you don’t have a contract and you’re offering the service for free.”
Statistics confirm a sharp uptick in the small but growing number of births to Haitian-born women in Massachusetts — up 89 percent from 2020 to 2023. Births to all Massachusetts residents during the same time period grew only 0.9 percent, according to data from the Massachusetts Department of Public Health. In the first nine months of this year alone, 1,990 babies were born to Haitian mothers, public health data shows. That number exceeds the total for every recent year but 2023, which it’s on pace to surpass by year’s end.
More difficult to discern is how many of the pregnancies result in stillbirths and miscarriages. Data from the state and the Centers for Disease Control and Prevention is not up to date.
Suchlosses can have dire consequences for women, especially if they have no other children: They forfeit their bed in a family shelter.
Jesusla Etienne and her husband were staying at one of the state’s overflow shelters while she was pregnant with their first child. The hard cots were uncomfortable, but the growing family was together.
Six months into her pregnancy, Etienne went into labor. Her baby was premature and did not survive.
“I lost my child in the program,” Etienne said.
She was given three to four weeks to leave the shelter, because she no longer qualified. Huddled with her husband on the cold floor at Logan Airport one night in late June, Etienne showed a handful of photos of her baby in the hospital.
“They didn’t treat me well,” she said.
The state said it does not keep track of how many families were removed from emergency shelter because they were no longer pregnant.
“In the rare and tragic case that a woman in[Emergency Assistance]loses a pregnancy and becomes ineligible for the program, case-management staff do everything in their power to support them, including allowing them extra time to remain in shelter, providing them with continued services, and working with them to identify alternative housing options,” said Connor, the housing agency spokesman.
If life here is hard, the road here was harder. For many of these women, the journey to Massachusetts was harrowing. A mother in Taunton told the Globe she was six months pregnant and dodged gunfire as she boarded the plane leaving Haiti last fall. One mother said she and her family were stopped by police in Central America who demanded money to let them pass. Another told a local counselor she’d had a miscarriage while traveling the forbidding Darién Gap — the treacherous jungle route that forms the only land bridge between North and South America.
Sherlie Elisse, 34, from Haiti, was recovering from a Cesarean and a difficult delivery when she fled to Mexico with her 1-month-old son, Elisonn Saint Juste. She had been warned by her doctor that it would be dangerous to travel with Elisonn, who was born premature. While in Mexico, he had trouble breathing and had to be hospitalized for 15 days, she said. When she arrived in Boston in late June, her son, now 10 months old, was fighting a cold and chest congestion. At the time, mother and son were sleeping on the airport floor and she worried for his health, being exposed to so many other people.
Obstetricians and birthing advocates said many of the women they have seen here arrived with trauma either from their homeland or their journey.
Sexual violence — always a risk — has exploded along the route through the Darién Gap, which is now heavily traveled and controlled by criminal gangs. Doctors Without Border/Médecins Sans Frontières, whose medical teams tend to patients along the route in Panama, reported a sevenfold spike in the monthly number of survivors of sexual violence treated in December 2023.
It is unclear how many pregnancies are the result of rape or other forms of sexual coercion as vulnerable migrants make their way to America. But a spokeswoman for the Migration Policy Institute, a nonpartisan think tank on immigration, called sexual assault along the journey “horrifyingly common” and cited anecdotal reports that the threat is so well known that some women and girls begin birth control before setting off on their journey.
Haitian culture, steeped in Catholicism, has traditionally discouraged contraception, noted Tracey Taldon, a clinical social worker who has been working with migrants in the Taunton shelter. That’s one of the reasons that so many Haitian migrants arrive in America pregnant, local advocates said.
It’s a misconception to think that migrants get pregnant in order to gain some advantage in the immigration system, said Sarah Sherman-Stokes, associate director of the Immigrants’ Rights and Human Trafficking Program at the Boston University School of Law.
A baby born in the United States becomes a citizen — regardless of the mother’s immigration status — but that birthright statusdoes not increase a mother’s chances of gaining asylum here, Sherman-Stokes said.
“The only way a US citizen child could benefit a noncitizen parent is when that child is 21 and can petition for the parent,” she said. “Until then, there’s no direct line between being a US citizen child and obtaining an immigration benefit for a parent.”
The challenges these new arrivals face extend well beyond the physical. Some Massachusetts health centers have begun screening pregnant patients more frequently for depression and trauma.
Dr. Stephany Giraldo Eierle, a physician specializing inperinatal psychiatry at the Family Health Center of Worcester, said hormonal changes during pregnancy can contribute to anxiety and depression. On top of that, many of these women may feel isolated, or have traveled without their mental health medications, or experienced trauma along the way, Giraldo Eierle said.
“They are survivors of violence, they’ve lost a family member to violence, or they are in domestic violence situations,” she said, adding that their troubles include the “trauma of leaving everything behind.”
Counselinghas been sparse, though the state’s Department of Mental Health connects with shelter providers if there’s an incident at a shelter or a resident has a specific need. More often, volunteers or independent therapists have become aware of problems at a particular shelter and donated their time to work with families there.
Maurice, the social worker who got approval to begin volunteering in a Plainville shelter, said she got involved because she heard of an obvious need — a pregnant woman approaching her due date with no idea who would watch her older child while she was in the hospital.
“I said, ‘Why hasn’t anybody addressed this problem?’ ” said Maurice. “She can’t be the only single mom without any support that goes to the hospital to give birth and doesn’t have anybody to watch the other child.’”
Maurice was struck by how isolated the women were in the hotel. To reach the nearest coffee shop or supermarket, they would have to walk nearly a mile, much of it along the berm of a busy highway. They had food and shelter but no emotional or mental health support, recalled Laure Lindor, clinical director of the Multicultural Counseling Center in Dedham. “Nobody has checked up on us,” she recalled them telling her.
Maurice and Lindor — who both do outreach through a group called the Behavioral Health Providers Collaborative — went door-to-door in the hotel to find pregnant and postpartum women for a support group. For their first meeting, Maurice said, she found 21 women.
There was “depression behind every single door,” said Lindor.
Many of the migrants had survived the devastation of the earthquake in Haiti 14 years ago and some had spent years in South America before making their arduous journey to the United States. Now they face a very different reality than what they had imagined: Jobless, unable to communicate, secluded in hotel rooms with restless children, many are weathering a dramatic “letdown.”
“They thought it was going to be quite different. America is the land of opportunity. America is the land where you do well,” said Lindor. “They didn’t know about the challenges and the struggles they would encounter once they got here.”
The collaborativeran asocial emotional group for the shelter’s children, as well as parenting groups for men and women, until a social service provider assumed oversight of the shelter in the spring. By that time, a community seemed to be taking shape, with the mothers beginning to watch each other’s children, Maurice said.The counselors continue to see some of the mothers they met there, both virtually and in person, and to deliver them baskets of supplies for their newborns.But they have yet to make inroads in other hotel shelters.
Doctors and health workers who have worked with mothers from shelters said they have been dismayed by the quality of the food being provided — and often not eaten — at these sites: moldy oranges, hard rice, and undercooked meats.
“The type and quality of food they’re getting access to is definitely not as healthy as we would want it to be,” said Dr. Monica Mendiola, OB-GYN medical director at NeighborHealth in East Boston, where she sees pregnant patients from shelters.
NeighborHealth offers a weekly market for women to shop for fresh food and vegetables; WIC supplemental benefits allow women to purchase specific foods to sustain their pregnancies and young children and also gives them access to a nutritionist.
But without stoves at the shelters, preparing their own food can be a challenge.
“Most patients come in pretty healthy,” she said. “And then when they’re introduced to the American diet, there’s a lot of processed food and not having direct access to cook their own food, they can become gestational diabetics or they’re put into a higher echelon of hypertension.”
Joan Salge Blake, a clinical professor of nutrition at Boston University, said she has seen images of some of the shelter food. “I have no idea what that food was,” she said. “That was not identifiable.”
Pregnancy requires about 340 extra calories a day in the second trimester and about 450 extra calories a day in the third trimester, she noted. To produce breast milk, a woman needs even more — about 500 extra calories a day, though some can be drawn from fat stores if she has gained an adequate amount of weight during pregnancy.
Iron is especially important for fetal development, Salge Blake noted, and nutrients are key. None of that can be gained from an unappetizing meal that’s left on the plate.
“It’s not nutrition unless you eat it,” she said.
Midou, the mother living in the southeastern Massachusetts shelter, has been trying to prepare for her baby due in November. She has been going to her regular appointments at Whittier Street Health Center in Roxbury, where she is also able to pick up diapers and clothes. She is following her doctor’s instructions to drink milk and getting exercise by walking around the hotel parking lot.
She dreams of one day opening a clothing shop, like she had in Haiti. Then she and her husband will be able to support their children and ensure they have enough to eat, Midou said.
She and her family are safe here in Massachusetts, she said. Her husband has found a factory job, and although it is a three-hour commute, it is a start.
For now, that is enough.
“I still have life,” Midou said. “I still have hope.”
Deirdre Fernandes can be reached at deirdre.fernandes@globe.com. Follow her @fernandesglobe. Stephanie Ebbert can be reached at Stephanie.Ebbert@globe.com. Follow her @StephanieEbbert.
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Publish date : 2024-10-06 23:14:00
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