Millions of the most medically underserved women in America enter local jails each year, where their reproductive health care and family planning needs are grossly overlooked. Women in city and county jails frequently face barriers to accessing contraception, abortion, prenatal care, and disease screening and treatment. But preventive family planning can be improved in jails around the United States by implementing a few core tenets for those incarcerated there.
Although the direct results of improving such care have not yet been studied, it seems a safe guess that releasing healthier, more empowered women with control over their fertility would have positive outcomes for
The U.S. Department of Justice reports that the female jail population has been the fastest-growing correctional population. In 2012, women accounted for more than 26 percent of all persons arrested, primarily for drug-related charges. Regardless of the growing rate of female incarceration, the National Commission on Correctional Health Care has stated that women’s sex-specific health-care needs remain unmet due to their minority status in a male-dominated jail population.
There are no federally mandated guidelines for women’s health care in jails. Correctional health-care arrangements vary; contracted providers may deliver health services at jails on site, or incarcerated persons may be transported to local hospitals or clinics for care. Often, these health care arrangements do not include appointments with obstetrics and gynecological health providers. The scholar and lawyer Kendra Weatherhead argues that the medical inadequacies incarcerated women face infringe on their rights established in the Eighth and 14th Amendments.
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Although some members of the public may believe that contraception and other reproductive care needs aren’t necessary because of facilities’ sex-segregation, discontinuing women’s birth control and not providing contraceptives before release may increase the likelihood of women experiencing an unintended pregnancy post-incarceration. Jails are different than prisons in that they are designed for short-term stays of people in pretrial detention or who have been sentenced to less than one year for low-level felonies. The average length of stay in America’s jails is around 30 days, but while jail time is short, it is also frequent. Recidivism rates are alarmingly high in the United States—half of women who have been incarcerated return to jail at least once within three years after their release.
Unfortunately, many women have a revolving-door experience with incarceration. An unintended pregnancy may further complicate a woman’s efforts to meet her probation or parole requirements; thus, helping women avoid unintended pregnancies may lead to a reduction in recidivism, or at least a reduction in women returning to jail with unwanted pregnancies, for which they may be unable to decide the outcome.
Overall, most women in jail are between the reproductive ages of 18 and 45; are sexually active; and already have children, for whom they are the primary caregivers. It is also estimated that 25 percent of incarcerated women are either pregnant or gave birth in the year prior to their arrest. Compared to women who have never been arrested, women with a history of involvement in the corrections system experience higher rates of unintended pregnancies, abortion, sexually transmitted infections, and domestic and sexual violence—again displaying the need for improved health care in jails.
To assess women’s family planning needs and desires for contraception, the following recommendations should be initiated in all local jails housing women.
Upon booking into jail, all women should be asked if they are sexually active with men and currently using a method of birth control.
If she is using a hormonal birth control method, ensure it is continued. Women incarcerated in U.S. jails are subject to discontinuation of their current contraceptive methods because of an assumption that birth control is an unnecessary medication in a sex-segregated jail. Generally, women experiencing incarceration are not given previously prescribed birth control pills, or kept on schedule with other hormonal methods such as Ortho Evra (the patch), NuvaRing (the ring), or Depo-Provera (the shot). In the case of managing a health issue such as endometriosis, a woman may be allowed to remain on birth control, but even then, discontinuation is common. This practice carries risks: Because hormonal birth control can take time to become effective, this puts women at risk of unintended pregnancy if they have to reinitiate birth control after release rather than continuing on a jail’s prescription. Furthermore, women’s health insurance and income are suspended during incarceration, which could further postpone a woman’s re-initiation of birth control while she waits for her insurance to activate or a first paycheck and an appointment with a family planning provider.
All reproductive-aged women should be asked if they are interested in initiating birth control during their jail stay.
An unintended pregnancy after incarceration could hinder a woman’s ability to successfully reintegrate into her community and increase her likelihood of returning to jail. After incarceration, most women have children they need to care for or regain custody of, and they often have to find housing and jobs—things that an unintended pregnancy could make more complicated. Most incarcerated women are sexually active and plan to have sex with male partners soon after their release and hope to avoid unintended pregnancies. However, women who are incarcerated are more likely to come from poor communities where access to contraceptive education and services is limited. Because health care in jail is subsidized, women experiencing incarceration who wish to could receive free family planning counseling and services, especially effective, reversible, long-term methods such as the arm implant, Implanon, or intrauterine devices such as Mirena, Skyla, Liletta, or ParaGard—methods that are especially difficult for disadvantaged, uninsured women to access in the community. At least two jails in the United States are providing incarcerated women with access to contraception during their stay, one in Rhode Island, the other in San Francisco, California. But two facilities on opposite sides of the country are not nearly enough.
If a woman had unprotected sex within five days prior to arrest and is eligible and interested in taking emergency contraception, it should be offered to her.
A 2009 study surveyed women within 24 hours of their arrest in San Francisco. They found that 29 percent were eligible for emergency contraception based on the above guidelines, and among those women, almost half were willing to take emergency contraception if it was offered to them in jail. Additionally, 71 percent of all women surveyed said they would accept an advance supply of emergency contraception upon release from jail. The researchers estimate that access to emergency contraception at time of arrest and upon release could potentially benefit more than 750,000 women entering the criminal justice system every year.
Administrators should establish whether a woman is currently pregnant or if she would like to take a pregnancy test.
The American Congress of Obstetricians and Gynecologists states that at any given time, approximately 6 to 10 percent of incarcerated women are pregnant, many of whom find out they are pregnant in a correctional facility. Unfortunately, pregnant women in jail are inconsistently counseled on their options for pregnancy outcome and access to termination services. Incarceration impedes women’s ability to access abortion in the case of unintended pregnancy and causes additional stress to women who desire to deliver and parent. If a woman is pregnant, she should be asked what her intentions are for the pregnancy outcome and should be provided with resources to accomplish her intentions. Women’s rights to prenatal care, humane treatment, and abortion services do not cease because of incarceration; however, incarceration greatly complicates their access to such services. This may result in pregnancy and delivery complications or a woman being forced to continue an unwanted pregnancy because she was unable to access an abortion.
If women want to become pregnant after release, they should be offered preconception counseling, prenatal vitamins, and information about parenting resources, such as Children’s Health Insurance Plan (CHIP) and Women, Infants and Children (WIC).
Women with a history of incarceration often face pregnancy complications and deliver low-birth weight babies due to poor prenatal nutrition or mother’s drug use. Providing women with resources and services promoting healthy pregnancies benefits women, their children and communities.
The fight for reproductive rights is difficult enough for women who have never experienced incarceration—the millions of women who enter U.S. correctional facilities have it worse and the problem is growing. We must challenge the system of mass incarceration occurring in America and fight to keep women out of jail for nonviolent offenses through advocating for better substance abuse treatment and alternatives to incarceration. Unfortunately, women already in these facilities often have few resources to advocate for themselves. We must engage with jail administrators and local legislators to ensure incarcerated women have access to reproductive health-care services and family planning resources. Jails are our jails. People from our communities are held there, and our money funds what they do and don’t have access to.
It is our responsibility to ensure reproductive rights and autonomy for those behind bars.