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Reproductive Health Locked Up

by Janna Frieman

March 22, 2012

In January, a woman prematurely gave birth to twins in her cell within 24 hours of entering a Pennsylvania county jail. Despite the fact that she was known to be pregnant, and despite the fact that this was obviously a high-risk pregnancy due to drug use (detected during intake) and a lack of prenatal care, when the new inmate complained of nausea and vomiting, she was only cursorily checked and sent back to her cell. Jim Baylor, a nurse at the Luzerne County Correctional Facility where the incident occurred, was interviewed on a local news radio station. When asked about why the woman was sent back to her cell when she was still in distress, he had this to say about her medical condition:

“There was no...uh... baby parts, or anything like that... visible, so she went back upstairs,” according to
an interview on local radio.

I'm no medical professional, but I'm pretty sure that “no baby parts visible” is not the gold standard of criteria to determine whether a woman with a high-risk pregnancy needs immediate medical attention. Within 45 minutes of being sent back to her cell, the woman went into labor and delivered twins, one of whom died at the hospital shortly thereafter.

This is not the first such incident, and it won't be the last as long as women's reproductive health needs continue to be misunderstood and underserved in the nation's prisons and jails. Women are a relatively new incarcerated population, and the correctional system is struggling to accommodate their unique health concerns. The Clara Bell Duvall Reproductive Freedom Project, a part of the ACLU of Pennsylvania, recently
released a report
examining how prepared Pennsylvania county jails are to provide reproductive care to their female populations.

It is important to note that the study focused on whether jails had policies in place to deal with things like STI testing, abortion access, prenatal nutrition, or labor and delivery, and made no comment on the actual practices of county jails; practices are just as likely to be better than written policies as they are to be worse.

Even so, the under-preparedness that the report reveals is shocking. Many prisons have no written guidelines for Ob/Gyn care or gender-specific intake screenings (like pregnancy tests) for female inmates. The vast majority have no mechanism in place for annual check-ups or Pap smears; inmates, many of whom have limited health knowledge, must request such services at the appropriate intervals if they want to receive the nationally-accepted standard of care. Despite the fact that Pennsylvania has a law requiring correctional facilities to provide prenatal care, 10 (out of 57) facilities had no policy about providing this care, and there are no set standards for what “adequate” prenatal care entails.

Most strikingly -- in light of the recent incidents -- almost 90 percent of Pennsylvania jails have no written policies about labor and delivery. An estimated six percent of female inmates arrive pregnant. When do they call a doctor? What constitutes real distress or danger? When do they take the inmate to the hospital? Most jails lack standard procedures for this critical time and leave these decisions in the hands of underqualified, undertrained individuals (“there was... no baby parts...”). There should be no surprise when things go wrong and women don't make it to the hospital in time.

Incarcerated individuals rely wholly on their imprisoning institutions to provide for their health needs. Poor pregnancy or other reproductive health outcomes due to lack of adequate care are cruel and unusual, decidedly not an acceptable punishment for any crime. And they are largely preventable. Comprehensive, medically-sound, and compassionate policies -- and practices that adhere to them -- can go a long way toward improving reproductive health services for incarcerated women.

The report has been distributed to prison board members, wardens, county solicitors and medical contractors and has received surprisingly positive responses. Many of those involved in the criminal justice system share our concerns about the advisability of locking up so many women -- women who overwhelmingly have committed low level, non-violent offenses and who deal with myriad challenges like substance abuse, physical and sexual abuse, and mental illness.

We are paying a very high price to maintain the system as it is. Even if society treats the incarcerated as people who don’t count -- they do cost, and the current system costs a lot. Community-based programs are cheaper, more effective at ensuring public safety and more humane.

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Janna Frieman is an intern with the ACLU-PA’s Clara Bell Duvall Reproductive Freedom Project. She is pursuing a master's in Social Policy at the University of Pennsylvania’s School of Social Policy and Practice.

Also see ”From Our Archives: Bold Discussions of ABORTION” by the Editors in this edition of On The Issues Magazine.

See ”Professionals and Activists: Nursing Students for Choice” by Erika M. Staub RN, PHN and Jacqui R. Quetal RN, FNP in the Cafe of this edition of On The Issues Magazine.


Vinod posted: 2012-04-22 14:19:23

I am certainly not dnneiyg that their are horrible people capable of doing horrible things. It's just not that easy to put all of the people incarcerated into one category. When people say there is no rehabilitation efforts, it really does bother me because that's simply not true. Some work and some don't. Some programs change based on the failure or lack of success. They are continuously being evaluated, tremendous effort is expended my many people to try to make things better. If we were to throw the book away at every single person who is incarcerated, we would be doing humanity a HUGE injustice. That's why there's degrees and descretion. But keep in mind, in always individuals who enforce those laws or apply that descretion. We don't always see what they see. There really is no perfect answer, because some people truly do deserve the death penalty, and some where at the wrong place, the wrong time, then there are those who never were taught right from wrong, but survival . There are so many variations and reasons, some are excuses and some are straight facts.

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