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Garcia-Alexander G, Thompson M. Judgment, shame, and coercion: the criminal legal system and reproductive autonomy. HEALTH & JUSTICE 2024; 12:6. [PMID: 38363420 PMCID: PMC10870550 DOI: 10.1186/s40352-024-00259-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/22/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND A growing body of research has called attention to limitations to reproductive autonomy in both women who are socially disadvantaged and in those who have had contact with the criminal legal (CL) system. However, it is unclear whether CL system contact influences contraceptive use patterns and how these processes unfold. We utilize a mixed-methods approach to investigate whether history of arrest is associated with receipt of contraceptive counseling, use of long-term contraception, sterilization, and subsequent desire for reversal of sterilization. We further consider how agents in and around the CL system may influence women's reproductive decisions and outcomes (856 survey respondents; 10 interviewees). RESULTS We observe that women who have been arrested more commonly report receipt of contraceptive counseling and sterilization. They are also significantly more likely to want their sterilization reversed. Our in-depth interviews suggest that women with CL contact experience considerable shame, and in some cases, coercion to limit fertility from various agents in and outside the criminal legal system including medical providers, Parole/Probation Officers (POs), guards, and family members. CONCLUSIONS Our findings suggest the need for ongoing attention to how exposure to this system may promote uneven use of certain forms of contraception and dissatisfaction, i.e., desire for reversal of sterilization, among these women. Findings further suggest that de-emphasizing the CL system as a means through which to address reproductive needs should be considered.
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Affiliation(s)
- Ginny Garcia-Alexander
- Department of Sociology, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, 78249, USA.
| | - Melissa Thompson
- Department of Sociology, Portland State University, P.O. Box 751, Portland, OR, 97201, USA
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Routh D, Simmons R, Sanders J, Gero A, Tanner HA, Turok DK. Building an implementation framework to address unmet contraceptive care needs in a carceral setting: a systematic review. HEALTH & JUSTICE 2023; 11:43. [PMID: 37861888 PMCID: PMC10588068 DOI: 10.1186/s40352-023-00243-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 09/29/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND The provision of contraceptive care for incarcerated individuals has been largely inconsistent and has contributed to, at best, inadequate care, and at worst reproductive abuses, violence, and coercion. While previous research has identified strategies to remedy known issues, to date, very few recommendations have been implemented across the carceral system. To address this, we conducted a systematic review of policy and practice recommendations to improve contraceptive care to reproductive-aged, incarcerated individuals in the United States. METHODS We conducted this systematic review utilizing the Joanna Briggs Institute methodology and framed it within the National Implementation Research Network's (NIRN) Exploration stage. We searched PubMed, PSYCInfo, SCOPUS, ProQuest, Web of Science, MedLine, Social Science Citation Index and reference sections of included materials. Basic study information, explicitly stated policy and practice recommendations, and discussions and conclusions that subtly provide recommendations were extracted in full text. We utilized a thematic analysis approach to analyze the extracted text. RESULTS A total of 45 materials met the inclusion criteria. Seven overarching themes were identified: 1) policy changes needed to implement care; 2) need for contraceptive care in carceral systems; 3) justice agency barriers regarding contraceptive care provision; 4) policy barriers to contraceptive access; 5) funding strategies to improve care; 6) patient preferences for contraceptive care delivery; and 7) healthcare provider knowledge regarding contraceptive care. The seven themes identified shed light on the need for, gaps, barriers, and facilitators of current contraceptive care provision to incarcerated individuals. CONCLUSION This systematic review accomplished two goals of NIRN's Exploration stage. First, the compiled evidence identified a clear need for change regarding policies and practices pertaining to contraceptive care provision to incarcerated individuals in the United States. Second, our findings identified several evidence-based solutions supported both by research and professional healthcare organizations to address the identified need for change. This study provides an initial blueprint for correctional agencies to implement the necessary changes for improving contraceptive care provision to incarcerated populations. The correctional system is in a unique position to deliver much-needed care, which would result in many potential benefits to the individuals, correctional system, and community at large.
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Affiliation(s)
- Douglas Routh
- Division of Family Planning, Department of Obstetrics & Gynecology, University of Utah School of Medicine, 30 N 1900 E, Room 2B200, Salt Lake City, UT, 84132, USA.
| | - Rebecca Simmons
- Division of Family Planning, Department of Obstetrics & Gynecology, University of Utah School of Medicine, 30 N 1900 E, Room 2B200, Salt Lake City, UT, 84132, USA
| | - Jessica Sanders
- Division of Family Planning, Department of Obstetrics & Gynecology, University of Utah School of Medicine, 30 N 1900 E, Room 2B200, Salt Lake City, UT, 84132, USA
| | - Alexandra Gero
- Division of Family Planning, Department of Obstetrics & Gynecology, University of Utah School of Medicine, 30 N 1900 E, Room 2B200, Salt Lake City, UT, 84132, USA
| | - Hannah Aanderud Tanner
- Division of Family Planning, Department of Obstetrics & Gynecology, University of Utah School of Medicine, 30 N 1900 E, Room 2B200, Salt Lake City, UT, 84132, USA
| | - David K Turok
- Division of Family Planning, Department of Obstetrics & Gynecology, University of Utah School of Medicine, 30 N 1900 E, Room 2B200, Salt Lake City, UT, 84132, USA
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Sufrin CB, Devon-Williamston A, Beal L, Hayes CM, Kramer C. "I mean, I didn't really have a choice of anything:" How incarceration influences abortion decision-making and precludes access in the United States. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2023; 55:165-177. [PMID: 37394626 DOI: 10.1363/psrh.12235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
OBJECTIVE To understand how the punitive, rights-limiting, and racially stratified environment of incarceration in the United States (US) shapes the abortion desires, access, and pregnancy experiences of pregnant women, transgender men, and gender non-binary individuals. METHODS From May 2018-November 2020, we conducted semi-structured, qualitative interviews with pregnant women in prisons and jails in an abortion supportive and an abortion restrictive state. Interviews explored whether participants considered abortion for this pregnancy; attempted to obtain an abortion in custody; whether and how incarceration affected their thoughts about pregnancy, birth, parenting, and abortion; and options counseling and prenatal care experiences, or lack thereof, in custody. RESULTS The conditions of incarceration deeply shaped our 39 participants' abortion and pregnancy decisions, with some experiencing pregnancy continuation as punishment. Four themes emerged: (1) medical providers' overt obstruction of desired abortions; (2) participants assuming that incarcerated women had no right to abortion; (3) carceral bureaucracy constraining abortion access; and (4) carceral conditions made women wish they had aborted. Themes were similar in supportive and restrictive states. CONCLUSIONS Incarceration shaped participants' thoughts about pregnancy and their abilities to access abortion, consider whether abortion was an attainable option, and make pregnancy-related decisions. These subtle carceral control aspects presented more frequent barriers to abortion than overt logistical ones. The carceral environment played a more significant role than the state's overall abortion climate in shaping abortion experiences. Incarceration constrains and devalues reproductive wellbeing in punitive ways that are a microcosm of broader forces of reproductive control in US society.
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Affiliation(s)
- Carolyn B Sufrin
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - Crystal M Hayes
- Department of Maternal and Child Health Center of Excellence, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Camille Kramer
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Rajagopal K, Landis-Lewis D, Haven K, Sufrin C. Reproductive Health Care for Incarcerated People: Advancing Health Equity in Unequitable Settings. Clin Obstet Gynecol 2023; 66:73-85. [PMID: 36044632 PMCID: PMC9851923 DOI: 10.1097/grf.0000000000000746] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
There are over 150,000 incarcerated females in the United States. Structural inequities, including racism, adversely affect the reproductive health outcomes, autonomy, and access to care that people in custody face. This article reviews the status of reproductive health and health care among incarcerated women and describes ways that community OB/GYNs can address health inequities by providing comprehensive, compassionate care to incarcerated people, especially when they come to community settings for care while they are in custody. To address reproductive health disparities and inequities that adversely affect incarcerated individuals, community providers can implement these recommendations and also engage in advocacy.
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Affiliation(s)
- Karissa Rajagopal
- University of New England College of Osteopathic Medicine, Biddeford, Maine
| | | | | | - Carolyn Sufrin
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland
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Abstract
The American College of Obstetricians and Gynecologists supports the health and well-being of all who seek obstetric and gynecologic care and advocates to secure quality health care for all, without regard to immigration status. Policies that infringe on the health and rights of immigrants and limit access to health care, anti-immigrant rhetoric, and punitive immigration-enforcement activities all have detrimental effects on health. Depending on individual circumstances, immigrants may have unique health needs, such as injuries sustained in the process of immigrating or in the workplace, exposure to communicable diseases, exposure to toxins in the workplace, and advanced presentation of disease due to barriers to obtaining health care, among others.
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Lipnicky A, Stites S, Sufrin C, Bello JK, Shlafer R, Kelly PJ, Ramaswamy M. Jail Provision of Pregnancy and Sexual Health Services in Four Midwestern States. Womens Health Issues 2023; 33:97-104. [PMID: 36096980 DOI: 10.1016/j.whi.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/10/2022] [Accepted: 07/21/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Women incarcerated in local jails have pregnancy and sexual health needs, yet little information is available about what services are provided and how jail administrators prioritize this care. Our objective was to document jails' provision of pregnancy and sexual health services in four states in the Midwest. METHODS We invited all jail administrators (N = 347) in Kansas, Missouri, Iowa, and Nebraska to participate in a web-based survey conducted from November 2017 to October 2018. We asked administrators which pregnancy and sexual health services they offered and to rate the importance of offering services. Results were analyzed using descriptive statistics and logistic regression. RESULTS The survey response rate was 55% (192/347). Jails most often provided pregnancy testing (n = 116 [60%]) and distribution of prenatal vitamins (n = 85 [44%]). Sexually transmitted infection treatment was offered at 23% of jails (n = 45). Larger, accredited jails located in urban areas and with high numbers of clinical providers on staff were more likely to provide sexual health services. Jails with privately contracted health care were more likely to provide pregnancy services compared with other entities providing medical care. The most prioritized sexual health service was sexually transmitted infection testing, with 39% of administrators believing it was important. Only 6% of administrators responded that contraception was important. CONCLUSIONS Local jails in the Midwest do not meet the basic reproductive and sexual health needs of women. Provision of these services is not a priority for jail administrators. Appropriate partnerships could engage administrators and increase the availability of services to meet the needs of women in jail.
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Affiliation(s)
- Ashlyn Lipnicky
- University of Kansas School of Medicine, Kansas City, Kansas
| | - Sierra Stites
- University of Kansas School of Medicine, Kansas City, Kansas
| | | | | | - Rebecca Shlafer
- University of Minnesota Medical School, Minneapolis, Minnesota
| | | | - Megha Ramaswamy
- University of Kansas School of Medicine, Kansas City, Kansas
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Ethical Approach for Managing Patient-Physician Conflict and Ending the Patient-Physician Relationship: ACOG Committee Statement No. 3. Obstet Gynecol 2022; 140:1083-1089. [PMID: 36441938 DOI: 10.1097/aog.0000000000004999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Physicians have an ethical obligation to foster a therapeutic alliance with their patients. If the therapeutic relationship becomes strained, physicians should attempt to resolve the conflict, when possible, through intentional patient-physician discussion or through a third-party mediator. If return to a therapeutic relationship is not possible or mutually desirable, ending the patient-physician relationship may be the best option for the patient and the physician. This Committee Statement provides an ethical framework for managing patient-physician conflict and evidence-based tools and interpersonal interventions to help rebuild meaningful connection with patients. Guidance for the ethical termination of care when the therapeutic alliance cannot be restored also is provided, including institutional responsibilities to patients and physicians.
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Wouk K, Piggott J, Towner Wright S, Palmquist AE, Knittel A. Lactation Support for People Who Are Incarcerated: A Systematic Review. Breastfeed Med 2022; 17:891-925. [PMID: 36301257 PMCID: PMC9700340 DOI: 10.1089/bfm.2022.0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Lactation support, defined here as the access to educational resources, supplies, mental health and psychosocial support, skilled lactation counseling, and peer support, has been identified as critical to optimal health outcomes for birthing parents and infants. People who give birth while incarcerated are likely to receive suboptimal lactation support. The purpose of this review is to explore the literature on lactation support for incarcerated people to identify existing programs and policies, gaps in lactation support and ways to address the gaps, and incarcerated people's perspectives on breastfeeding and lactation support. Methods: We conducted a systematic review of the peer-reviewed literature to identify studies that addressed two main concepts: (1) breastfeeding and (2) incarcerated populations in the United States. Results: After meeting the eligibility criteria, 29 studies were included in the qualitative synthesis of the findings. Studies highlight the importance of supporting birthing people who want to provide milk to their infants in a way that is desired, psychologically safe, and structurally supported. Programs are needed to delay or prevent parent-infant separation after birth, provide education around breastfeeding misconceptions, and link to resources and ongoing support for both breastfeeding and milk expression. Implementation of breastfeeding programs may be most effectively undertaken with clear policies and dedicated leadership either internally or through community or health care partnerships. Discussion: This review highlights the policies and practices that hinder adequate lactation support for birthing parent-infant dyads who are incarcerated and describes feasible policies, education, and clinical support that can be used to improve care.
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Affiliation(s)
- Kathryn Wouk
- Pacific Institute for Research and Evaluation, Chapel Hill, North Carolina, USA
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jaslyn Piggott
- Department of Obstetrics and Gynecology, George Washington University, Washington, District of Columbia, USA
| | - Sarah Towner Wright
- Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Aunchalee E.L. Palmquist
- Carolina Global Breastfeeding Institute, Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Andrea Knittel
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
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Hall B, Atrio J, Moore S, Lorvick J, Cropsey K, Ramaswamy M. Perceived healthcare quality and contraception utilization among persons recently incarcerated. JOURNAL OF CRIMINAL JUSTICE 2022; 83:101974. [PMID: 37663234 PMCID: PMC10473011 DOI: 10.1016/j.jcrimjus.2022.101974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Purpose Previously incarcerated women have specific gender and physiologic needs that are poorly addressed on community re-entry. The objective of this study is to evaluate the relationship between contraception use and perceived healthcare quality post-incarceration. Additionally, we examine the association between social determinants of health and contraception use post-incarceration. Methods A secondary analysis of a cross-sectional study of reproductive-aged women with a history of criminal-justice involvement in three cities (n = 383) was performed. Questions related to demographics, social determinants of health, sexual and reproductive health practices, health services use, and healthcare quality were analyzed. Bivariate analysis and logistic regression examined associations between these variables and contraception utilization among persons recently incarcerated. Results 35% of the participants used a method to prevent pregnancy. There were no significant differences noted between contraceptive users and non-users in perceived healthcare quality. Participants who were not using a contraceptive method were more likely to lack health insurance and experience food insecurity when compared to contraceptive users. Conclusions Although there was no difference in perceived healthcare quality between contraceptive users and non-users, significant barriers to contraceptive access on community re-entry exist. More studies are warranted to explore the sexual and reproductive health of previously incarcerated women.
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Affiliation(s)
- Bianca Hall
- Department of Obstetrics, Gynecology and Women’s Health, Albert Einstein College of Medicine/ Montefiore Medical Center, Bronx, NY, USA
| | - Jessica Atrio
- Department of Obstetrics, Gynecology and Women’s Health, Albert Einstein College of Medicine/ Montefiore Medical Center, Bronx, NY, USA
| | - Shawana Moore
- College of Nursing, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jennifer Lorvick
- RTI International Community Health and Implementation Research Program, Berkeley, CA, USA
| | - Karen Cropsey
- Department of Psychiatry, University of Alabama, Birmingham, AL, USA
| | - Megha Ramaswamy
- Department of Population Health, University of Kansas, Kansas City, KS, USA
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Logue TC, Wen T, Staniczenko A, Huang Y, D’Alton ME, Friedman AM. Delivery hospitalizations among incarcerated women. Am J Obstet Gynecol 2022; 227:343-345.e2. [PMID: 35378097 DOI: 10.1016/j.ajog.2022.03.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 11/01/2022]
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Sanjuan PM, Fokas K, Tonigan JS, Henry MC, Christian K, Rodriguez A, Larsen J, Yonke N, Leeman L. Prenatal maternal posttraumatic stress disorder as a risk factor for adverse birth weight and gestational age outcomes: A systematic review and meta-analysis. J Affect Disord 2021; 295:530-540. [PMID: 34509068 PMCID: PMC10481878 DOI: 10.1016/j.jad.2021.08.079] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 07/29/2021] [Accepted: 08/25/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although not routinely assessed, prenatal posttraumatic stress disorder (PTSD) is associated with poor maternal mental health and mother-infant bonding. Prenatal PTSD may also be associated with birth weight and gestational age outcomes, but this remains unclear. This systematic review and meta-analysis investigated the association of prenatal PTSD with risk of low birth weight (LBW) or preterm birth (PTB) (dichotomous medically-defined cut-offs) or with birth weight (BW) or gestational age (GA) (continuous variables). METHODS A comprehensive literature search was conducted in Web of Science, MedLine, PubMed, and PsychInfo. Data were collected and processed according to Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Study quality was assessed with the Newcastle-Ottowa Quality Assessment Scale. Pooled effect sizes were estimated with random-effects models (correlation for continuous and odds ratios for dichotomous outcomes). RESULTS Sixteen studies with 51,470 participants (prenatal PTSD 8%) were included in 4 meta-analyses. Maternal prenatal PTSD was associated with higher risks of LBW (OR = 1.96; 95% CI, 1.26, 3.03; P = .003), PTB (OR = 1.42; 95% CI, 1.16, 1.73; P = .001), and reduced GA (r = -0.04; 95% CI, -0.06, -0.01; P = .002). LIMITATIONS Different designs across studies, variety of PTSD assessment practices, and a small pool of studies were noted. CONCLUSIONS Findings suggest prenatal PTSD presents increased risks of LBW, PTB, and reduced GA. Evidence of physical harm to neonates from prenatal PTSD provides a powerful rationale to increase prenatal PTSD screening and identify effective prenatal interventions to improve maternal and child outcomes.
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Affiliation(s)
- Pilar M Sanjuan
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, United States; Department of Family and Community Medicine, University of New Mexico School of Medicine, United States.
| | - Kathryn Fokas
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, United States
| | - J Scott Tonigan
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, United States
| | - Melissa C Henry
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, United States
| | - Korinna Christian
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, United States; Department of Family and Community Medicine, University of New Mexico School of Medicine, United States
| | - Andrea Rodriguez
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, United States
| | - Jessica Larsen
- University of New Mexico School of Medicine, United States
| | - Nicole Yonke
- Department of Family and Community Medicine, University of New Mexico School of Medicine, United States
| | - Lawrence Leeman
- Department of Family and Community Medicine, University of New Mexico School of Medicine, United States; Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, United States
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Pan YL, Beal L, Espino K, Sufrin CB. Female permanent contraception policies and occurrence at a sample of U.S. prisons and jails. Contraception 2021; 104:618-622. [PMID: 34400155 DOI: 10.1016/j.contraception.2021.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 07/20/2021] [Accepted: 08/02/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE(S) Incarcerated individuals have an unmet need for contraception, yet have also been subject to coercive permanent contraception practices. Data do not exist on prison and jail policies around access to permanent contraception or how often it occurs among women in custody. We sought to describe permanent and reversible contraception policies at U.S carceral institutions and the frequency of these procedures. STUDY DESIGN We surveyed a convenience sample of 22 state prison systems and 6 county jails from 2016 to 2017 about female permanent contraception and reversible contraception policies. In addition, 10 prisons and 4 jails reported 6 months of monthly data on the number of postpartum permanent contraception procedures performed on women who gave birth in custody. We analyzed results for descriptive statistics. RESULTS Eleven prisons (50%) and 5 jails (83%) permitted female permanent contraception; 7 of these prisons and 3 of these jails allowing permanent contraception did not have a written policy about it. Six prisons and no jails provided access to permanent but not reversible contraception. Over 6 months, 3 women from 2 prisons and 4 women at 2 jails received postpartum permanent contraception. CONCLUSION(S) The majority of prisons and jails in our study allowed incarcerated women to have permanent contraception in custody, often without formalized policies in place. Postpartum permanent contraception occurred during the study period. Given the inherent lack of autonomy of incarceration and history of sterilization abuses in this marginalized group, policy-makers should advance policies that avoid coercive permanent contraception and increase access to reversible contraception in carceral settings. IMPLICATIONS Many carceral institutions permit women to undergo permanent contraception but provide no access to reversible contraception; this practice raises concern for compromised autonomy and further reproductive marginalization of a group with limited access to quality reproductive health care.
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Affiliation(s)
- Y Linda Pan
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Lauren Beal
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Kareen Espino
- Marin Community Clinic, San Rafael, CA, United States
| | - Carolyn B Sufrin
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, United States.
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Abortion Access for Incarcerated People: Incidence of Abortion and Policies at U.S. Prisons and Jails. Obstet Gynecol 2021; 138:330-337. [PMID: 34352850 DOI: 10.1097/aog.0000000000004497] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/13/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To understand abortion incidence among incarcerated people and the relation to prison and jail pregnancy policies. METHODS We collected abortion numbers and policy data from convenience sample of 22 state prison systems, all Federal Bureau of Prisons sites, and six county jails that voluntarily reported monthly, aggregate pregnancy outcomes for 12 months in 2016-2017. Sites also completed a baseline survey of institution characteristics and pregnancy policies, including abortion. We reported facility policies and abortion incidence according to state-level abortion characteristics. RESULTS Only half of state prisons in the study allowed abortion in both the first and second trimesters, and 14% did not allow abortion at all. Of the 19 state prisons permitting abortion, two thirds required the incarcerated woman to pay. Four jails of the six study jails (67%) allowed abortions in the first and second trimesters, and 25% of those required the incarcerated woman to pay for the procedure. The three prisons and two jails that did not allow abortions were in states considered hostile to abortion access. In the state and federal prisons studied, 11 of the 816 pregnancies (1.3%) that ended during the study time period were abortions. Of the 224 pregnancies that ended at study jails, 33 were abortions (15%), with more than half of those (55%) occurring in the first trimester. The abortion ratio (proportion of pregnancies ending in abortion) was 1.4% for prisons and 18% for jails. CONCLUSION Although some incarcerated individuals have abortions, many prisons and jails have restrictive policies surrounding abortion, either through self-payment requirements or explicit prohibition. Findings from this study should prompt further inquiry into abortion incidence in these settings and address interventions to ensure incarcerated people, in accordance with legal requirements and health equity, have access to abortion.
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