Meeting the Health Care Needs of Pregnant Inmates

(Originally posted on Feministing.)

Today, Perspectives on Sexual and Reproductive Health published a nationwide survey — "Incarcerated Women and Abortion Provision: A Survey of Correctional Health Providers," by Carolyn B. Sufrin, Mitchell D. Creinin, and Judy C. Chang. For the first time, we have a comprehensive understanding of whether incarcerated women can obtain abortion care in U.S. correctional facilities. The authors surveyed health professionals who provide clinical care in prisons; only 68 percent of respondents indicated that women in their facilities can obtain "elective" abortions. To state the disturbingly obvious flip-side of that statistic: more than 30 percent of respondents indicated that women within their facilities could not access abortion care.

A few weeks ago, an investigative piece in the Texas Observer reported, "For pregnant women in immigration detention facilities, it is virtually impossible to obtain an abortion." Interviews with sexual assault counselors, researchers, and advocates reveal that pregnant detainees — including those who are pregnant as a result of having been raped while crossing the border — face immense, often complete, barriers when they seek abortion information and services. According to an Immigration and Customs Enforcement (ICE) spokesperson quoted in that story, of nearly 1,000 pregnant detainees in 2008 "no detainee has had a pregnancy terminated while in ICE custody," though as the article also makes clear, we know that at least some of these women would have requested information about terminating their pregnancies.

What exactly is going on? First, let's put to rest any lingering doubts: The Supreme Court did notrecently decide that pregnant women lose their right to have an abortion when they are in prison, and the Bush administration did not push through a midnight regulation banning reproductive health care for incarcerated women. To the contrary, as I explain in a Viewpoint (PDF) piece published along with the Sufrin study, the law is clear -- women do not lose their right to abortion because of imprisonment, and correctional authorities must ensure that women in their custody have adequate access to abortion care. Likewise, pregnant women who plan to carry to term have a constitutional right to medical care throughout pregnancy, childbirth, and postpartum recovery. Unfortunately, too often authorities disregard the unique health needs of pregnant women and assume that they have discretion to permit or deny care as they see fit. As Sufrin's survey confirms, when it comes to abortion, this can lead to a hodgepodge of policies, practices, and perceptions among correctional authorities and staff.

This gap between the health needs and rights of pregnant inmates, and the services they can actually access, is, of course, not completely surprising. It is one more result of a system in which prisoners are subject to discretionary policies and practices that are largely shielded from public scrutiny. On the other hand, the widespread misunderstanding, and in some cases complete disregard, of the rights of incarcerated women is startling. Given sheer numbers, any facility that houses female inmates should expect to see pregnant women and must prepare to meet their unique health needs. Yet, in creating an online, state-by-state guide of correctional pregnancy-care standards in facilities throughout the country, I could not readily locate any relevant policies in 16 states. And, of the pregnancy-care standards located in 34 states and the District of Columbia, only 20 referenced both prenatal and abortion care, leaving a total of 30 states completely silent on abortion access.

While the results of these recent surveys and reports may seem discouraging, I remain hopeful. As the treatment of incarcerated women has increasingly become a topic of advocacy, public health projects, policy making, and public discussion we have seen positive change. For instance, advocates and policy-makers are reforming the inhumane practice, common in many prisons and jails, of shackling pregnant women taken to hospitals for labor and delivery. In more and more states, community organizations are bringing family-planning services, and birthing and parenting classes directly to women in prison. And recent court cases in Arizona and Missouri have made clear that correctional facilities may not deny women access to abortion care.

So, although our work is far from done, the Sufrin study offers another critical step forward for comprehensively addressing the range of health services incarcerated women need as they prepare to reclaim their lives, return to their families and re-enter the community.