Breaking the Cycle

Written by Samantha Bronson
Martha Ryan '72 is founder of San Francisco's Homeless Prenatal Program.

THE WOMAN haunted Martha Ryan’s thoughts. Homeless, addicted to drugs, HIV-positive, and pregnant, she would receive prenatal care only when Ryan ’72 sought her out.

After her baby was stillborn, the woman continued her life on the streets. Yet Ryan, a nurse practitioner, kept tabs on her through word-of-mouth, ignoring others’ insistence that such efforts were futile. When Ryan heard the woman was pregnant again, she still believed in her potential to change and asked an acquaintance to find her.

She was in Ryan’s office the next day.

“I can’t believe you still care,” Ryan recalls the woman saying that day. Because of Ryan’s care, the woman stopped using drugs, delivered a healthy, HIV-negative baby, and was hired by Ryan as an outreach worker.

“(Pregnancy) is a window of opportunity for somebody to turn their life around,” says Ryan, founder and executive director of the Homeless Prenatal Program in San Francisco’s Mission District. “Nobody wants to hurt a baby. These women want to have a healthy baby, but they don’t know how to do it.”

Thanks to Ryan’s nonprofit organization, thousands of San Francisco women have been learning that and more for the past 17 years. Housed in a spacious building once used as a dot-com incubator, the organization nurtures its own ideas about serving poor women: All can change their lives if given the right opportunities and support. Homeless Prenatal offers prenatal care, family counseling, housing and job assistance, parenting education, and referrals to substance abuse programs.

“What we’re trying to do is break a cycle,” says Ryan. “We are trying to ensure the children who are born to the women we serve will never become homeless again.”

The numbers prove Ryan’s approach works. The organization helps about 2,500 families each year through its different programs. Of the more than 1,400 births Homeless Prenatal has been a part of over the years, 90 percent of the babies were born healthy and drug-free. The organization has also helped more than 600 women receive counseling and treatment for drug and alcohol addiction and helped nearly 2,500 families find permanent housing.

The numbers tell only part of the story. Homeless Prenatal is a success because of the personal connection and trust forged between Ryan, clients, and staff.

Consider Bridchette Johnson, who in 1994 was addicted to crack, sleeping on public benches, and four months pregnant. Desperate to have a drug-free baby, Johnson followed a friend’s recommendation and went to Homeless Prenatal. From the moment she walked in, Johnson remembers, she was treated with respect. No one judged her and no one looked down on her.

“As crazy as I was, as loud as I was, she would just look at me and give me a hug,” says Johnson. “They felt like I was worth something, so that made me feel like I was worth something.”

With Homeless Prenatal’s assistance, Johnson found housing, entered a drug treatment program, and received prenatal care. The staff also made sure she had food, vitamins, and baby clothes and supplies, and invited her to join a support group.

Several months later, Johnson gave birth to a healthy, drug-free baby boy. Johnson’s story twists and turns through relapses and prison time, but each time she sought help from Ryan and others at Homeless Prenatal, they welcomed her without condescension. Now Johnson is on the other side, greeting clients as they come in the door. More than half of the 50-member staff are former clients—Ryan knows these women are the best link to the community she is trying to serve. And when the women make changes that benefit themselves and their families, they are eager to share those experiences with others in similar situations. Johnson, for example, is no longer homeless or addicted to drugs and says she is a different person than when she first met Ryan.

“I love her for helping me change my life,” says Johnson. “She knows I’d do anything for her.”
That love and admiration is evident the moment Ryan walks in a room, with staff and clients alike greeting her with hugs. Even as a staff member explains a challenging situation, Ryan smiles and maintains her positive outlook. She is clearly in her element.

Homeless Prenatal’s clients also look at home. A typical morning there finds women waiting in the building’s reception room, a central gathering space with chairs grouped around a coffee table. Along one wall, donated bread and fruit are available for clients. Another wall features a rack of clothing in all sizes, free for the taking. Upstairs, mothers-to-be sift through maternity clothing before taking their seats for a prenatal class. At the end of the eight-week series, they will celebrate during a joint baby shower, leaving with armloads of new baby gear. In a nearby room, other mothers-to-be stretch and tone in a prenatal yoga class. Next to the yoga room is Homeless Prenatal’s childcare center where clients drop off their children while onsite attending a class or meeting with case managers and counselors.

Ryan is the only nurse on staff, but the program collaborates with midwives from San Francisco General Hospital so that women can receive ongoing prenatal care at Homeless Prenatal. The program acts as a social services agency for poor women, hiring case managers, social workers, and therapists. The idea behind the program’s offerings, says Ryan, is to provide a supportive environment at what is often one of the lowest points in these women’s lives.

“We really believe we were all given strengths,” says Ryan. “God didn’t make some of us better than others, but some have been beaten down for so long, they don’t realize they have strengths.”

Judging by the program’s annual budget, a variety of outside groups also recognize the potential of the women. Of Homeless Prenatal’s $3.1 million budget, about two-thirds comes from city-funded grants, with the remainder raised from foundations, individual donors, and event proceeds.

Although helping homeless and other poor women realize their strength has become her
lifework, Ryan did not set out to do this. She graduated with a bachelor’s degree in French and then taught English in Ethiopia through the Peace Corps. Inspired to give back more, she trained as a nurse, worked for San Francisco General Hospital, and volunteered at three African refugee camps for six months at a time. It was there she realized the vital role women play in a community’s health.

Around that time, Ryan heard that several pregnant women were staying at a local homeless shelter and that none was receiving prenatal care. Skeptical that homeless women would be pregnant, Ryan found three women at different stages in their pregnancies. She began volunteering once a week, providing basic prenatal care as well as referring the women to other resources for care. As she got to know the women, she realized there were many others like them.

“I would tell people this is a terrible thing,” says Ryan, “and everyone would say, ‘Oh, it’s awful,’ but no one did anything.”

Instead, she did something. Ryan submitted an explanation of her work as a grant proposal, and was awarded a small amount of funding from the San Francisco Foundation. In 1989, the Homeless Prenatal Program was born.

During that first year, the program provided prenatal care to 72 pregnant women out of a closet-sized room at the shelter. The program grew so much—both in terms of clients and services—that it moved to a building on Market Street and eventually to its current location on 18th Street. Along the way, the program expanded to include families.

“Every day we see miracles happen,” says Ryan. “We see women who have the courage to change their lives. Women who have very little hopefulness, yet they have the courage to look inside themselves, find their strengths, and move forward so they can be the best possible parent to their children. We see this happen and that is what keeps me motivated.”