Seeing Past the Sentence: Caring for Pregnant Women Who Are Incarcerated

ABSTRACT

The number of women who are incarcerated in the United States has grown significantly since 1980. Caring for pregnant women who are in the correctional system requires special knowledge and the skills of advocacy and compassion. The purpose of this article is to discuss strategies to provide compassionate, sensitive, and trauma-informed care that demonstrates the love of Christ to incarcerated pregnant women.

"Breastfeeding in public" for incarcerated women: the baby-friendly steps

Background

Women are the fastest-growing population in carceral facilities in Canada. Most incarcerated women are mothers, with above-average parity. The incarceration of women has implications not only for women's health, but for that of their children. For example, how is breastfeeding and access to human milk supported in the context of imprisonment? Both carceral and health services are publicly-funded and administered in Canada. Due in part to the well-documented ill-health burden of imprisoned women, health and carceral functions overlap in the spaces of confinement. This paper discusses "breastfeeding in public" in relation to imprisoned women: separated from the public, yet in publicly-funded spaces under public servant control. With increasing adoption of Baby Friendly Hospital Initiative (BFI) Ten Steps in Canadian health centres, there is a need to consider the health centre spaces precluded from its application and make visible the women and children affected. This paper uses the BFI Steps as a lens to consider the environment of confinement for the breastfeeding incarcerated person. The exclusion of breastfeeding and access to human milk for imprisoned women and children extends the punitive carceral function beyond the experience of incarceration and beyond the experience of the convicted mother.

Discussion

Carceral facilities lack breastfeeding policies, foundational to breastfeeding support. Despite high fertility and parity among incarcerated women, carceral health care providers are not required to demonstrate maternity and reproductive health care specialization. The overarching mission of carceral institutions remains security, and support for breastfeeding among incarcerated women is hampered in spaces of conflict, punishment, surveillance and control. A minimal requirement to support exclusive breastfeeding is to promote the mother being with the infant and most incarcerated mothers are separated from their infants. Incarcerated women lack support, information, and community connections for extended breastfeeding beyond six months. Carceral facilities are not welcoming environments for breastfeeding families. Despite the incompatibility of breastfeeding with incarceration, BFI Step 10, coordinating discharge, demonstrates opportunity for improvement through community and health care provider engagement.

Conclusion

Incarceration challenges the reach and applicability of the BFI Steps to enhance breastfeeding and to problematize the idea of breastfeeding "in public."

Pregnant in prison: An integrative literature review

BACKGROUND

Pregnant women in prisons are recognised as a marginalised group. However, there is a limited understanding of the women's unique maternity needs and how correctional institutions and maternity service providers respond to these needs.

AIM

The aims of the review are threefold.

METHOD

An integrative literature review was undertaken. A comprehensive search strategy using seven electronic databases resulted in the retrieval of 363 articles. Of them, 32 peer-reviewed studies met the final selection criteria and were included in this review which utilised the Critical Appraisal Skills Program tools and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart. Thematic analysis identified universal themes.

FINDINGS

Three dominant themes emerged related to the experience of pregnant women in prison: (1) risks and vulnerability factors; (2) prison enablers and supports; and (3) prison barriers. Extant research on risks and vulnerability factors is disproportionate to research examining how prisons can enable or obstruct responding to the women's perinatal needs. Limited research on the midwifery support available to the women in prison is available. Significantly, only two out of 32 reviewed papers include research directly conducted with the pregnant women in prison.

CONCLUSION

Pregnant women in prisons have complex needs. More research is required to understand how prisons can enhance the pregnancy experience by engaging pregnant women in prisons as research participants.