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Inside The Ethics Committee: Preventing Pregnancy in Homeless Women

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Beth_Eastwood 09:58, Friday, 27 July 2012

Editor's note: Inside The Ethics Committee this week covers the subject of Preventing Pregnancy in Homeless Women. You can listen again to the programme or download the series for free. PM

Joan Bakewell


Homeless women who are addicted to drugs often turn to sex work for money. Some become pregnant, often many times, with tragic consequences - their children often end up in care. What lengths should a medical team go to to encourage these women to use contraception?

The number of people sleeping rough on Britain’s streets is rising, and the need for supported housing continues. But providing a roof over someone's head is just the start. A nurse specialist, working in day centres and hostels, provides health services for the homeless. It’s an ideal opportunity to try to engage with clients, who usually fall under the radar of the general practitioner. Physical health problems associated with living outside are common, and many suffer from mental health problems and drug addiction.

Sex work provides a means for women to escape the streets at night, and fund a drug habit. But the chaotic nature of these women’s lives means contraception use is sporadic and pregnancies occur. Many of the women who have suffered the loss of several children to the care system still don’t have long term contraception in place.

  • What lengths should the medical team go to to encourage these women to avoid unwanted pregnancies?
  • Should they offer them money?
  • Would this be ethical?
  • Do we have the right to interfere in this way when people lead chaotic lives?

Joan Bakewell is joined on the panel by Ann Skinner, Founding Director of Resolving Chaos and Chair of Homeless Link, Deborah Bowman, Professor of Ethics and Medical Law at St George’s University of London, Richard Ashcroft, Professor of Bioethics at Queen Mary College, London and Dr Tamsin Broom, Sexual Health Consultant at Sandyford , Glasgow.

Beth Eastwood is producer of Inside The Ethics Comittee


  • Comment number 1.

    Homeless women addicted to drugs should ultimately be compelled to take advantage of long term contraception. I would have no problem with them agreeing to be sterilized for a few hundred pounds - money well spent.

    The truth is that some of these problem women have had more than eight babies, each of which has been taken from them at birth. It is a no-brainer that vagrants having babies places an excessive burden on taxpayers. In a recent episode of the Report it was estimated that the average annual cost of looking after a child in a care home was £200,000 (a figure that excludes, for example, police time in locating them when they run away).

  • Comment number 2.

    I must say that the phrase 'problem women' is part of the problem. These 'women have problems'. They need solutions and the problems stem way back before they were homeless. As a charity we work with these ladies and have seem transformation take place as they begin to be cared for, gain a portion of self esteem,(many for the first time in their lives) given some basic life skills, including sexual health and then begin to get trained in the search for meaningful employment. Green Pastures are doing this at no cost to the taxpayer. Govt need to listen to charities who get their hands dirty in order to resolve these problems. The problem is they are not, and we face the prospect of more homeless women, more of them getting pregnant as a result of crazy policies.

  • Comment number 3.

    Heart-rending! It seems they don't have a voice, (Inner, speaking up for themselves or in the scheme of things.) they have so often lost any voice they had to drugs and chaotic circumstances. But it must be there. Safe dwelling, contraception, rehabilitation in easy stages are vital routes but how can we encourage these humans, living in misery, to speak for themselves... what do they feel... underneath the dependence on drugs and unreliable 'friends' and 'exploiters'... often both in the same man?

  • Comment number 4.

    The ethics committee concentrated on the rights of the women concerned rather than on any children that would be born. Clearly not all children with mothers who are drug addicts will be harmed but this is often the case. Such harm should have been considered in equal measure to the rights of the women in deciding about the rights and wrongs of incentivising contraception for such women. The fact that the ethics committee did not mention the rights of people born in such cases indicates that they were less comfortable with infringing the rights of people today than imposing imposing harm on people tomorrow. A case of institutional intergenerational oppression if ever there was one.

  • Comment number 5.

    Why was there no mention of the children? I find it hard to accept that we can blithely allow so many children to come into the world in such dire circumstances, being physically affected by the drugs in their mothers' systems and then destined for a very difficult life in care. Why is the wellbeing of these children not taken into account? We should definitely encourage women who are taking drugs to use long term contraception until they are in a position to take care of a child. This would be best for both mother and child and any way of achieving that is worth it, be it discussion, persuasion or money.

  • Comment number 6.

    While I appreciate your reference to Nazi Germany in the context of Euthenasia, please do not forget that the term was invented in USA, our own Sir Julian Huxley was an early supporter though later he resiled. Also let us remember that in a Scandinavian country, compulsory sterilisation was practiced LEGALLY until the early 1970s. In England too, sterilisation of women considered to be mentally deficient and at risk, sometimes were sterilised.

  • Comment number 7.

    'With tragic consequences-their children often end up in care'-It would seem that it would be better not to exist at all than to be a bright eyed waif in the care of others.

  • Comment number 8.

    Portugal decrimalised all of its illegal drugs and addiction fell by 50%. Will we follow suit? No prizes for guessing the answer!

    "But they are drug addicts, they don't matter," I hear a choir of blue rinses proclaim in full song.

  • Comment number 9.

    What was slightly disturbing to me was that I didn't hear any mention of psychologically engaging the women to enable them to make their own choices. Methods such as Motivational Interviewing are very successful(but of course not 100%) in a number of areas, such as heroin use. This is not a way to get people to do what they don't want to do, but to explore the beliefs underlying a behaviour, and enable them to articulate intrinsic reasons to make a change. This, I think, should be considered before incentive.

  • Comment number 10.

    I have worked as a prison drug worker and at conferences requested for the inclusion of prisoners in developing proposals and therapeutic approaches. This was never done. This attitude was repeated tonight. The people themselves should be involved and the division between them and the professionals (with their superior prescriptive attitude) should be significantly reduced. I worked when the process was not so rigid and dominant as nowadays and the individual(s) with themseloves could be trusted. This can produce surprising results but takes a considerable cultural risk and change of the power imbalance.


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