Written by Ira Memaj and Robert Fullilove
We recognize that transmen, non-binary people, and people who identify as women also need and have a right to access sexual and reproductive health services. In this blog, we use the term “women” inclusively.
Women in jails and prisons are the fastest growing incarcerated population in the U.S. Since 1970, the rate of incarcerated women has increased by more than 700%. Laws and policies that arose during the “war on drugs” and “tough on crimes” era have not only contributed to this increase, but also to the disproportionate representation of poor women, women of color, and sexual minorities. According to the Vera Institute of Justice, about 66% of incarcerated women identify as Black, Latinx, or members of other non-white ethnic or racial groups. LGBTQ+ individuals represent 42.1% of women in prison and 35.7% of women in jails. Despite the exponential increase of incarcerated women, there is a lack of attention to women’s experiences in correctional facilities. About 60% of women in state prisons and 80% of women in jails are mothers of children aged 18 or younger. Moreover, 3.8% of women are pregnant at the time of being admitted to prison. Many incarcerated women of reproductive age experience womanhood, pregnancy, labor and delivery, and mothering in correctional facilities that were and continue to be designed for men. As the rate of incarcerated women increases, concerns about reproductive justice take center, especially with the rapid spread of COVID-19.
Overcrowding, poor infrastructure, unhygienic conditions, physical and sexual abuse, and substandard medical care are some of the conditions that create and exacerbate negative health outcomes for incarcerated women. The majority of the women who are imprisoned already suffer from some kind of chronic conditions influenced by poverty, trauma, mental illness, and unstable housing. In one study, almost one third of incarcerated women reported irregular menstrual cycles. However, most women and girls in prisons do not have access to menstrual products. A plethora of studies have also reported the high prevalence of STIs and HIV among incarcerated women. For example, a recent report shows that these rates are multifactorial, including previous history of STI, inconsistent condom use with multiple partners, and lack of medical attention. Incarcerated women have limited access to contraceptives, counseling in preconception and termination of pregnancy, and access to services that optimize mental health. Additionally, incarcerated pregnant women continue to be shackled during pregnancy, labor, and post-partum. Instruments of restraint can produce multiple negative outcomes for pregnant women including hemorrhage, epidural complications, and emergency caesarian section.
The coercive nature and dehumanization of incarcerated women through the neglect of sexual and reproductive health services and rights is further compounded by the ongoing pandemic. Since the beginning of the pandemic, jails and prisons were predicted to become COVID-19 hotbeds. Indeed, a study by Johns Hopkins School of Public Health reports that COVID-19 cases for incarcerated people are 5.5 times higher than the U.S. population case rate. Even after adjusting for age and sex, the rate for COVID-19 related deaths is three times higher for incarcerated people as compared to the U.S. general population. Although there have been many narratives from men behind bars sharing their experience amidst COVID-19, the voices of incarcerated women have been ignored. At Central California Women’s Facility, Kandice Ortega stated that due to the lack of PPE, many women used their menstrual products to keep the facility clean. In April 2020, Andrea Circle Bear, a pregnant indigenous woman who was incarcerated for a minor drug offense, was not released early as recommended by public health officials. She soon contracted COVID-19 and died after delivering her child. According to the CDC, “pregnant people are an increased risk for severity from COVID-19, including ICU admissions, mechanical ventilation, and death, as compared to non-pregnant people.” Regulations implemented to slow the transmission of COVID-19 have also presented challenges to incarcerated women. For example, many incarcerated mothers cannot see their children due to restricted family visits. Additionally, incarcerated pregnant women may go through labor and delivery alone due to COVID-19 restrictions that limit the number of people in the delivery room. The full extent of COVID-19’s impact on incarcerated women is yet to be known, however, as public health officials we continue to push healthcare systems and government officials to make urgent decisions about care delivery that benefit incarcerated women.
Resources and funding of certain existing public health efforts are re-allocated to COVID-19 related efforts. Incarcerated women already face reduced access to many reproductive and sexual health services. This leads to a sequelae of negative health outcomes including maternal mortality. Racism, sexism, and classism—especially apparent in the carceral system—further exacerbate the lack of accessibility to medical attention. Public health officials must work closely with correctional facilities, legislators, and community activists to provide solutions that are centered in intersectionality and human rights framework. Reproductive and sexual health resources must not be overshadowed by the urgency of COVID-19, and incarcerated women and pregnant people must not be ignored when such decisions are made. The medical community and federal and state officials must continue to illustrate the gaps in reproductive care and ensure that incarcerated women, girls, pregnant people, and LGBTQ+ identifying people have access to such services, even in the midst of a global pandemic.
Ira Memaj, MPH., is a public health educator and researcher of reproductive health and incarceration at Columbia University Medical Center. [email protected]
Robert Fullilove, EdD., is a professor of sociomedical sciences at Columbia University Medical Center. [email protected]
Please note that blog posts are not peer-reviewed and do not necessarily reflect the views of SRHM as an organisation.