Understanding the social situation as well as the physical and mental health status of homeless women during the perinatal period

This report provides quantitative data and precise accounts of the perinatal health of homeless women, focusing on residential instability and access to care in Île-de-France. Midwives, doctors, social workers, 115/SIAO teams, PMI, and housing associations can use it to substantiate their alerts, adapt their practices, and argue for resources or changes in systems. It is particularly useful for designing secure perinatal pathways for pregnant women housed in hotels, with third parties, or on the street.

Source: 📒 Understanding the social situation as well as the physical and mental health status of homeless women during the perinatal period

  📜🔗LINK 

Number of pages: 76 pages

1. ANALYTICAL SUMMARY

1.1. Context, audiences, and issues

The report describes the situation of homeless women during the perinatal period (pregnancy and the first months postpartum) in Île-de-France, in a context of increasing infant mortality and significant socio-spatial health inequalities. In 2025, at least 3,381 newborns, corresponding to 3,320 mothers, began their lives homeless in the region, with over 3,000 housed in social hotels, representing about 2–2.5% of births. The majority of these women are migrants, facing residential instability, almost no financial resources, partial access to rights, and massive social isolation. The REPERES project aims to document the consequences of these housing conditions on the physical and mental health of women and their children, as well as on access to and use of healthcare, relying on a mixed methodology (quantitative and qualitative).

1.2. Operational contributions for the field

The report provides robust indicators on socio-demographic profiles, housing pathways, exposure to violence, mental health, food and menstrual insecurity, pregnancy monitoring, childbirth, and contraception for homeless women. It distinguishes two quantitative components (REPERES Hotel and REPERES Solipam) that characterise different levels of vulnerability, and offers a detailed analysis of residential wandering and its practical impacts on access to care. It identifies levers for local actors: strengthening social and health support in perinatal care, adapting monitoring methods (interpretation, simplified readings, telephone follow-up), securing accommodation during the first 1,000 days, and structuring partnerships between hospitals, PMI, 115/SIAO, and associations. The recommendations target both professional practices (identifying violence, health mediation, longitudinal follow-up) and public policies (prioritising accommodation, strengthening the healthcare offer, scientific monitoring).

2. KEY POINTS OF THE DOCUMENT

1. A massive but largely invisible population (p.8–12, 18–21)

   The study estimates that by 2025 at least 3,381 newborns will have started their lives homeless in Île-de-France, primarily accommodated in social hotels, with a significant proportion of women coded as "homeless" in the PMSI each year (≈2–2.6% of births). The women studied are predominantly migrants, in significant social and financial precariousness, with marked social isolation: 88–89% report having fewer than three people to rely on in case of a problem.

2. Residential wandering and extreme instability of pathways (p.23–24, 51–53)

   Women followed through Solipam have a median of four places of residence during the perinatal period, with some having up to 36, and more than one in two women having experienced at least one period of homelessness and frequent stays with others, often accompanied by exchanges and risks of violence. This forced mobility is identified as a major factor in renouncing care and the fragmentation of pregnancy and post-partum pathways.

3. Severely deteriorated mental health and exposure to violence (p.26–31, 43–48)

   The report documents significant exposure to multiple forms of violence (psychological, physical, sexual, administrative) and female genital mutilation, with access to care sometimes hindered by refusals and discrimination. Standardised tools (EPDS, PC-PTSD-5, Mini) highlight levels of depression and post-traumatic stress symptoms that are significantly higher than the general population, linked to residential precariousness, isolation, and food insecurity.

4. Access to rights, care, and health literacy severely weakened (p.20–21, 34–38, 54–57)

   Between 13% (RH) and 26–27% (RS) of women have no health coverage despite frequent theoretical eligibility for AME, and 36–42% do not have social support at the time of inclusion. Knowledge of contraceptive methods is limited, particularly in the Solipam component, although a clear improvement is observed at 3 months post-partum, highlighting the positive effect of structured support and health mediation.

5. Methodological strengths, limitations, and follow-up perspectives (p.65–67)

   The combination of random sampling in social hotels and a cohort via Solipam, enriched by a qualitative component and medical-administrative data, makes REPERES a methodologically robust tool for informing public policies in the Île-de-France region. However, the authors identify blind spots (absence of minors, difficulties with rare events, exposure to violence inadequately explored in certain areas) and propose to continue data collection, to better link medical and social data, and to follow children at 2 years old, including from a neurodevelopmental perspective.

3. ACTION POINTS FOR LOCAL ACTORS 

1. Secure perinatal accommodation and limit homelessness (p.10–12, 23–24, 51–53, 68–70)

   For the 115/SIAO teams, local social services, PASH, and associations, the challenge is to limit changes in accommodation locations during pregnancy and the first months of life, prioritising pregnant women and young mothers in stable arrangements. In a given area, this involves operational dialogue between SIAO, maternity hospitals, PMI, and accommodation structures to avoid discharges from maternity to the street or to very short-term accommodations, which are particularly harmful during the perinatal period.

2. Structure a perinatal follow-up adapted to precariousness (p.13–17, 40–48, 54–58, 70)

   Maternity units, PMI, independent midwives, PASS and perinatal networks can draw inspiration from the Solipam model: repeated telephone follow-up, systematic interpreting, health mediation, use of standardised EPDS/PC-PTSD-5 questionnaires, coordination with referring social workers. Locally, this can translate into the establishment of midwife/social worker pairs, specific reception times for women housed in hotels or on the streets, and protocols for identifying homelessness situations at each prenatal consultation.

3. Strengthen access to rights and continuous social support (p.20–21, 70–71)

   Territorial social services, CCAF, food aid associations and accommodation structures must anticipate the duration of residential instability by providing continuous support, even in the event of a change of address (inter-structure bridges, single point of contact, follow-up "outside the walls"). The challenge is to systematise the opening and maintenance of rights (AME, C2S, benefits, specific aids), by integrating regular coordination times between health/social/housing actors.

4. Develop health mediation and team training (p.37–38, 54–57, 70)

   Care and accommodation structures can integrate health mediators or peers to work on health literacy (pregnancy, warning signs, contraception, nutrition, mental health) and reduce non-utilisation and refusals of care. At the same time, training modules on perinatality in extreme precarity, violence, discrimination, and intercultural care should be deployed for maternity professionals, PMI, emergency services, 115, SIAO, social workers and volunteers.

5. Use REPERES data for territorial advocacy (p.8–12, 65–67, 68–70)

   Territorial coordinations (CLS, CPTS, local mental health councils, local observatories) can mobilise the REPERES indicators to objectify the needs for accommodation places, midwives, interpretation, mediation, and social support. Local authorities and ARS can rely on these results to adjust territorial schemes (perinatality, emergency accommodation, prevention) and to prioritise homeless pregnant women in accommodation and healthcare access policies.

4. ADDITIONAL REFERENCES

🔍➕ For more information, see the articles referenced by "Pratiques en Santé" on the theme of mental health - psychological health ➡️🔗https://pratiquesensante.odoo.com/4-2-sante-mentale-et-psychique- parenting ➡️🔗https://pratiquesensante.odoo.com/5-3-parentalite

5. CROSS-ANALYSIS — VALUES OF HEALTH PRACTICES

• Literacy: The report mobilises telephone interpretation, reformulations, and adapted materials for questionnaires, but does not yet offer formalised literacy tools for women (simplified guides, FALC).

• Empowerment: Life stories and mapping workshops give space to women's experiential knowledge, but their decision-making power over accommodation pathways remains very limited.

• Participation: The study incorporates the voices of women and professionals in a logic of co-construction of the analysis, but does not describe a sustainable governance mechanism including representatives of the affected women.

• Community health: The collective dimension appears through workshops, the Solipam network, and the articulation between systems, but the report remains focused on individual pathways rather than on organised community dynamics.

• Ethics: The biases related to migration status, gender, precariousness, and homelessness are explicitly described, with a methodological framework to limit the risks of stigma and ensure informed consent.

• Human rights: The study documents violations of rights (lack of stable housing, refusals and denials of care, violence), and advocates for responses consistent with the principles of equity and inclusion.

• Intersectorality: Partnerships between Samusocial, Solipam, ARS, maternity hospitals, 115/SIAO, associations, and interpretation illustrate an intersectoral approach, even though coordination breakdowns persist.

• Partnership: The REPERES model is based on formalised collaborations between observatories, perinatal health networks, operational hubs, and public funders, with an active scientific committee.

• Combating discrimination: The report shows discrimination (refusal of care, housing conditions, violence) and emphasises non-judgment, but the translation into concrete anti-discrimination tools for teams remains to be developed.

VIGILANCE POINTS IN ANIMATION

Clearly present sensitive themes: homelessness, violence (psychological, physical, sexual), female genital mutilation, extreme precariousness, mental health, migration, and discrimination.

• Risks of emotional triggering :

  • Accounts of violence experienced before and during pregnancy, including sexual violence and coercion related to housing.

  • Testimonies of homelessness, nights spent on the street during pregnancy or with a newborn, and hunger.

  • A situation of great insecurity for mothers and their children, which may resonate with personal experiences among participants (professionals or peers).

In training, provide: clear rules for speaking, the possibility of breaks, prior identification of resource persons (psychologist, supervisor), guidelines for non-judgment and confidentiality, and the possibility of debriefing at the end of the session.

6. EVALUATION OF THE RELIABILITY OF THE RESOURCE

• Scientific relevance :

  • Mixed methodology (cross-sectional study in social hotels, cohort via Solipam, qualitative component) with random sampling, use of standardized tools (EPDS, PC-PTSD-5, Household Hunger Scale), cross-referencing with PMSI databases, SI-SIAO, ROSALIE.

  • Recognised limitations (non-inclusion of minors, difficulties with rare events, minimum estimation of numbers, exposure to violence partially measured) and prospects for consolidation.

  • Current situation: data from 2019–2025 analysed, publication in 2026, alignment with recent international literature and the policies of the first 1,000 days.

    → High scientific relevance to inform perinatal health in extreme poverty in Île-de-France.

• Operational relevance :

  • Indicators directly transposable for territorial diagnostics (number of homeless newborns, frequency of hotel accommodation, duration of homelessness, rate of health non-coverage, refusals of care).

  • Qualitative analyses and actionable recommendations to adjust practices (identification of vulnerabilities, organisation of follow-up, coordination between actors, prioritisation of accommodation places).

    → Very strong operational relevance for professionals and volunteers in perinatal care, accommodation, and social services, with a need for adaptation beyond the Île-de-France.

7. MCQ — 5 QUESTIONS

PART 1 — Questions (without answers)

Question 1 (p.10–12)

In 2025, what estimate does REPERES give for the number of newborns who started their life without a home in Île-de-France?

a) Approximately 1,000 newborns

b) Approximately 2,000 newborns

c) Approximately 3,500 newborns

d) Approximately 5,000 newborns

Question 2 (p.23–24, 51–53)

In the REPERES Solipam section, which characteristic of women's residential pathways stands out the most?

a) A majority with no change in living situation

b) Almost no mobility during pregnancy

c) A median of four living situations during the perinatal period

d) Accommodation exclusively in social reintegration and accommodation centres (CHRS)

Question 3 (p.20–21)

Among the women included in REPERES Hôtel, what proportion has no health coverage at the time of inclusion?

a) 3%

b) 13%

c) 30%

d) 50%

Question 4 (p.34–38)

In the REPERES Solipam section, what change in knowledge about contraception is observed between the beginning of pregnancy and three months postpartum?

a) The proportion of women who know no method of contraception increases

b) The proportion of women who know at least three methods decreases

c) There is no significant variation in knowledge

d) The proportion of women knowing at least three methods is increasing

Question 5 (p.65–67)

Among the methodological limitations identified by the authors, which is explicitly mentioned?

a) The total absence of a qualitative component

b) The exclusion of underage women from the study

c) The impossibility of using PMSI data

d) The absence of random sampling

PART 2 — Commented correction

Question 1

✅ Correct answer: c) Approximately 3,500 newborns

📝 Explanation: The presented estimate combines SIAO/Delta and PMSI data and concludes that in 2025 approximately 3,381 newborns began their lives without a home, rounded to "approximately 3,500". Source: p.10–12.

Question 2

✅ Correct answer: c) A median of four living places during the perinatal period

📝 Explanation: The report indicates that in Solipam, women have a median of four living places between the start of pregnancy and the child's 3 months of life, with pathways reaching up to 36 places, characterising a high level of residential mobility. Source: p.23–24, 51–53.

Question 3

✅ Correct answer: b) 13%

📝 Explanation: In REPERES Hotel, 13% of women have no health coverage, despite often residing in France for more than three months and thus having theoretical eligibility for AME. Source: table 4, p.20–21.

Question 4

✅ Correct answer: d) The proportion of women knowing at least three methods is increasing

📝 Explanation: In Solipam, the proportion of women who do not know any method decreases from 21% to 5%, while those who know at least three methods increase from 14% to 33% at 3 months postpartum. Source: p.37–38.

Question 5

✅ Correct answer: b) The exclusion of underage women from the study

📝 Explanation: The authors explicitly mention the exclusion of minors for legal reasons, which creates a blind spot regarding early pregnancies, among the identified methodological limitations. Source: p.66.

8. FREQUENTLY ASKED QUESTIONS (FAQ)

1. Who are the women concerned by the REPERES study? (p.18–23)

   The study concerns women without a home during the perinatal period (pregnant or having given birth within the last 4 months) in Île-de-France, mostly migrants, with very limited resources and often housed in hotels, with third parties, or on the street.

2. How were the women recruited for the study? (p.13–17)

   Two quantitative components were established: random selection of women housed in hotels via Delta (REPERES Hotel) and inclusion of all pregnant women followed by the Solipam network over a given period (REPERES Solipam), supplemented by a qualitative component.

3. What is residential wandering in this report? (p.8–10, 23–24, 51–53)

   Residential wandering refers to the rapid succession of temporary or informal housing locations (hotels, street, third parties, emergency services) without lasting stability, with frequent moves related to the saturation of services.

4. What are the main impacts of wandering on the health of women and newborns? (p.8–9, 41–48, 51–56)

   Wandering leads to delays in pregnancy follow-up, renunciation of care, deterioration of mental health (depression, post-traumatic stress), increased food insecurity, higher obstetric risks, and greater exposure to violence.

5. How does the study address the issue of violence? (p.26–31, 24)

   The report documents exposure to a plurality of violence (psychological, physical, sexual, FGM, housing-related blackmail), relying on quantitative data and qualitative narratives, although the measurement is not exhaustive in all areas.

6. What role does the Solipam network play in women's journeys? (p.5, 13–17, 16–17)

   Solipam coordinates the perinatal follow-up of pregnant women in great precariousness, offers repeated interviews during pregnancy and postpartum, articulates access to care and housing, and serves as an essential anchor point for women in wandering.

7. What recommendations are made for professionals? (p.68–71)

   The report recommends raising awareness and training teams on perinatality in contexts of precariousness, improving detection and reporting, securing housing, structuring coordinated care pathways, and using REPERES data for advocacy and adjustment of public policies.

9. REWRITING IN EASY TO READ LANGUAGE 

Title

Pregnant women without homes in Île-de-France

According to the REPERES report, March 2026.

A. Context and issues (EASY TO READ)

• Some pregnant women do not have stable housing.

• They live on the street, in hotels, or with people they know little.

• In 2025, around 3,500 babies were born under these conditions in Île-de-France.

• These women have little money and few people to rely on.

• They often struggle to see a doctor or midwife regularly.

• Their health and that of their baby are at greater risk.

B. What the report provides (Easy to Read)

• The report provides specific figures on these women and their babies.

• It explains their housing situations during pregnancy.

• It shows the difficulties in eating, accessing healthcare, and feeling safe.

• It also discusses the violence they experience.

• It offers ideas for better supporting them on the ground.

• It provides suggestions for changing the organisation of care and accommodation.

C. Key points in Easy to Read

• Many women frequently change their sleeping locations.

• Some sleep on the street during pregnancy or after giving birth.

• Many do not have health coverage even though they are entitled to it.

• They have very little money for baby needs (milk, nappies, clothes).

• They often have mental health issues: severe sadness, fear, stress.

• Associations and teams like Solipam help them understand their rights and healthcare.

• The report calls for more stable accommodation places for these women and their babies.