Evidence-based recommendations to improve reproductive healthcare for incarcerated women

• DOI: https://doi.org/10.1108/IJPH-07-2016-0031
• Date: 11 September 2017
• Published date: 11 September 2017
• Pages: 200-206
• Author: Andrea Knittel,Angeline Ti,Sarah Schear,Megan Comfort
• Subject Matter: Health & social care,Criminology & forensic psychology,Prisoner health,Sociology,Sociology of crime & law,Public policy & environmental management,Policing,Criminal justice

Evidence-based recommendations

to improve reproductive healthcare

for incarcerated women

Andrea Knittel, Angeline Ti, Sarah Schear and Megan Comfort

Abstract

Purpose –The purpose of this paper is to describe standards for evidence-based reproductive healthcare

for incarcerated women.

Design/methodology/approach –The literature on reproductive healthcare in the US criminal justice

system and recommendations from professional organizations were reviewed and critical areas of concern

were identified. Within these areas, studies and expert opinion were synthesized and policy

recommendations were formulated through an iterative process of group discussion and document

revision. This brief specifically addresses women’s incarceration in the USA, but the recommendations are

grounded in a human rights framework with global relevance.

Findings –Women who are incarcerated have health needs that are distinct from those of men, and there is

a clear need for gender-responsive reproductive healthcare within the criminal justice system. This brief

identifies five core domains of reproductive healthcare: routine screening, menstruation-related concerns,

prenatal and postpartum care, contraception and abortion, and sexually transmitted infections.

The recommendations emphasize the continuity between the criminal justice system and the community,

as well as the dignity and self-determination of incarcerated women.

Originality/value –This brief provides a unique synthesis of the available evidence with concrete

recommendations for improving the reproductive healthcare for incarcerated women.

Keywords Criminal justice system, Women prisoners, Reproductive health, Incarceration,

Women’s health, Detention

Paper type General review

Background

Women who areincarcerated have health needsthat are distinct from thoseof men. In 2013 in the

USA, a one-day census estimated 111,300 women incarcerated in prisons, which are generally

long-termfederally or state-controlledfacilities, and 102,400 womenincarcerated in jails, which are

shorter-termand usually locally controlledfacilities (Glaze et al., 2014).The number of incarcerated

women has continued to grow in recent years, and an ever-larger proportion of women in the

community have come into contact with the criminal justice system, a trend that is mirrored in

Europe, Asia, and Central and South America (Penal Reform International, 2015).

The availabledata consistently demonstratethat women involved in the criminal justicesystem are

at high risk for unintended pregnancies, preterm birth and low birth weight, sexual violence and

trauma, and sexually transmitted infections (STIs), both while they are incarcerated and once they

return to their communities (Bell, 2004). Complicating this is a lengthy and distressing history of

forced sterilizations and concerning rates of sexual trauma experienced by women before and

during incarceration. Research shows that a majority of incarcerated women in the USA (greater

than seven in ten, in some studies) have experienced sexual trauma (McDaniels-Wilson and

Belknap, 2008). Trauma-informed care is a model of healthcare that explicitly recognizes and

addresses these experiences, yet it is not routinely practiced in most correctional settings.

Received 18 July 2016

Revised 9 December 2016

5 April 2017

Accepted 17 May 2017

Andrea Knittel is a Resident

Physician and Angeline Ti is a

Family Planning Fellow, both at

the University of California,

San Francisco, San Francisco,

California, USA.

Sarah Schear is a Medical

Student at the School of Public

Health, UC Berkeley –UC

San Francisco Joint Medical

Program, University of

California, Berkeley, Berkeley,

California, USA.

Megan Comfort is a Senior

Research Sociologist at RTI

International, San Francisco,

California, USA.

PAGE200

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INTERNATIONALJOURNAL OF PRISONER HEALTH

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VOL. 13 NO. 3/4 2017, pp. 200-206, © Emerald Publishing Limited, ISSN 1744-9200 DOI 10.1108/IJPH-07-2016-0031