Evaluation of birth companions perinatal and peer support provision in two prison settings in England: a mixed-methods study

• DOI: https://doi.org/10.1108/IJPH-09-2021-0099
• Published date: 02 February 2022
• Date: 02 February 2022
• Pages: 125-142
• Subject Matter: Health & social care,Criminology & forensic psychology,Prisoner health,Sociology,Sociology of crime & law,Public policy & environmental management,Policing,Criminal justice
• Author: Gill Thomson,Rose Mortimer,Michelle Baybutt,Karen Whittaker

Evaluation of birth companions

perinatal and peer support provision in

two prison settings in England: a

mixed-methods study

Gill Thomson, Rose Mortimer, Michelle Baybutt and Karen Whittaker

Abstract

Purpose –This paper reports on insights from an evaluation of Birth Companions (BC) (a UK-based

charity) perinatal supportin two prison settings in England. The initiative involvedthe provision of group

and/orone-to-one perinatal support and training womenprisoners as peer supporters.

Design/methodology/approach –A mixed-methods studywas undertaken that involved observations

of support groupsand peer support supervision sessions(n = 9); audio recorded interviews (n = 33)with

prison and health-carestaff, women in prison, peer supportersand BC staff; analysis of existing routinely

collected data by BC and notes undertaken during regular meetings (n = 10) with the BC Project

Manager.Thematic analysis was undertaken supportedby MAXQDA qualitative data analysis software.

Findings –BC provided instrumental/practical support, emotional support, information support,

signposting to services and advocating for women to the prison concerning their perinatal needs and

rights.Key themes revealed that support had an impact on the lives of perinatal women by creatinga safe

place characterised by meaningful interactions and women-centred approaches that facilitated access

to wider care and support. The servicemade a difference by empowering women and providing added

value for peer supporters, prison, health-care and BC staff. Key enablers and strategies for the care of

perinatalwomen and the delivery of perinatalsupport are also detailed.

Originality/value –Through longitudinaldata and the involvement of a range of stakeholders,this study

evidences the subtleties of support provided by BC and the potential it has to make a difference to

perinatalwomen in prison and those volunteeringor working within the prison system.

Keywords Women’s health, Health in prison, Health promotion, Women prisoners, Human rights,

Qualitative research

Paper type Research paper

Background

Perinatal women in custody, which includes those who are pregnant or who have

experienced a perinatal loss –miscarriage, termination, stillbirth, child removed following

the birth –are a particularly vulnerable population with specific reproductive and

psychosocial health needs (Home Office, 2007). Approximately 600 pregnant women enter

prison in England each year, and about 100 babies are born in prison in the UK annually

(Epstein and Brown, 2020), with complaints about a lack of readily available and rigorous

data in this area being highlighted (Davies, 2019). Many pregnant women who are

incarcerated often continue to engage in risky health behaviours such as smoking and

substance misuse (Fowler and Rossiter, 2017). Currently, very few studies have been

conducted examining the mental health experiences of pregnant women in prison in the

UK. However, a small body of international research suggests that pregnant incarcerated

(Informationabout the

authorscan be found at the

end of this article.)

Received 29 September 2021

Revised 15 October 2021

26 October 2021

Accepted 26 October 2021

©Gill Thomson, Rose

Mortimer, Michelle Baybutt and

Karen Whittaker. Published by

Emerald Publishing Limited.

This article is published under

the Creative Commons

Attribution (CC BY 4.0) license.

Anyone may reproduce,

distribute, translate and create

derivative works of this article

(for both commercial and

non-commercial purposes),

subject to full attribution to the

original publication and

authors. The full terms of this

license may be seen at http://

creativecommons.org/licences/

by/4.0/legalcode

Thanks, are extended to all

participants and to staff who

helped facilitate access.

Funding: HMPPS Grant (via

BC).

Conflict of interest: The authors

have no conflict of interest.

DOI 10.1108/IJPH-09-2021-0099 VOL. 19 NO. 2 2023, pp. 125-142, Emerald Publishing Limited, ISSN 1744-9200 jINTERNATIONAL JOURNAL OF PRISONER HEALTH jPAGE 125

women are likely to experience depression and anxiety, which (together with poor health

behaviours) places them at high risk of adverse maternal and fetal outcomes (Mukherjee

et al., 2014;Shaw et al., 2015). An Australian retrospective cohort study found that babies

born to incarcerated women were more likely to be born premature, have low birth weight

and require hospitalisation compared to community controls (Walker et al.,2014).

Pregnancy, neonatal loss and removal of a child following the birth are also associated with

profound negative impacts on maternal mental health (Cacciatore, 2013;Eloff and Moen,

2003;Huang et al., 2012), with women reportedto display “deep grief” (Wood, 2008).

There are several international standards concerning the rights of women in prison, someof

which relate to pregnant women. Rule 48 of the Bangkok Rules (United Nations General

Assembly, 2010) states: “programmes for birthing companions, where they are available in

the community, should also be made accessible to women in prison.” The United Nations

Standard Minimum Rules for the Treatment of Prisoners (the Nelson Mandela Rules)(United

Nations General Assembly, 2015) refers to pregnant women in Rule 28: “In women’s

prisons, there shall be specialaccommodation for all necessary prenatal and postnatal care

and treatment. Arrangements shall be made whereverpracticable for children to be born in

a hospital outside the prison. If a child is born in prison, this fact shall not be mentioned in

the birth certificate.” Indeed, since 1957 international standards have prescribed that

women prisoners should give birth in ordinary hospitals (Council of Europe, 2006). In

England and Wales, it is stated that pregnant women should have the same key maternity

entitlements to National Health Service (NHS) care as the general maternity population

(Public Health England, 2018). Public Health England (2018) recommends a

comprehensive range of provisions for pregnant women and new mothers in prison,

including antenatal education and specialised peer support; there is some evidence that

when enhanced perinatal care is provided, women can experience good outcomes,

including decreased likelihood of preterm delivery and reduced recidivism (Bard et al.,

2016). However, many prisons in England and Wales do not provide the recommended

services. Pregnant women in prison can face barriersin accessing adequate ante/postnatal

care, including essential items, and their needs can be overlooked in prisons designed to

house men (Walker et al., 2014;Abbott,2019, 2020). Prison staff are often unaware of the

basic needs of perinatal women as well as Prison Service Instructions (PSIs) (National

Offender Management Service (NOMS), 2014). Pregnancy-related PSIs concern the need

to provide pregnant prisoners with adequate nutrition and rest, to support applications to

Mother and Baby Units, and include guidance against transporting pregnant women in

cellular vans or using handcuffs afterarrival at hospital (NOMS, 2014).

Mother and Baby Units (MBUs) were introduced in UK prisons in the 1960s; in England and

Wales, there are 12 women’s prisons, six of which have MBUs. MBUs are units that house

mother and infant dyads (generally up to 18months of age) and offer opportunities for

mothers to bond with their baby in a more stable environment (O’Keefe and Dixon, 2015).

Women in prisons without MBUs and who give birth in custody either gain places at MBUs

at other prisons or are separated from their babies and go back into the main prison

population. Similarly, women who give birth in prisons with MBUs can also be separated

from their infants due to their perceived level of parenting capability and risk. Pregnant

women in prisons without MBUs are unable to benefit from experience and expertise built

up by staff in prisons that have MBUs, and non-MBU prisons face challenges in facilitating

women’s applications for MBUplaces due to a lack of understanding (Sikand, 2015).

Currently, there are few published reports on perinatal interventions delivered in prisons

(Ferszt and Erickson-Owens, 2008;Hogg, 2014;Shlafer et al., 2018). The Minnesota Prison

Doula project was a 12-week group-based support programme that provided pregnancy,

birth and parenting services to incarcerated women in the USA (Shlafer et al.,2018).

Women who accessed the group reported more parenting confidence and more support

from both other detainees and prison staff (Shlaferet al.,2018). The UK-based nine session

PAGE 126 jINTERNATIONAL JOURNAL OF PRISONER HEALTH jVOL. 19 NO. 2 2023