Essay on the Effects of Incarceration on Pregnancy

Women of child-bearing age may face pregnancy and mothering in a correctional environment primarily designed for men. Seventy-six percent of incarcerated women are at a reproductive period of between 18 and 44 years, and about 3 to 4% of women are expectant during their admission to prison (Shlafer et al., 2017). By international standards, the rates of incarceration for women in the U.S. are very high. Pregnancy, delivery, lactation, and parenting require unique consideration during imprisonment. Taking care of incarcerated pregnant women has challenges where pregnancies are often unplanned and complicated due to prenatal care, substance abuse, maternal trauma, mental illness, poor nutrition, limited social support, and chronic medical conditions (Friedman, Kaempf, & Kauffman, 2020). It is difficult for the incarceration system to care for the needs of incarcerated women because prisons were initially designed for men. Challenges also arise during the transportation of pregnant women to and from medical facilities, access to obstetrical services, and coordinating with health care providers. Pregnant women do not control their prison environment, which has adverse effects on their dietary requirements, naps, medical administration, and sleeping times (Kelsey et al., 2017). Despite heterogeneous practices and policies for prenatal care for correctional settings, incarcerated women experience risk factors for poor pregnancy outcomes. Female offenders are at a greater risk of having premature delivery, low-birth-weight infants, and stillbirths. This essay focuses on a review of literature on the impact of incarceration on pregnancy, including access to prenatal care, nutritious diet, social support, and the use of restraints.

Lack of Access to Prenatal Care

Prenatal care is a recommended element for a healthy pregnancy by leading organizations like the World Health Organization and the American Academy of Paediatrics. Arising number of pregnant women have been advised to receive early and adequate prenatal care to reduce the adverse infant and maternal healthcare outcomes. Testa and Jackson (2020) conducted research showing that exposure to incarceration during pregnancy worsens parental care. The study examined the relationship between exposure to incarceration during pregnancy and the barriers to prenatal care in the U.S. Negative logistic and binomial regression models were utilized to determine the relationship between the imprisonment of a woman, i.e., incarceration that happened 12 months before the focal birth and various barriers to prenatal care (Testa & Jackson, 2020). Results showed that incarceration exposure elevated the barriers to prenatal care, including lack of transportation to health care appointments, communication with doctors, follow-up of abnormal tests, and the guardianship of the baby after delivery. The research demonstrates that an incarceration is a stressful event that significantly elevates hardships and negatively influences the health of both incarcerated people and their family members. Incarcerated pregnant women receive inadequate prenatal care, linked to various health problems, including preterm birth and low birth weight. Incarcerated pregnant women are part of the disadvantaged segments of the population that continue to face diminished access to prenatal care (Kelsey et al., 2017). Despite the standards for obstetric care that applies to patients, even those living in correctional facilities, the risks factors linked to incarceration and the operating systems in the prisons create unique challenges to the provision of routine obstetric care for the inmates.

According to Daniel (2020), all U.S jails and prisons are provided with prenatal care under the Eight Amendment in the Constitution. Still, there are no federal standards detailed to ensure that women are receiving the care they require. The National Commission on Correctional Health Care produced a set of standards for the treatment of pregnant women in prison-like the proper medical examination as an element of prenatal care, limited use of restraints during pregnancy, and specialized care for pregnant women with problems of substance abuse (Daniel, 2020). However, states fail to make their Department of Corrections policies available public or write the guidelines to care for incarcerated pregnant women. Daniel (2020) tracked states that offered written policy health standards for providing the bare minimum for incarcerated pregnant women. The data indicated a widespread lack of protocols to care for pregnant women in state prisons. Sometimes the policies that exist on medical care for pregnant incarcerated women often lack the provision of basic medical needs. The majority of the state prison systems require some medically offered prenatal care, but 12 states failed to write any policy on this essential element of a healthy pregnancy (Kelsey et al., 2017). The data explains why the Bureau of Justice Statistics discovered that only 54% of pregnant women in prison reported getting prenatal care during imprisonment. Pregnant women in prisons are highly likely to experience pregnancy complications due to poor diet, sexually transmitted infections, and substance abuse. The pregnancies are viewed as high-risk, needing special treatment to ensure that their kids are born in perfect health. The study revealed that 22 states and the federal bureau of prisons do not provide any guidelines for specialized care for high-risk pregnancies (Kelsey et al., 2017). Incarcerated pregnant women require exceptional care to protect them from adverse pregnancy outcomes. Johns Hopkins School of Medicine indicated that in some states, more than 20% of prison pregnancies end in miscarriages and others in preterm birth rates, which is way over the national average of about 10% (Daniel, 2020). These differences in pregnancy outcomes are due to the inconsistent medical care provided to women in prisons and the lack of universal policy standards to make the pregnancies outcome more equitable.

Poor Prenatal Nutrition

Incarcerated pregnant women are highly vulnerable to pregnancy complications linked to poor nutrition. Incarcerated individuals often don’t receive the minimum requirements for whole grains, lean protein, vegetables, and fruits. They are typically fed the recommended amounts of refined starches, added sodium, and sugars. There are nutritional shortcomings in the prisons menus, and the only option besides the menu is the commissary, where 90% of the products are categorized as unhealthy and should be avoided (Shlafer et al., 2017). Instant oatmeal, for example, contains low fiber and is highly sweetened, and is not on the recommended list. Pregnant inmates have nutritional needs which are minimally met by the prison systems. Expectant prisoners have no control over their diet and often do not receive the dietary requirements for healthy pregnancy outcomes. Shlafer et al. (2017) stipulate that prisons do not cater to the dietary needs of pregnant inmates because it leads to additional costs to purchase extra food and prenatal vitamins.

Lack of Social Support

Incarceration has unique features that make it different from other difficult life events during pregnancy. Incarceration is often unexpected and sudden life occurrence that forcibly removes the pregnant woman from the household and sustains the removal for an extended period. An incarceration is a disruptive event as it typically happens without notice and forcibly restructures households in a way that is different from other major events such as death or divorce (Testa & Jackson, 2020). The sudden shock harmfully contributes to the expectant’s mother’s hardships, including economic hardship and stress. Racine et al. (2020) that low social support elevates depressive symptoms in pregnancy, postpartum, and the emergence of postpartum depression. The findings indicated that low social support is a risk factor for depression, thus the need for social support for pregnant and postpartum women. The current prison system increases shame, victimization, and passivity, which elevate the lack of social support from the inmate’s family members and friends. Expectant inmates don’t receive the support they would otherwise receive from their partners and family, elevating their stress and anxiety levels. According to Kelsey et al. (2017), in many prison systems, women in labor aren’t allowed to have friends or family members to attend the delivery. The women lack continuous emotional and physical support before, during, and after birth. Expectant inmates don’t receive the reassurance of emotional support as they go through the strenuous process of carrying a baby.

Use of Shackling and Restraints

According to Friedman, Kaempf, and Kauffman (2020), the use of shackling and restraints among expectant inmates is very controversial. Shackling uses mechanical devices that limit the inmate’s movement, including belly chains, handcuffs, soft restraints, and ankle cuffs. The limitations prevent the expectant inmate from escaping or helping others escape or harming themselves and others. However, most incarcerated women aren’t violent offenders, and there are no escape attempts known for inmates restrained during childbirth. These factors raise the concern of the need for shackling. Various legal and medical organizations such as the American Psychological Association have opposed the routine use of shackles during pregnancies (Friedman, Kaempf, & Kauffman, 2020). There are different potential adverse health effects of restraints, including limited mobility, delays in medical assessments during obstetrical emergencies, and elevated discomfort. Restraints elevate the risk of blood clots and interfere with labor and delivery. Only 22 states have legal restrictions to the use of shackles during active labor and delivery. The Bureau of Justice Assistance stipulated that using restraints should be limited when essential, such as the risk of harm or escape that cannot be controlled using reasonable means like increased staffing or enhanced security measures (Friedman, Kaempf, & Kauffman, 2020).

Summary

Inconclusion, pregnant inmates have significant risk factors for poor pregnancy outcomes. Incarceration presents various difficulties for pregnant women: lack of access to prenatal care, poor nutritional uptake, absence of social support, and experiencing restraints and shackling. Pregnant inmates have difficulties accessing prenatal care due to communication and transportation issues to and from the health facilities. The prison policies do not stipulate the need to provide pregnant inmates with the essential health care they need during pregnancy. The inmates have no control over their diets lead to poor nutritional diets risking pregnancy outcomes. The inmates do not get social support from friends and family, which elevates their stress and anxiety, leading to postpartum depression. Using mechanical restraints when dealing with pregnant inmates increases their risk factors like getting blood clots, delays in access to obstetric emergencies, and elevated discomfort.

References

Daniel, R. (2020). Prisons neglect pregnant women in their healthcare policies.

Friedman, S. H., Kaempf, A., & Kauffman, S. (2020). The realities of pregnancy and mothering while incarcerated. The journal of the American Academy of Psychiatry and the Law, 48(3), 365-375.

Kelsey, C. M., Medel, N., Mullins, C., Dallaire, D., & Forestell, C. (2017). An examination of care practices of pregnant women incarcerated in jail facilities in the United States. Maternal and child health journal, 21(6), 1260-1266.

Racine, N., Zumwalt, K., McDonald, S., Tough, S., & Madigan, S. (2020). Perinatal depression: the role of maternal adverse childhood experiences and social support. Journal of affective disorders, 263, 576-581.

Shlafer, R. J., Stang, J., Dallaire, D., Forestell, C. A., & Hellerstedt, W. (2017). Best practices for nutrition care of pregnant women in prison. Journal of Correctional Health Care, 23(3), 297-304.

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), 7331.