States Take Action to Create Better Health Outcomes for Incarcerated Women

October 24, 2019 | ASTHO Staff

The health concerns of incarcerated women are often left out of conversations related to health equity and optimal health for all. Women are incarcerated at an increasing rate; there are nearly eight times as many women in state and local prisons today as there were in 1980. According to the federal Bureau of Justice Statistics, nearly 75 percent of incarcerated women are between 18 and 44, an age range during which women have specific health concerns surrounding reproductive, prenatal, and postpartum care.

Unfortunately, there can be a shortage of basic, quality healthcare and services for incarcerated women, including poor treatment during pregnancy and the absence of postpartum services. Earlier this year, the California legislature considered a bill that would address these issues in state prisons and county jails. The bill would require a correctional facility to follow up with a potentially-pregnant incarcerated woman and schedule her for laboratory work to verify pregnancy within three business days. If the woman is pregnant, the bill would require the correctional facility to schedule a prenatal examination and subsequent prenatal care for her along a specified timeline. Under the bill, incarcerated pregnant women would also have access to a medical social worker and community-based programs relating to pregnancy and lactation, prenatal vitamins, and childbirth education, and would be protected from shackling or solitary confinement. In addition, the bill would provide services and facilities for breastfeeding and mandate health check-ups at one week, two weeks, six weeks, and 12 weeks postpartum.

While California’s bill is an example of comprehensive legislation aimed at reducing the challenges to optimal care and services for incarcerated pregnant women, many other states have considered legislation that individually addresses some of these challenges. Below is an overview of recent state legislation focused on menstrual hygiene, physical restriction during prenatal care and pregnancy, and postpartum care for incarcerated women.

Physical Restrictions

Restricting incarcerated women during pregnancy check-ups and delivery has gained public attention in recent months. Although the majority of female inmates are nonviolent offenders, many are handcuffed or restrained as a precaution when they are transported during pregnancy. Restraining a woman during pregnancy can lead to injuries or even hemorrhaging during childbirth and can also prevent bonding between the newborn and mother.

As of February 2018, 22 states prohibited or limited the use of shackles with pregnant women. In 2019, two states enacted such laws. Nebraska amended its Healthy Pregnancies for Incarcerated Women Act by prohibiting the use of physical restraints for a pregnant detainee at any time, even during transport to the hospital. Georgia enacted a bill prohibiting not only physical restraints during pregnancy, but also solitary confinement, strip searches, and unauthorized medical examinations.

Postpartum Care and Breastfeeding

The postpartum period, sometimes referred to as the “fourth trimester,” is an extremely important and vulnerable time for women. During this time, breastfeeding women need additional support and new mothers are at risk for postpartum depression. There is no set standard of care for postpartum and breastfeeding women in correctional facilities and, consequently, the infant mortality rate for children whose mothers are incarcerated is more than twice the rate of children outside the prison system. It is important to provide mothers with proper services such as full physical health checkups at six weeks postpartum and mental health services and screenings. Although postpartum women represent a small population of women in correctional facilities, accommodating these women is essential to the well-being of both mother and child. Breastfeeding has significant health and emotional benefits for both the infant and mother, but can become a complicated and difficult process in correctional facilities. To enable women to pump and store breast milk, facilities need to acquire the appropriate equipment, allow women to pump frequently in a private and clean space, devise protocols for appropriate milk handling and storage, and coordinate transferring the milk to the infant’s caregivers.

In 2019, Wisconsin and New Mexico enacted legislation pertaining to postpartum care and breastfeeding for incarcerated women. Wisconsin’s bill allows pregnant and postpartum women to access educational materials related to breastfeeding. The bill also requires that any inmate that has given birth in the past 12 months must be given access to proper supplies to produce and maintain an active supply of breast milk. This legislation also provides incarcerated pregnant and postpartum women with access to a doula and mental health services. New Mexico’s bill requires correctional facilities to provide materials for breastfeeding, breast milk storage, and support when an incarcerated mother is ceasing breastfeeding. The bill also provides access to medication assisted treatment for mothers with substance use disorders.

State health agencies can improve incarcerated women’s mental and physical health by advocating for and enforcing policies that address this population’s unique needs. They also have an opportunity to partner with and educate corrections agencies on the importance of establishing these services to improve health outcomes among incarcerated women and move forward in the pursuit of health equity.