It is estimated that 16% of infants born from the DTES are exposed to drugs or alcohol as fetuses (Loock et al., as cited in Poole, 2000). In 1999, an attempt was made to estimate the number of substance using pregnant women in the lower mainland requiring medical aide. Legare & Bodnar (as cited in Poole, 2000), emphasize the difficulty in making such an estimate as many women in this situation are reluctant to seek prenatal care, are unidentified by their physician, or are unaware of the effects of drug and alcohol use on the fetus. A study conducted by Clark (2001) on pregnant substance abusing women, determined that 56% of the participants did not graduate from high school, 92% were unemployed, and 48% were relying on pubic assistance as their major source of income. Homeless women become more vulnerable to disease, violence and abuse as they have increased exposure to hostile environments. Rest, and adequate nutrition can be challenging to attain, and consequently, prenatal care can become a low priority for women (Overbo et al., 1994). Two thirds of women undergoing substance abuse treatment have experienced physical and/or sexual abuse. Poole (2000) states that women often come from unstable childhood situations, having experienced emotional, physical and sexual abuse as well as abandonment. Jansson & Velez (1999) claim that substance-abusing women are frequently from multigenerational drug abusing families. According to Hagan (as cited in Jansson & Velez) 83% of addicted women were raised in households in which parents also abused substances. According to a study conducted by Selleck & Redding (1997), registered nurses often hold views toward pregnant substance abusers that are more punitive than supportive. Poole & Isaac (2001) state that women in their Canadian study hold fear that "the child protection system will respond in an arbitrary fashion and automatically apprehend their children on the basis of use alone, if they admit to needing help with drug use, especially for illicit substances" (p. 15). According to a study by Milligan et al. (2002), many pregnant substance-abusing women lack trust in physician-client confidentiality. This distrust in confidence leads to fear of revealing drug addiction and therefore a deterrent to seeking prenatal care (Levine, 2001).