Contraception need and available services among incarcerated women in the United States: a systematic review

Abstract

Context: Seventy-five percent of incarcerated women are of reproductive age, most of whom are at-risk for unintended pregnancy. Women who are incarcerated come disproportionately from socioeconomically disadvantaged backgrounds and often lack access to desired reproductive health care. While the carceral system provides a unique opportunity to fill this gap, a better understanding of the contraceptive needs, desires, and plans of incarcerated women is needed to optimize health care provision within the carceral system. A review of current contraceptive services available to women inmates may both identify model care programs and shed light on areas for improvement. Evidence acquisition: PubMed electronic database used to identify relevant articles published between January 1975 and September 2019 using a systematic review method. Results: Twenty-five articles met the inclusion criteria and answered four key questions surrounding contraception in the carceral system. Most articles (48%) represented scientific research. Other publications identified by this review were expert commentaries, policy briefings, guidance and recommendations reports, and law and bioethics reviews. Conclusions: Incarcerated women desire access to standard and emergency contraception from carceral health care systems. Knowledgeable family planning practitioners providing patient-centered and trauma-informed care and public health interventions linking newly released inmates to community clinics can help alleviate inmates' concerns regarding initiating desired contraception while incarcerated.

Reproductive healthcare in prison: A qualitative study of women’s experiences and perspectives in Ontario, Canada

“…The results of this study are consistent with prior research. US studies involving women in prison [1][2][3]12,13,[25][26][27] have also identified barriers to accessing contraception in prison and after release, despite women's interest in and motivation to access contraception [1,13,28]. A small number of studies have used qualitative approaches to explore reproductive health issues among women in prison [10,16,17,29]; these studies examined specific issues such as sterilization [16] and the prevention of sexually transmitted infections on release [29].…”

“…Our finding that women in prison are made to feel like their health concerns are not legitimate has been echoed in other work [ 31 , 32 ]. Previous studies have identified that some women see their time in prison as an opportunity to access healthcare [ 31 , 33 ], including contraceptive services [ 13 ]. A recent Canadian study conducted focus groups with 11 admitted women and six healthcare staff in a provincial correctional facility, and similar to our study, found that factors influencing the use of women’s health services in prison were lack of gender-specific services, mistrust of healthcare providers, and fragmentation of healthcare [ 33 ].…”

“…The experiences of participants in this study exemplify and are consistent with ways in which imprisonment interferes directly with reproductive justice, i.e., the ability to decide if and under which conditions a woman will or will not have a baby [ 35 ]. Improving access to reproductive healthcare is a clear way to promote reproductive justice for women in prison, especially because it is well-documented that time in prison can serve as an opportunity to address healthcare needs [ 1 , 4 , 13 , 15 , 26 , 36 ]. Further, as detailed in the United Nations Rules for the Treatment of Women Prisoners and Non-custodial Measures for Women Offenders (Bangkok Rules), women in prison have a right to accessible healthcare, a healthy environment, and access to reproductive and sexual health services [ 37 ].…”

“…We planned to conduct four to six, one-hour, focus groups with four to eight women per group to explore diverse perspectives and achieve data saturation [ 24 ]. The focus group guide ( S1 File ) was developed by project team members (JL, JJ, EN, FK) based on the study objectives, issues identified in previous research [ 1 , 13 , 25 ], and data from our aforementioned survey [ 4 ]. The guide included questions on attitudes toward pregnancy and contraception, experiences of healthcare related to these issues, barriers to contraception, and suggestions for improving access to contraception in prison.…”

“…While previous quantitative studies from the US have shown that most women are interested in accessing reproductive healthcare while in prison [2,[10][11][12], issues such as stigma and healthcare quality may prevent women from accessing desired care even when available [10,13]. The World Health Organization and the United Nations recommend the provision of reproductive healthcare, specifically including contraception and pregnancy-related care, for women in prison [14].…”