Reproductive Justice Disrupted: Mass Incarceration as a Driver of Reproductive Oppression

We describe how mass incarceration directly undermines the core values of reproductive justice and how this affects incarcerated and nonincarcerated women. Mass incarceration, by its very nature, compromises and undermines bodily autonomy and the capacity for incarcerated people to make decisions about their reproductive well being and bodies; this is done through institutionalized racism and is disproportionately done to the bodies of women of color. This violates the most basic tenets of reproductive justice—the right to have a child, not to have a child, and to parent the children you have with dignity and in safety. By undermining motherhood and safe pregnancy care, denying access to abortion and contraception, and preventing people from parenting their children at all and by doing so in over-policed, unsafe environments, mass incarceration has become a driver of forms of reproductive oppression for people in prison and jails and in the community

Pandemic detention: life with COVID-19 behind bars in Maryland

BackgroundPeople incarcerated during the COVID-19 pandemic face higher vulnerability to infection due to structural and social factors in carceral settings. Additionally, due to the higher prevalence of chronic health conditions among carceral populations, they are also at risk for more severe COVID-19 disease. This study was designed to explore the experiences of people incarcerated in prisons and jails in Maryland during the height of the pandemic.MethodsWe conducted semi-structured phone interviews between January 2021 and April 2022 with ten individuals incarcerated in Maryland carceral facilities during the height of the U.S. COVID-19 pandemic and were subsequently released from prison or jail. We transcribed the interviews, coded them, and engaged in content analysis, an inductive analytical approach to developing themes and meaning from qualitative data.ResultsFour themes emerged from participants’ descriptions of their experiences: (1) distress from fear, vulnerability, and lack of knowledge about COVID-19 and how to protect themselves, (2) shortcomings of prison and jail administrators and other personnel through lack of transparency and arbitrary and punitive enforcement of COVID-19 protocols, (3) lack of access to programming and communication with others, and (4) absence of preparation for release and access to usual re-entry services.ConclusionParticipants responded that the prison and jails’ response during the COVID-19 pandemic was ill-prepared, inconsistent, and without appropriate measures to mitigate restrictions on liberty and prepare them for release. The lack of information sharing amplified their sense of fear and vulnerability unique to their incarceration status. Study findings have several institutional implications, such as requiring carceral facilities to establish public health preparedness procedures and making plans publicly available

Jailcare: The Safety Net of a U.S. Women's Jail

Institutions of incarceration are widely understood for their punitive, depriving, and at times even violent characteristics. Yet prisons and jails also provide medical care and other services that people marginalized by poverty, addiction, racism, and other forces of structural inequality might not otherwise have. This dissertation investigates the everyday contours of care in an urban women's jail in California. Based on six years of clinical work as an Ob/Gyn in the jail's clinic; ethnographic fieldwork throughout the jail and its surrounding community; and over 40 interviews with jail workers, medical staff and inmates, I describe how this jail was constituted by caregiving relationships which were inextricably linked to disciplinary structures, particularly for pregnant women. Deficiencies in the public safety net, market shifts, and trenchant problems in the criminal justice system meant that cycling between jail and the streets was a normative rhythm of everyday life for many of the urban poor. Recidivism was less a statistic and more an intimate relationship between inmates and jail workers. First, I describe how the medical triage system upon entry to jail diagnosed the deficiencies of people's lives on the streets. Next, I explore the quotidian rhythms of the jail medical clinic, and how health providers cultivated ambiguity as a form of caregiving to a patient who is also a prisoner. I then focus on reproduction as a key site where the deficiencies of public services and their substitution with incarceration were made visible. Custody and medical apparatuses in jail managed the figure of the pregnant inmate, with her gestating fetus, both as worthy of tender care and as a liability threat to the institution. Pregnant women similarly experienced jail with ambivalence, even desiring the relative safety of this punitive space. The ambiguity surrounding pregnant, incarcerated women, combined with their experiences of marginality outside, produced jail as a place--often the only place--where these women could enact a normative ideal of motherhood. Particularly for marginalized, reproducing women, jail has become an integral part of America's social and medical safety net

Patient-Led Approaches to a Vaginal Birth After Cesarean Delivery Calculator

ObjectiveTo describe patient approaches to navigating their probability of a vaginal birth after cesarean (VBAC) within the context of prediction scores generated from the original Maternal-Fetal Medicine Units' VBAC calculator, which incorporated race and ethnicity as one of six risk factors.MethodsWe invited a diverse group of participants with a history of prior cesarean delivery to participate in interviews and have their prenatal visits recorded. Using an open-ended iterative interview guide, we queried and observed these individuals' mode-of-birth decisions in the context of their VBAC calculator scores. We used a critical and feminist approach to analyze thematic data gleaned from interview and visit transcripts.ResultsAmong the 31 participants who enrolled, their self-identified racial and ethnic categories included: Asian or South Asian (2); Black (4); Hispanic (12); Indigenous (1); White (8); and mixed-Black, -Hispanic, or -Asian background (4). Predicted VBAC success probabilities ranged from 12% to 95%. Participants completed 64 interviews, and 14 prenatal visits were recorded. We identified four themes that demonstrated a range of patient-led approaches to interpreting the probability generated by the VBAC calculator: 1) rejecting the role of race and ethnicity; 2) reframing failure, finding success; 3) factoring the physical experience of labor; and 4) modifying the probability for VBAC.ConclusionOur findings demonstrate that a numeric probability for VBAC may not be highly valued or important to all patients, especially those who have strong intentions for VBAC. Black and Hispanic participants challenged the VBAC calculator's incorporation of race and ethnicity as a risk factor and resisted the implication it produced, especially that their bodies were less capable of achieving a vaginal birth. Our findings suggest that patient-led approaches to assessing and interpreting VBAC probability may be an untapped resource for achieving a more person-centered, equitable approach to counseling

Perspectives on Patient-Centered Family Planning Care from Incarcerated Girls: A Qualitative Study

Study objectiveWe applied a patient-centered care (PCC) framework to explore incarcerated girls' experiences of and preferences for family planning (FP) care.DesignWe conducted qualitative semistructured interviews with incarcerated girls to explore domains of PCC: access to care, patient preferences, information and education, emotional support, family and friends, physical comfort, coordination of care, and continuity and transition.SettingA juvenile detention center (JDC) in an urban California county.ParticipantsGirls incarcerated during the study period.Interventions and main outcome measuresTranscripts were analyzed using directed content analysis to identify themes related to PCC and additional overarching themes.ResultsTwenty-two participants completed interviews. Overarching themes of stigma and autonomy emerged as influential in girls' experiences and preferences for FP care. Participants described stigma related to incarceration, sexual activity, and lack of contraception use. Participants' desire for autonomy contributed to concerns around FP care. Despite this, most desired access to FP care while incarcerated. Many valued relationships they had with JDC providers, reporting more trust and familiarity with JDC providers than those in the community. Constraints of incarceration decreased availability of emotional supports and decreased involvement of family in health-related decision-making, which worsened girls' experiences with FP care and enhanced their sense of autonomy. Difficulties with care coordination and transitions between the JDC and community often resulted in fragmented care.ConclusionProviding patient-centered FP care in JDCs is desirable but complex, and requires prioritizing patient preferences while recognizing the strengths and limitations of providing FP care within JDCs

Pregnancy Prevalence and Outcomes in 3 United States Juvenile Residential Systems

To describe the number of admissions of pregnant adolescents to US juvenile residential systems (JRS) and the outcomes of pregnancies that ended while in custody.Prospective study.Three nonrandomly selected JRS in 3 US states.Designated reporter at each JRS reporting aggregate data on various pregnant admissions, outcomes, and systems’ policies.None.Monthly number of pregnant people admitted, pregnant people at the end of the month, births, preterm births, cesarean deliveries, miscarriages, induced abortions, ectopic pregnancies, maternal and newborn deaths, and administrative policies.There were 71 admissions of pregnant adolescents reported over 12 months from participating JRS. At the time of the census, 6 of the 183 female adolescents (3.3%) were pregnant. Eight pregnancies ended while in custody. Of these, 1 pregnancy was a live full-term birth, 4 were miscarriages, and 3 were induced abortions. There were no newborn deaths or maternal deaths. Administrative policies and services varied among the JRS. For example, all JRS had a prenatal care provider on-site, whereas 2 JRS helped cover the costs of abortions.To our knowledge, this study is the first to report the estimates of pregnancy and pregnancy outcomes among justice-involved youth in JRS. Our findings indicate that there are pregnant adolescents in JRS and most return to their communities while pregnant, highlighting the importance of continuity of care. More work is needed to understand the complexities of health care needs of justice-involved pregnant youth during and after their incarceration

Shackling and Pregnancy Care Policies in US Prisons and Jails

Objectives: The number of incarcerated women in the United States has risen exponentially. Many are of childbearing age with 3-4% being pregnant at intake. Despite the need for comprehensive pregnancy-related health care in prisons and jails, there is no oversight that requires adherence to the established standards. The objective of this study was to assess prison and jail pregnancy policies and practices with an emphasis on restraint use and compliance with anti-shackling legislation. Methods: We conducted a survey of 22 state prisons and six jails, including the five largest jails, from 2016–2017 regarding pregnancy policies and practices including restraint use, prenatal care, delivery and birth, and other pregnancy accommodations. We compared reported restraint policies to state legislation at the time of the survey. Results: Data indicate that pregnancy policies and services in prisons and jails vary and compliance inconsistencies with anti-shackling legislation exist. A third of the prisons and half of the jails did not have accredited health care services. All study facilities provided prenatal vitamins and most provided supplemental snacks. Most facilities stationed an officer inside the hospital room during labor and delivery, but nearly one-third of facilities did not require a female-identifying officer. Conclusions for practice: Limited oversight and standardization of carceral health care and accommodations for pregnant people lead to variability in prisons and jails. Prisons and jails should adopt and implement standards of care guidelines to ensure the safety and well-being of pregnant people who have unique healthcare needs. Incarcerated pregnant people should be viewed as expectant parents in need of comprehensive health care, rather than as criminals who forfeited their right to a safe, respectful, and humane childbirth

“I Mean, I Didn\u27t Really Have a Choice of Anything:” How Incarceration Influences Abortion Decision‐making and Precludes Access in the United States

Objective: To understand how the punitive, rights-limiting, and racially stratified environment of incarceration in the United States (US) shapes the abortion desires, access, and pregnancy experiences of pregnant women, transgender men, and gender non-binary individuals. Methods: From May 2018–November 2020, we conducted semi-structured, qualitative interviews with pregnant women in prisons and jails in an abortion supportive and an abortion restrictive state. Interviews explored whether participants considered abortion for this pregnancy; attempted to obtain an abortion in custody; whether and how incarceration affected their thoughts about pregnancy, birth, parenting, and abortion; and options counseling and prenatal care experiences, or lack thereof, in custody. Results: The conditions of incarceration deeply shaped our 39 participants\u27 abortion and pregnancy decisions, with some experiencing pregnancy continuation as punishment. Four themes emerged: (1) medical providers\u27 overt obstruction of desired abortions; (2) participants assuming that incarcerated women had no right to abortion; (3) carceral bureaucracy constraining abortion access; and (4) carceral conditions made women wish they had aborted. Themes were similar in supportive and restrictive states. Conclusions: Incarceration shaped participants\u27 thoughts about pregnancy and their abilities to access abortion, consider whether abortion was an attainable option, and make pregnancy-related decisions. These subtle carceral control aspects presented more frequent barriers to abortion than overt logistical ones. The carceral environment played a more significant role than the state\u27s overall abortion climate in shaping abortion experiences. Incarceration constrains and devalues reproductive wellbeing in punitive ways that are a microcosm of broader forces of reproductive control in US society