Counties' Inadequate Reproductive Health Policies Put Incarcerated Women at Risk

PHILADELPHIA - Women incarcerated in Pennsylvania are legally entitled to reproductive health care, but none of the county jails that house women inmates in the commonwealth have adequate policies ensuring access to such care, according to a report released today by the American Civil Liberties Union of Pennsylvania. The report marks the first time jail policies about women's reproductive health have been assessed across the state.

"The lack of clear policies puts the health of thousands of Pennsylvania women at risk," said Reggie Shuford, executive director of the ACLU of Pennsylvania. "In some cases, these policies fail to meet basic constitutional standards, leaving counties legally vulnerable."

Several recent events, including the premature birth of twins to a drug-addicted mother in Luzerne County Correctional Facility and the subsequent death of one of the babies, highlight the critical need for Pennsylvania's county prisons to adopt comprehensive reproductive health policies and follow them.

Originally designed with male prisoners in mind, jails have been slow to adapt to the dramatic shifts in the demographics of those incarcerated. The rate of incarcerated women nationally is growing at 11.2 percent annually - twice the rate of men. As a result, prisons have inadequate policies that do not take into consideration the unique needs of female prisoners.

The report, "Reproductive Health Locked Up: An Examination of Pennsylvania Jail Policies," (4945K pdf) exposes an uneven patchwork of health care policies in the 57 county jails in Pennsylvania that house women. Those policies often fail to address the most basic reproductive health services, such as pregnancy testing, prenatal care, screening and treatment for sexually transmitted infections, and access to abortion services.

There are more than 3,800 women in Pennsylvania county jails at any given moment. Three-quarters of these women are of reproductive age, and the majority are mothers and the sole caretakers of their children. Most are incarcerated for nonviolent crimes, are undereducated, come from minority groups, and fall below the poverty line. Approximately 6 percent of all female inmates are pregnant upon admission to jail.

"The government is responsible for the health of the people it imprisons. It's shocking that there are no uniform health care standards for incarcerated women in county jails," said Carol Petraitis, the report's author and the director of the ACLU-PA's Duvall Reproductive Freedom Project. "Individual jail officials shouldn't have unbridled discretion over whether thousands of women have access to basic reproductive health care."

Copies of the report were mailed to all county prison board members, solicitors, wardens, and medical contractors last week. In its cover letters, the ACLU-PA highlighted the particular weaknesses of each jail and offered to work with the counties to improve their policies and practices.

The report focuses solely on county jails and does not include information about the policies of the state or federal prisons, juvenile facilities, or immigration detention centers. The statistics were gathered through the state Right to Know Law. While the report examines jail policies, it is important to note that practices could vary significantly, and this report makes no attempt to ascertain actual practice. It is very important that both policies and practices meet constitutional standards.

Of the 57 counties that house women, the ACLU-PA found:

• Only twelve counties had gender-specific health screenings.
• Ten counties have no policy on testing for pregnancy.
• Eleven counties had no written policies about prenatal care.
• It was unclear from the information whether any of the prisons provided adequate nutritional needs for pregnant women in any county prison were being met. Adequate prenatal nutrition is crucial to a healthy birth.
• Only two counties required all inmates to be tested for STDs and HIV during intake.
• Twenty counties had no abortion policies.
• No county allowed women to use contraception for the purpose of pregnancy prevention during incarceration. Irregular use of hormonal contraception can greatly increase the risk of pregnancy, particularly for those women with short jail stays.

This report contains a series of recommendations that could be immediately implemented at any county jail so that incarcerated women have access to comprehensive health care. Those recommendations include developing policies that would:

• Provide routine reproductive health care including, age-appropriate mammography, screening for STDs and HIV, and Pap tests.
• Educate women about contraception and family planning.
• Provide women with emergency contraception upon request.
• Screen all women for pregnancy, especially those that are high risk.
• Provide mental health services to women following miscarriage, abortion and birth.
• Prepare for the timely transport of pregnant women to appropriate facilities for labor and delivery.
• Provide pregnant women with adequate prenatal care and nutrition.

The report includes a table listing each county prison and the existence or lack thereof of particular policies related to reproductive health care.

The report and related materials are available online.