Providing medical care for prisoners is not a popular (or well-reimbursed) endeavor. Only a handful of doctors and researchers work in this field; my colleague Dr. Carolyn Sufrin is one of them. Sufrin is an obstetrician/gynecologist at San Francisco General Hospital and is on the faculty at UCSF. I recently spoke with her about her work.
Mission Loc@l: How did you become interested in caring for incarcerated women?
Carolyn Sufrin: When I was a first-year ob/gyn resident in Pittsburgh, I delivered the baby of a woman from a nearby prison. She was shackled to the bed during delivery. I wondered what would happen to the baby when she went back to prison.
The next morning I was checking in on her and we had a discussion about contraception. She decided to use the vaginal contraceptive ring. So I wrote a prescription for it and placed it on her chart. I paused, questioning whether she actually needed birth control, and if the prescription I wrote would be honored at the prison.
ML: Can you briefly describe the clinical work you do in this area?
CS: I care for incarcerated women at the San Francisco County Jail. I work with a women’s health nurse practitioner. Together we see women for a range of routine and complicated pregnancy-related and gynecologic concerns. This includes offering birth control options to women and, if they are interested, starting them on a method before they are released back into the community.
ML: What are some of the main health problems you see in incarcerated women?
CS: Many incarcerated women have had limited access to health care before they have come to jail. Sexually transmitted infections are very common. A very high proportion of these women have experienced physical or sexual abuse in the past, and this has long-standing effects on their health.
Many of these women have issues with substance abuse. When they are in custody and not using drugs, they often notice things about their body that they haven’t before. So many of them come to us complaining of pelvic pain or abnormal periods.
ML: What about incarcerated men versus women?
CS: Compared to incarcerated men, women have a much higher rate of symptoms of a mental illness. Depression, anxiety, bipolar disorder, post-traumatic stress disorder — it’s as high as 70% among some women. Pregnancy is an obvious health issue which differentiates incarcerated women from men.
ML: If women give birth while incarcerated, do they get to be with their infants at all?
CS: What is allowed varies from county to county, state to state. But in general, women get to be with their infants while they are both still in the hospital, which usually lasts two to three days.
If the woman is being held in a local jail, then her baby goes either to a family member or into custody of the state. Usually she can see the baby once a week at visiting hours if a family member brings the baby.
Prisons are for people serving longer sentences, so some states have programs which allow the infant to stay with the mom in a special nursery wing of the prison. Depending on where the woman is, the baby can stay with her from four weeks up to 18 months.
ML: What about breastfeeding?
CS: This can be very challenging. If she is in a local jail and separated from her baby, then she has to pump breast milk. The clinic will store the milk until the family can pick it up, and then it is given by bottle to the baby.
ML: If incarcerated women want an abortion, is this available?
CS: Incarcerated women have the right to choose an abortion, just like every other woman in the U.S. In many facilities it is no problem for a woman to get an abortion in custody. The clinic at the correctional facility helps to make the appointment and facilitates transport. These are things that incarcerated women have limited ability to arrange themselves.
In reality, it is often restricted by rules and the political beliefs of the people who are in charge at a local level. I have heard stories from many women at other facilities about women not being allowed to leave the facility for an abortion. Or women may be required to get a court order for being transported, which is not required for all medical transports. This can take time and sometimes the approval comes through too late, when abortion is no longer possible.
And so some women are forced to carry undesired pregnancies to term. This is a kind of punishment which men don’t have to experience.
ML: Do incarcerated women need birth control, and if so is it provided for them?
CS: The majority of incarcerated women are in their 20s and 30s — what we call “reproductive age.” So family planning is an important piece of their comprehensive women’s health care. The risks of a woman getting pregnant while she is incarcerated are low. Assault by male guards is known to happen, but it is highly underreported. At some prisons, women may be allowed to have conjugal visits from their male partners. And it’s important that women have the option of starting birth control before they’re released. If a woman wants to be on birth control, it should be available to her.
Despite research which shows the importance and feasibility of doing this, many facilities do not offer birth control. If they do, they might only have birth control pills available. I did a survey of correctional health care providers across the country and found that only 38 percent of providers were able to offer birth control to women before release. There are no standardized policies.
ML: What type of prenatal care do incarcerated women receive?
CS: Prisons and jails are required to provide routine prenatal care, either on site or at a local hospital. While clear standards exist from the National Commission on Correctional Health Care, there is definitely variation by state and county. A recent comprehensive report by the Rebecca Project found that 38 states had inadequate prenatal services.
ML: What changes would you like to see in the system?
CS: One of the most pressing issues is ending the practice of shackling of pregnant women in labor. Believe it or not, only 10 states—10!—have laws which prohibit this practice.
It is medically dangerous, as restraints can interfere with the need for unpredictable procedures during labor and delivery. In addition, the security risk of a woman in labor, with painful contractions, sometimes with an epidural, is low. More than 70 percent of these women have been arrested for nonviolent crimes, anyway. This is a barbaric practice that has been condemned by a number of medical professional societies and the United Nations.
I think we also need to work to standardize the services offered to women, including mental health care and access to contraception for women. Prison and jail administrators need to be made more aware about women’s specific health needs, and how they differ from men’s needs.