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“Instead of providing proven systems of support to pregnant people experiencing homelessness, the city is choosing to delay help through an unnecessary study, failing to deliver what it already knows works.”
This spring, New York City proposed a new research study on pregnant people seeking shelter that raises significant ethical and methodological concerns. The study would randomly assign pregnant people arriving at the city’s Prevention Assistance and Temporary Housing (PATH) intake centers to one of three groups: one receiving $1,200 monthly to stay with family or friends (via the Pathway Home program), one immediately receiving CityFHEPS vouchers to move into permanent affordable housing, and a control group that would remain in a shelter awaiting their turn to receive CityFHEPS vouchers.
The city’s stated goal is to determine which intervention helps pregnant people avoid or shorten shelter stays. While it’s important that policy be guided by research-backed evidence, this study’s design, which withholds housing support from subjects based on chance, raises considerable ethical concerns while failing to meet methodological standards.
While random assignment through a Randomized Controlled Trial (RCT) can help identify results of scientific intervention, denying housing support to a group of pregnant people does not meet critical scientific and ethical standards. We already know that housing insecurity during pregnancy is associated with increased pregnancy complications and adverse birth outcomes–risks that cannot be justified in the name of scientific inquiry.
The Belmont Report, issued by the federal government in 1979 in response to egregious research practices like the Tuskegee Syphilis Study, lays out three foundational principles for ethical research involving human subjects: respect for persons, beneficence, and justice. This proposed study violates all three.
It undermines respect for persons by involving a highly vulnerable population – pregnant people experiencing homelessness – under circumstances that might challenge the validity of informed consent. While the Department of Homeless Services (DHS) has stated that the program is voluntary, the potential of immediate access to life-altering benefits like CityFHEPS or Pathway Home, may make consent feel less like a choice and more like a necessity.
The study violates beneficence by exposing participants in the control group to prolonged housing instability, rather than minimizing risk and maximizing possible benefits. Additionally, it randomly assigns some to Pathway Home even if they lack eligible hosts, depriving pregnant people of meaningful support. Furthermore, Pathway Home fails to assess whether the host home may pose a risk of interpersonal violence.
Finally, the study also violates justice by placing the burden of research on a marginalized group while withholding proven housing benefits. Under the proposal, only those assigned to CityFHEPS would get immediate access without typical requirements, leaving the control group unfairly denied quick access to stability based solely on chance–a proposal that likely would not pass ethical review from any Institutional Review Board (IRB), a type of oversight body meant to protect vulnerable patients and ensure studies meet basic ethical standards. Unfortunately, the city has decided to move forward with the study without seeking approval from an IRB.
Even setting aside serious ethical concerns, the study fails on scientific grounds. RCTs require comparable groups and equal access to interventions, but this study fails on both counts. Pathway Home requires a willing host, yet participants are assigned before verifying eligibility, meaning that some are placed in groups they cannot benefit from.
If someone placed in the Pathway Home group has no family or friends to stay with, they are structurally excluded. Treating these people as if they had access to the program skews data and distorts conclusions drawn from the data.
Beyond ethics and design flaws, the study’s research goals are vague. The city claims its goal is, “to track the three groups over time, measuring factors such as days in shelter and housing placements,” but these metrics are poorly defined.
The city regularly touts the success of the CityFHEPS program in helping people move from shelter to permanent housing. Yet instead of providing proven systems of support to pregnant people experiencing homelessness, the city is choosing to delay help through an unnecessary study, failing to deliver what it already knows works.
Alison Wilkey is director of government affairs and strategic campaigns for Coalition for the Homeless. Rachel Swaner is vice president of policy, research, and advocacy at the Community Service Society.