Invisible women: correctional facilities for women across Canada and proximity to maternity services

Abortion and contraception within prison health care: a qualitative study

BACKGROUND

Although abortion was completely decriminalized in Canada 36 years ago, barriers to pregnancy prevention and termination persist across the country, such as travel and information gaps. Research demonstrates incarcerated people face barriers to family planning care, yet there is no systematic data collection of sexual and reproductive health experiences and outcomes among incarcerated people in Canada. The aim of this study was to explore family planning care experiences among women and gender diverse people who have experienced incarceration in Canada.

METHODS

We conducted a qualitative community-based research study using focus groups for data collection and reflexive thematic analysis to generate key themes. Our study team included members with lived experience of incarceration. We conducted recruitment in partnership with community organizations. We asked about accessing abortion and contraception while incarcerated and on release.

RESULTS

We conducted six focus groups with 35 recently incarcerated participants. Five themes emerged: (1) Competing health needs; (2) Institutional barriers to care; (3) Mistreatment and unethical care; (4) Health knowledge gaps; and (5) Challenges to care-seeking in community.

CONCLUSION

People in prison experience concurrent unmet health needs that crowd out sexual and reproductive health. Prison procedures and perceived unethical professional behaviours impinge care-seeking. Information about abortion and contraception is not readily available in prison. Barriers to care persist upon release. Family planning professionals may improve care for people who experience incarceration by recognizing concurrent mental health needs; anticipating impact of prior negative experiences on care-seeking; challenging limitations to health education in prison; and addressing post-release challenges for patients.

"A prison is no place for a pandemic": Canadian prisoners' collective action in the time of COVID-19

Since the onset of COVID-19, social protest has expanded significantly. Little, however, has been written on prison-led and prison justice organizing in the wake of the pandemic-particularly in the Canadian context. This article is a case study of prisoner organizing in Canada throughout the first 18 months of COVID-19, which draws on qualitative interviews, media, and documentary analysis. We argue that the pandemic generated conditions under which the grievances raised by prisoners, and the strategies through which they were articulated, made possible a discursive bridge to the anxieties and grievances experienced by those in the community, thinning the walls of state-imposed societal exclusion. We demonstrate that prisons are sites of fierce contestation and are deeply embedded in, rather than separate from, our society. An important lesson learned from this case study is the need for prison organizing campaigns to strategically embrace multi-issue framing and engage in sustained coalition building.

Distance between institutions of incarceration and procedural abortion facilities in Canada

OBJECTIVES

People incarcerated in facilities for women and girls face barriers to accessing abortion, including unclear legislation, operational procedures, and distance. While medication abortion could mitigate distance barriers, prison is not a hospitable environment for medication abortion. Considering this limitation, this paper aimed to identify the distance from institutions of incarceration designated for women and girls to procedural abortion facilities in Canada.

STUDY DESIGN

This study builds on an inventory of the 67 institutions of incarceration designated for women and girls across 13 provinces and territories in Canada, previously created by the authors. Procedural abortion facilities were identified using publicly available directories. Distances were calculated using Google Maps. The closest procedural abortion facility was identified for each institution, as well as the gestational age limit of each facility.

RESULTS

Of the 67 institutions, 23 (34%) were located 0 to 10km from a procedural abortion facility. Fourteen (21%) were located 10.1 to 20km away. Ten (15%) were located 20.1 to 100km away. Eleven were located 100.1 to 300km away (16%). The remaining 9 (13%) were located between 300.1 and 738km away. Distances ranged from 0.1 to 738km. The greatest distances were among institutions in northern Canada.

CONCLUSIONS

This paper identified a large range of distances between institutions of incarceration and procedural abortion facilities in Canada. Physical distance is only one measure of accessibility of abortion services. For incarcerated people, contextual factors including carceral policies and procedures present barriers to care, with significant impact on health equity.

IMPLICATIONS

Distance between carceral institutions and procedural abortion facilities reduces equitable access to reproductive health services for incarcerated populations. Pregnant people should be protected from imprisonment to ensure reproductive autonomy.

The Intersection of Abortion and Criminalization: Abortion Access for People in Prisons

Most incarcerated women are of reproductive age, and more than a third of women will have an abortion during their reproductive years. Although women are the fastest growing population in Canadian prisons, no one has studied the effect of their incarceration on access to abortion services. Studies outside of Canada indicate rates of abortion are higher among people experiencing incarceration than in the general population, and that abortion access is often problematic. Although international standards for abortion care among incarcerated populations exist, there conversely appear to be no Canadian guidelines or procedures to facilitate unintended pregnancy prevention or management. Barriers to abortion care inequitably restrict people with unintended pregnancy from attaining education and employment opportunities, cause entrenchment in violent relationships, and prevent people from choosing to parent when they are ready and able. Understanding and facilitating equitable access to abortion care for incarcerated people is critical to address structural, gender-, and race-based reproductive health inequities, and to promote reproductive justice. There is an urgent need for research in this area to direct best practices in clinical care and support policies capable to ensure equal access to abortion care for incarcerated people.

Sexual and Reproductive Health Outcomes among Incarcerated Women in Canada: A Scoping Review

BACKGROUND

Women are the fastest growing population in Canadian prisons. Incarceration can limit access to essential health services, increase health risks and disrupt treatment and supports. Despite legal requirements to provide care at professionally accepted standards, evidence suggests imprisonment undermines sexual and reproductive health. This scoping review asks, "What is known about the sexual and reproductive health of people incarcerated in prisons for women in Canada?"

METHODS

We use the Joanna Briggs Institute methodology for systematic scoping reviews. Databases searched include MEDLINE, CINAHL, PsycINFO, Gender Studies Abstracts, Google Scholar and Proquest Dissertations and grey literature. The search yielded 1424 titles and abstracts of which 15 met the criteria for inclusion.

RESULTS

Conducted from 1994-2020, in provincial facilities in Ontario, British Columbia, Alberta and Quebec as well as federal prisons, the 15 studies included qualitative, quantitative and mixed methods. The most common outcomes of interest were related to HIV. Other outcomes studied included Papanicolaou (Pap) and sexually transmitted infection (STI) testing, contraception, pregnancy, birth/neonatal outcomes, and sexual assault.

CONCLUSION

Incarceration results in lack of access to basic services including contraception and prenatal care. Legal obligations to provide sexual and reproductive health services at professionally acceptable standards appear unmet. Incarceration impedes rights of incarcerated people to sexual and reproductive health.

Maternal incarceration in a provincial prison in Canada: A qualitative study

AIMS

To explore the experiences of provincially incarcerated mothers in Nova Scotia, Canada; and to make recommendations with respect to improving the experiences of mothers facing criminalization and their children.

DESIGN

This qualitative study is rooted in feminist standpoint theory, community-based research methodologies and prison abolition.

METHODS

Mothers who were currently or previously incarcerated were recruited by community partners. Between Fall 2021 and Winter 2022, 14 individual interviews and one focus group were conducted, for a total of 18 study participants. Data were analysed collaboratively using thematic analysis.

RESULTS

Three key themes were developed through the data analysis: Maintaining Connection, Broken Bonds and The Damage. Mothers shared experiences of trying to maintain connections with their children through numerous challenges, including emotional distress caused by the separation and significant logistical and financial barriers. Mothers felt their children unfairly bore the burden of their incarceration. They experienced a lack of or outright denial of services while incarcerated, and a lack of transitional support on release, making working towards parenting again difficult and discouraging.

CONCLUSION

For participants in our study, separation from their children during incarceration caused severe emotional distress and had serious implications on their right to parent and their relationships with their children. Incarceration for even brief periods has detrimental social impacts, and release planning does not prepare people for the challenges of repairing that damage. Conditions of maternal incarceration are in violation of international human rights laws.

IMPACT

Although we make some recommendations for reform (e.g. free phone calls), we focus on alternatives to incarceration for mothers experiencing criminalization. Findings will be shared with relevant institutional partners with the goal of impacting sentencing and incarceration practices.