The Need for Equitable Care
While women constitute a minority of the global imprisoned population, their numbers are significantly increasing. In Europe, statistics indicate that about 100,000 women are imprisoned daily, representing about 5% of the entire continent’s population (Voit et al., 2022). In the United States 215, 000 women are in jail, which is 9% of the country’s incarcerated population, a 30% increase since 2000 (Voit et al., 2022).
Despite the increasing numbers, the minority standing implies that the healthcare needs of imprisoned women and their newborns can be overlooked or fail to be met at all. In America, 38 states have insufficient or entirely lacking prenatal care in their prisons (Voit et al., 2022). This paper explores the need for equitable care among incarcerated women by presenting the background and the healthcare risks that inequitable healthcare practices present to the mother and the child.
Literature Review
Background Information
The health needs and associated risks of incarcerated pregnant women remain under-researched. The present limited literature points out that incarceration during pregnancy adversely affects parental care (Alirezaei & Roudsari, 2022). When pregnant women are imprisoned, this exposes them to various health risks, such as stress, low birth-weight newborns, and premature delivery. Despite this evidenced risk, there is still a lack of adequate measures to cater to the health needs of imprisoned women.
In a literature review, Alirezaei and Roudsari (2022) asserted that nearly half of the women incarcerated in US states do not receive pregnancy care. In addition, internationally, prison health is recognized as a substantial public health issue (Sufrin, Beal, Clarke, Jones, & Mosher, 2019). In 2009, the World Health Organization (WHO) acknowledged the lack of adequate care for incarcerated women (Augsburger et al., 2022). Specifically, the WHO proclaimed that current provisions for dealing with female lawbreakers often fall short of meeting their healthcare and basic needs.
Despite these insufficiencies, rules exist to safeguard healthcare among pregnant women and neonates. A review of relevant literature by Alirezaei and Roudsari (2022) asserts that the 2015 standard minimum rules for women prisoners’ treatment and the 2010 Bangkok rules guide how correctional settings should offer prenatal care. The scholar argues that the rules provide a healthy environment with identical healthcare standards to those in the community. The Eighth Amendment in the US also provides sufficient perinatal care through the ban on unusual and cruel punishment in prisons.
Moreover, the 1976 Estelle v. Gamble Supreme Court case guarantees all incarcerated persons’ constitutional right to healthcare. Nonetheless, a significant variance exists in providing prenatal care among inmates. In a survey conducted across 19 state prisons in the US, Testa and Jackson (2020) established that 12 facilities lacked an onsite healthcare provider. It also demonstrated that multiple states could have offered expectant women adequate nutrition.
Pendleton, Saunders, and Shlafer (2020), in a national survey they conducted among perinatal nurses, established that there exists stigma among incarcerated people, which often adversely affects the nature of the care they receive in hospitals. Detrimental, unconceivable practices persist in hospital environments: pregnant women are often shackled. They are only allowed to deliver in the presence of police, lack the support of friends during the prenatal period, and are even compulsorily detached from their newborn instantly after delivery. A study by Vedam et al. (2019) found that 20% of the 240 imprisoned women who gave birth at a hospital in Michigan state were separated from their newborns. The separation was forceful and often for motives that were not medical.
Particularly of concern to medics and scholars alike are the dangerous healthcare inequalities and disparities that imprisoned women often face. These dissimilarities frequently mirror the structural classism and racism that impact persons of color. Statistics indicate that in 2017, black women’s incarceration rate was twice that of their white counterparts (Voit et al., 2022). The disparity was even worse regarding pregnancy-linked mortality, with black women being three times more predisposed to death than their white counterparts.
Studies indicate that the inequalities persist even among other minorities, including American Indians. According to Voit et al. (2022), these inequalities often adversely impact the affected groups psychologically and physically. The psychological effects and consequences are often reflected in low birth weight and preterm births such mothers experience.
Legal ethics should prevail to help tackle the inequalities, and expectant women’s patient rights should be advocated, particularly among the most vulnerable: the minority. In addition, compassion, evidence, and general ethical practice should also guide clinical decisions among expectant women. Scholars Alenchery et al. (2018) presented evidence of the harms of immediate separation after birth and the benefits of skin-to-skin contact. The aim was to advocate for systematic legal changes to ensure that human rights for incarcerated women are adhered to.
Biased and Inconsistent Practice
Generally, in prisons, prenatal care follows a general schema where most of the care during pregnancy is offered at the prison. Alenchery et al. (2018) avow that this is the case when a qualified onsite healthcare practitioner is present. He further adds that for obstetric emergencies, high-risk pregnancies, and patients with the onset of labor, these are often transferred to prison-affiliated hospitals for care. In such cases, mothers typically are given a few days in the hospital after birth to spend with their children before they are returned to prison. The child is then placed for adoption with a family member or taken to a foster care system.
While prison nurseries sometimes exist, they are rare: only eight states have nursery prison programs in the US. Though women are sometimes offered early release furlough, the pregnancy experience in prison is highly disjointed. Sapkota et al. (2022) attribute this fragmentation to the fact that, traditionally, prisons have predominantly been designed for men and thus fail to account for women’s healthcare needs and parental responsibilities.
Activists and scholars have continually suggested that the trauma-inducing nature of prisons, particularly to expectant mothers, be trauma-reformed and made more gender-responsive. The compulsory removal of a newborn from the presence of its mother is an act that is directly opposed to such a reform. No national care standards exist regarding the contact between an imprisoned mother and their newborn baby. Thus, the assumed general population medical practice does not always translate to equitable care for incarcerated pregnant women. Individual prisons, hospitals, and carceral employees set mother-infant contact policies without national guidelines.
There is a lacuna in research on instant postpartum mother-newborn parting in the imprisoned population. Alenchery et al. (2018) state that existing practices range from prompt obligatory elimination to hospitals’ deliberate parting or setting restricted contact. Lack of adequate prenatal care can result in the notion of the imprisoned mother’s dangerousness and unworthiness.
Hospital, wardens, and Department of Corrections staff can internalize the belief that imprisoned women are more likely to injure their children. Nevertheless, there is no documented case of incarcerated women hurting their children in their initial days of life. Wilson et al. (2022) assert that while neonaticide cannot be ignored, women who perform the act have their profile well defined.
They often have concealed, hidden, or denied their pregnancy at a particular time. Most of them have also given birth outside of the hospital and failed to take part in prenatal care. In addition, most of the mothers recorded to have murdered their newborns have no record of a prior arrest. Therefore, without evidence, it cannot be supposed that expectant women in jails have an inherent likelihood of imposing harm to their newborns, thus warranting separation.
Risk and Benefit to the Newborn and Mother
The notion of safety that emanates from infant separation after birth is additionally weakened by evidence that supports the significance of the parent-child bond. Alenchery et al. (2018), in their research, document the American Academy of Pediatrics’ recommendation of routine, skin-to-skin, and unlimited contact between infants and their medically stable mothers during the postpartum period. The research documents the pivotal time just after birth, during which the newborn exhibits behaviors, including the breast crawl, on being positioned on the mother’s chest. This uninterrupted and immediate skin-to-skin contact plays a significant role in bond facilitation, thermoregulation, and breastfeeding and affects sleep-wake cycles.
If a newborn is separated from its mother during this critical period, it will fail to receive these vital benefits. Often, this results in a weakened mother-infant bond, dysregulation of behavior, and increased irritability. For the mother, this can be distressing, often causing postpartum depression. In addition, children whose mothers are in jail have demonstrated increased trouble with mental health outcomes and externalization as they grow older, including antisocial behaviors and drug abuse.
To eliminate these risks, there is a need for equitable care among imprisoned women. At the same time, several bodies have found the need for adequate perinatal care and the existence of laws that advocate for equitable healthcare among expectant mothers. Despite this, prisons and hospitals continue to break the bond between imprisoned mothers and their newborns, adversely affecting both mothers and newborns.
Addressing the issues to halt the adverse effects is essential. This should be done both at the legal and individual levels. The justice department ought to operationalize the pertinent laws that recognize the rights of all persons, including expectant mothers, to adequate medical care.
More so, given the fact that there are inadequate studies in the areas, more research is also needed to have conclusive results on the steps that state and federal prisons, detention centers, and local jails should implement to help operationalize these laws, including the Eighth Amendment. At the individual level, healthcare practitioners must acknowledge, recognize, and address the existing biases and seek to become allies to all patients’ fair and equitable treatment. They should work with the criminal justice system to ensure that incarcerated expectant women receive the same prenatal care as their free counterparts.
Practitioners are also crucial to ensuring equitable laws are operationalized. This should be done at the local, national, and state levels. They should seek organizational support at these levels to enact policy and clinical changes. Specific organizations, such as the American Medical Association, have issued a position and policy statement to ensure that best practices are embraced. An example here should seek the passing of best practice laws, such as anti-shackling laws.
References
Alenchery, A. J., Thoppil, J., Britto, C. D., Villar, d. O., Fernandez, L., & Rao, P. N. (2018). Barriers and enablers to skin-to-skin contact at birth in healthy neonates – A qualitative study. BMC Pediatrics, 18(48), 7-15. Web.
Alirezaei, S., & Roudsari, R. L. (2022). The needs of incarcerated pregnant women: A systematic review of the literature. International Journal of Community Based Nursing and Midwifery, 10(1), 2-17. Web.
Augsburger, A., Neri, C., Bodenmann, P., Gravier, B., Jaquier, V., & Clair, C. (2022). Assessing incarcerated women’s physical and mental health status and needs in a Swiss prison: A cross-sectional study. BMC, 10(8), 3-4. Web.
Pendleton, V., Saunders, J. B., & Shlafer, R. (2020). Corrections officers’ knowledge and perspectives of maternal and child health policies and programs for pregnant women in prison. International Journal for Equity in Health, 8(1), 7-10. Web.
Sapkota, D., Dennison, S., Allen, J., Gamble, J., Williams, C., Malope-Rwodzi, N.,… McGee, T. R. (2022). Navigating pregnancy and early motherhood in prison: A thematic analysis of mothers’ experiences. BMC, 10(32), 5-10. Web.
Sufrin, C., Beal, L., Clarke, J., Jones, R., & Mosher, W. D. (2019). Pregnancy Outcomes in US Prisons, 2016–2017. American Journal of Public Health, 4-10. Web.
Testa, A., & Jackson, D. B. (2020). Incarceration exposure and barriers to prenatal care in the United States: findings from the pregnancy risk assessment monitoring system. International Journal of Environmental Research and Public Health, 17(19), 7-10. Web.
Vedam, S., Stoll, K., Taiwo, T. K., Rubashkin, N., Cheyney, M., Strauss, N.,… Council, T. G.-U. (2019). Shackling and separation: Motherhood in prison. AMA Journal of Ethics, 16(77), 5-20. Web.
Voit, F. C., Kajantie, E., Lemola, S., Räikkönen, K., Wolke, D., & Schnitzlein, D. D. (2022). Maternal mental health and adverse birth outcomes. PLOS ONE, 17(8), 7-20. Web.
Wilson, R. F., Klevens, J., Fortson, B., Williams, D., Xu, L., & Yuan, K. (2022). Neonaticides in the United States—2008-2017. SAGE Journals, 12(1), 5-10. Web.