Here we are--we have reached the end. Now that we know the reality of trying to find adequate OB/GYN healthcare behind bars, what do we do about it? Is there some way to make things better? In this episode, I talk to three people pioneering change for incarcerated women and explore a variety of solutions.

SOURCES:

1. https://www.apha.org/Policies-and-Advocacy/Public-Health-Policy-Statements/Policy-Database/2022/01/07/Advancing-Public-Health-Interventions-to-Address-the-Harms-of-the-Carceral-System

2. https://www.usnews.com/news/healthiest-communities/articles/2020-10-12/new-moms-in-prison-get-help-from-someone-whos-been-there

3. Intergenerational transmission of attachment for infants raised in a prison nursery (2010) Byrne, M. W., Goshin, L.S., and Joestl, S. S.

4. “Guides to Promote Your Health and Wellbeing” from Grassroots Maternal and Child Healthcare & Mothers on the Rise

5. Child separation from incarcerated mothers (2020) Carlson, J. M.

6. Prison nurseries: Experiences of incarcerated women during pregnancy (2016) Fritz, S. and Whiteacre, K.

7. https://fsph.iupui.edu/research-centers/centers/cheer/grassroots/mothers-on-the-rise.html

8. https://www.wthr.com/article/news/local/mothers-on-the-rise-supporting-incarcerated-mothers-and-their-babies-indiana/531-b01d297c-f4c3-4322-a863-19b4a5fe76f6

9. “International report on the conditions of children of incarcerated parents: A survey of prison nurseries” (2017) Melanie Paurus via Children of Incarcerated Caregivers

10. https://wyofile.com/born-behind-bars-wyomings-approach-to-pregnancy-in-prison/

11. “Mothers Behind Bars: A state-by-state report card and analysis of federal policies on conditions of confinement for pregnant and parenting women and the effect on their children” (2010) The Rebecca Project for Human Rights and National Women’s Law Center

12. https://www.nationalaffairs.com/publications/detail/on-prison-nurseries

13. https://www.wbiw.com/2022/08/18/there-is-help-for-mothers-who-give-birth-in-prison/

14. https://www.youtube.com/watch?v=GWmfrpd-ohs&ab_channel=WACorrections

15. The effectiveness of prison nursery programs in reducing recidivism: A systematic review (2018) Ward, A. M.

16. Assessing outcomes for Wee Ones Nursery at Indiana Women’s Prison (2013) Whiteacre, K., Fritz, S., and Owen, J.

17. The importance of early bonding on the long-term mental health and resilience of children (2016) Winston, R. and Chicot, R.

There are some inmates in women's carceral facilities who are especially vulnerable to medical abuse and neglect. I didn't have enough time in one semester to adequately (and respectfully) cover all of those risk factors, so I chose to spotlight the LGBTQ+ community as just one poignant example.

I apologize for any audio anomalies that may result from my having to re-record a few segments, ironically enough, in the closet.

Sources:

1. “This is a prison, glitter is not allowed: Experiences of trans and gender variant people in Pennsylvania’s prison systems” (2011) Pascal Emmer, Adrian Lowe, & R. Barrett Marshall via The Hearts on a Wire Collective

2. Creating, reinforcing, and resisting the gender binary: a qualitative study of transgender women’s healthcare experiences in sex-segregated jails and prisons (2017) Hughto, J. M. W., Clark, K. A., Altice, F. L. et al.

3. Health care during incarceration: A policy position paper from the American College of Physicians (2022) Kendig, N. E., Butkus, R., Mathew, S., et al.

4. “Women and imprisonment in the U.S.: History and current reality” by Nancy Kurshan, Prison Activist Resource Center

5. Resistance Behind Bars: The Struggles of Incarcerated Women 2nd ed. (2012) by Victoria Law

6. “Coming out of concrete closets: A report on Black & Pink’s LGBTQ prisoner survey,” v. 2 (2015) from Black and Pink by Jason Lydon, Kamaria Carrington, Hana Low, et al.

7. Exploring healthcare experiences for incarcerated individuals who identify as transgender in a Southern jail (2018) McCauley, E., Eckstrand, K., Desta, B, et al.

8. “LGBTQ people behind bars: A guide to understanding the issues facing transgender prisoners and their legal rights” (2018) National Center for Transgender Equality

9. https://www.ncchc.org/position-statements/transgender-and-gender-diverse-health-care-in-correctional-settings-2020/

10. “Incarcerated LGTQ+ adults and youth” (2022) Emma Stammen & Nazgol Ghandnoosh via The Sentencing Project

Carceral institutions fall short even on the most basic preventative care for incarcerated women. Yet many inmates don't have access to any healthcare on the outside. How are we to reckon with the duality of jail/prison as a place of both medical harm and a public health resource?

SOURCES:

1. https://www.aafp.org/about/policies/all/incarceration.html

2. https://womenprisoners.org/sherrie-chapman-presente/

3. https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6403a1.htm

4. https://www.reuters.com/investigates/special-report/usa-jails-women/

5. Testing for HIV, sexually transmitted infections, and viral hepatitis in jails: Still a missed opportunity for public health and HIV prevention (2010) Flanigan, T. P., Zaller, N., Beckwith, C. G., et al.

6. Redistributing the Poor: Jails, Hospitals, and the Crisis of Law and Fiscal Austerity by Armando Lara-Millán

7. Resistance Behind Bars, 2nd Edition, by Victoria Law

8. “HIV in prisons, 2021: Statistical tables” (2023) from DOJ Bureau of Justice Statistics by Maruschak, L. M.

9. “Survey of prison inmates, 2016: Medical problems reported by prisoners” (2021) from DOJ Bureau of Justice Statistics by Maruschak, L. M., Bronson, J., & Alper, M.

10. https://www.ncchc.org/position-statements/administrative-management-for-people-living-with-hiv-in-correctional-institutions-2020/

11. https://www.ncchc.org/position-statements/sti-testing-for-adolescents-and-adults-upon-admission-to-correctional-facilities-2020/

12. https://www.ncchc.org/position-statements/womens-health-care-in-correctional-settings-2020/

13. http://womenprisoners.org/350000-award-to-sherrie-chapman/

14. Jailcare: Finding the Safety Net for Women Behind Bars by Carolyn Sufrin

15. HIV among persons incarcerated in the U.S.: A review of evolving concepts in testing, treatment, and linkage tocommunity care (2013) Westergaard, R. P., Spaulding, A. C., & Flanigan, T.P.

The U.S. carceral system is in the business of making reproductive choices for its inmates. In this episode, I examine some of the ways that incarceration controls women's reproduction. Some are forced to carry unwanted pregnancies. Others leave prison unable to get pregnant ever again, and they don't always know it.

SOURCES:

1. https://arrwip.org/projects/pregnancy-in-prison-statistics-pips-project/

2. Contraceptive needs among newly incarcerated women in a county jail in the United States (2018) Cannon, R., Madrigal, J. M., Feldman, E., et al.

3. Contraception policies in U.S. jails, prisons, and juvenile detention systems: A national survey (2021) Cheedalla, A. & Sufrin, C. B. https://pubmed.ncbi.nlm.nih.gov/34388036/

4. The realities of pregnancy and mothering while incarcerated (2020) Friedman, S. H., Kaempf, A., & Kauffman, S. https://jaapl.org/content/early/2020/05/13/JAAPL.003924-20

5. https://www.theguardian.com/us-news/2020/jun/30/california-prisons-forced-sterilizations-belly-beast

6. Contraceptive use and barriers to access among newly incarcerated women (2012) LaRochella, F., Castro, C., Goldenson, J., et al.

7. https://www.themarshallproject.org/records/955-sterilization-of-women-in-prison

8. https://revealnews.org/article/female-inmates-sterilized-in-california-prisons-without-approval/

9. https://www.theguardian.com/us-news/2021/jul/19/california-forced-sterilization-prison-survivors-reparations

10. https://lawblogs.uc.edu/ihrlr/2021/05/28/not-just-ice-forced-sterilization-in-the-united-states/

11. Female permanent contraception policies and occurrence at a sample of U.S. prisons and jails (2021) Pan, Y. L., Beal, L., Espino, K., et al.

12. https://www.prisonpolicy.org/blog/2021/12/08/reproductive_choice/

13. “If they hand you a paper, you sign it”: A call to end the sterilization of women in prison (2015) Roth, R. & Ainsworth, S. L.

14. What women want: A qualitative study of contraception in jail (2015) Schonberg, D., Bennett, A. H., Sufrin, C., et al.

15. When the punishment is pregnancy: Carceral restriction of abortion in the United States (2019) Sufrin, C.

16. Abortion access for incarcerated people: Incidence of abortion and policies and U.S. prisons and jails (2021) Sufrin, C., Jones, R. K., Beal, L., et al.

In one year between 2016-2017, 816 pregnancies ended while the mothers were in U.S. prisons and another 224 in jails. Our carceral facilities are not equipped for labor and delivery, and our medical facilities tend to see these mothers as inmates more than patients or parents.

SOURCES:

1. https://www.aafp.org/about/policies/all/incarceration.html

2. Promoting health care for pregnant women in prison: A review of international guidelines (2020) Alirezaei, S. & Roudsari, R. L.

3. “ACOG Committee Opinion Number 830: Reproductive Health Care for Incarcerated Pregnant, Postpartum, and Nonpregnant Individuals” (2021) The American College of Obstetricians and Gynecologists, Committee on Health Care for Underserved Women

4. https://www.amnestyusa.org/reports/usa-not-part-of-my-sentence-violations-of-the-human-rights-of-women-in-custody/

5. https://arrwip.org/projects/pregnancy-in-prison-statistics-pips-project/

6. Breastfeeding in incarcerated settings in the United States: A national survey of frequency and policies (2021) Asiodu, I., Beal, L., & Sufrin, C.

7. Imprisoning pregnant and parenting women: A focus on social justice, equal rights, and equality (2020). Cross, J.

8. https://www.businessinsider.com/50-of-countries-allow-children-to-live-with-their-mothers-in-prison-2018-3

9. Health care of pregnant women in U.S. state prisons (2012) Ferszt, G. G. & Clarke, J. G.

10. Equitable care for pregnant incarcerated women: Infant contact after birth—A human right (2020) Franco, C., Mowers, E., & Lewis, D. L.

11. Perinatal nurses’ experiences with and knowledge of the care of incarcerated women during pregnancy and the postpartum period (2019) Goshin, L. S., Sissoko, D. R. G., Neumann, G., et al.

12. Stigma and US nurses’ intentions to provide the standard of maternal care to incarcerated women, 2017 (2020) Goshin, L. S., Sissoko, G., Stringer, K. L., et al.

13. https://jaapl.org/content/early/2020/05/13/JAAPL.003924-20

14. Pregnancy and childbirth during incarceration: A qualitative systematic review of lived experiences (2022) Kirubarajan, A., Tsang, J., Dong, S., et al.

15. https://www.ncchc.org/position-statements/breastfeeding-in-correctional-settings-2018/

16. https://www.ncchc.org/position-statements/womens-health-care-in-correctional-settings-2020/

17. Jailcare: Finding the Safety Net for Women Behind Bars (2017) by Carolyn Sufrin

18. Pregnancy outcomes in US prisons, 2016-2017 (2019) Sufrin, C., Beal, L., Clarke, J., et al.

19. Pregnancy prevalence and outcomes in U.S. jails (2020) Sufrin, C., Jones, R. K., Mosher, W. D., et al.

20. Resistance Behind Bars: The Struggles of Incarcerated Women, 2nd Edition (2012) by Victoria Law

About 4% of women entering jail and prison in the U.S. each year are pregnant. What kind of healthcare does our punitive carceral system provide to pregnant inmates and their unborn children?

SOURCES:
1. www.aafp.org/about/policies/all/incarceration.html
2. Promoting health care for pregnant women in prison: A review of international guidelines (2020) Alirezaei, S. & Roudsari, R. L.
3. “ACOG Committee Opinion Number 830: Reproductive Health Care for Incarcerated Pregnant, Postpartum, and Nonpregnant Individuals” (2021) The American College of Obstetricians and Gynecologists, Committee on Health Care for Underserved Women
4. www.amnestyusa.org/reports/usa-not…men-in-custody/
arrwip.org/projects/pregnancy-…stics-pips-project/
5. Imprisoning pregnant and parenting women: A focus on social justice, equal rights, and equality (2020). Cross, J.
Health care of pregnant women in U.S. state prisons (2012) Ferszt, G. G. & Clarke, J. G.
6. Stigma and US nurses’ intentions to provide the standard of maternal care to incarcerated women, 2017 (2020) Goshin, L. S., Sissoko, G., Stringer, K. L., et al.
7. Within prisons, is there an association between the quantity of prenatal care and infant birthweight? (2008) Howard, D. L., Strobino, D., Sherman, S., et al.
8. “Pregnant behind bars” (2022) Hutchinson-Colas, J. & AlShowaikh, K.
9. Shackling and pregnancy care policies in US prisons and jails (2023) Kramer, C., Thomas, K., Patil, A., et al.
10. “Survey of Prison Inmates, 2016: Medical problems reported by prisoners” (2021) from DOJ Bureau of Justice Statistics, by Maruschak, L. M., Bronson, J., & Alper, M.
11. www.ncchc.org/position-statement…-individuals-2020/
www.ncchc.org/position-statement…nal-settings-2020/
12. “Mothers Behind Bars: A state-by-state report card and analysis of federal policies on conditions of confinement for pregnant and parenting women and the effect on their children” (2010) from The Rebecca Project for Human Rights and National Women’s Law Center
13. Jailcare: Finding the Safety Net for Women Behind Bars (2017) by Carolyn Sufrin
14. Pregnancy outcomes in US prisons, 2016-2017 (2019) Sufrin, C., Beal, L., Clarke, J., et al.
15. Pregnancy prevalence and outcomes in U.S. jails (2020) Sufrin, C., Jones, R. K., Mosher, W. D., et al.
16. Resistance Behind Bars: The Struggles of Incarcerated Women, 2nd Edition (2012) by Victoria Law

The United States has the largest incarcerated population in the world. About 10% of those inmates are women, and that proportion is growing. But our jails and prisons were not designed with women in mind. Are their specific healthcare needs being addressed?

SOURCES:
1. www.aafp.org/about/policies/all/incarceration.html
2. Health care in U.S. correctional facilities: A limited and threatened constitutional right (2023) Alsan, M., Yang, C. S., Jolin, J. R., et al.
3. “ACOG Committee Opinion Number 830: Reproductive Health Care for Incarcerated Pregnant, Postpartum, and Nonpregnant Individuals” (2021) The American College of Obstetricians and Gynecologists, Committee on Health Care for Underserved Women
4. www.amnestyusa.org/reports/usa-not…men-in-custody/
5. arrwip.org/projects/pregnancy-…stics-pips-project/
6. Improving health equity for women involved in the criminal legal system (2020) Golembeski, C. A., Sufrin, C. B., Williams, B., et al.
7. “Survey of Prison Inmates, 2016: Medical Problems Reported by Prisoners” by Lauren M. Maruschak, Jennifer Bronson, & Mariel Alper from the U.S. Department of Justice, Bureau of Justice Statistics
8. Resistance Behind Bars, 2nd Edition (2012) by Victoria Law
9. www.prisonpolicy.org/reports/chroni…unishment.html
10. www.prisonpolicy.org/reports/pie2023women.html
11. “Incarcerated Women and Girls” (May 2022) from The Sentencing Project
12. www.sentencingproject.org/reports/mass…tion-trends/
13. “Overlooked: Women and jails in and era of reform” (2016) Elizabeth Swavola, Kristine Riley, & Ram Subramanian via The Vera Institute of Justice.
14. “Federal Prisoner Statistics Collected under the First Step Act, 2022” from the U.S. Department of Justice, Bureau of Justice Statistics

Cover image by Samuel Stone from Pixabay