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Incarcerated women and abortion provision: a survey of correctional health providers.

Article Excerpt
On October 20, 2005, a woman incarcerated at a Missouri state prison in Vandalia, 80 miles south of St. Louis, was transported to a St. Louis abortion provider for a second-trimester abortion. While her procedure was medically uncomplicated, it was legally quite complicated. She had requested a pregnancy termination at approximately nine weeks' gestation, but because the policy of the Missouri Department of Corrections prohibited the transport of prisoners to obtain "elective" abortion care, her request had been denied. By the time she had been informed of the policy, reached legal counsel, sought an emergency court order and defeated two attempts by the state to appeal the emergency order, nearly two months had elapsed. Thus, when the corrections department finally complied with the court's order and prisoner Jane Roe obtained an abortion, she was already into her 18th week of pregnancy. (1)

Jane's case, Roe v. Crawford, proceeded as a class action on behalf of all women in the custody of the Missouri Department of Corrections desiring abortions. Two years later, on September 24, 2007, the Eighth U.S. Circuit Court of Appeals heard arguments surrounding the constitutionality of banning transport of prisoners to abortion facilities. In his opening statement, a counselor representing the state argued that "the decision of the Department of Corrections to stop sending prisoners out of prison to obtain nontherapeutic, that is, non-medically necessary; abortions is a reasonable, appropriate and constitutional measure.... A woman's right to an abortion is fundamentally inconsistent with incarceration." (2) The court disagreed: On January 22, 2008, the 35th anniversary of Roe v. Wade, the court held that the Missouri policy was unconstitutional. (2) This case and the controversies it has engendered demonstrate the need to consider and understand the reproductive health services that are accessible to incarcerated women.

Each year, millions of U.S. women are brought through the doors of a correctional facility. (3) At the end of 2005, more than 1.2 million were in custody--in jails or prisons, or on parole or probation. (4) These women disproportionately represent marginalized sectors of our society; they are predominantly women of color, poor, unemployed and undereducated, (3,5,6) and thus may not have adequate access to health care in general, and reproductive health services in particular. (7,8) Although many of them may spend only a short period of time in custody, their involvement with the correctional health system may represent one of their few opportunities to access medical care. (9-11)

Some 6-10% of women in custody at any given time are pregnant, and about 1,400 women per year give birth while incarcerated. (12) The number of incarcerated women who obtain abortions each year and the wantedness of their pregnancies are not known. However, among nonincarcerated American women, about half of all pregnancies are unintended, and 24% of pregnancies are terminated with an abortion. (13) Accordingly, it seems likely that a significant proportion of pregnant incarcerated women did not intend their pregnancies. In the only study to date of the reproductive health needs of incarcerated women, 84% of such women of reproductive age surveyed in Rhode Island reported having had an unplanned pregnancy, and 35% had a history of at least one abortion. (7)

Political scientist Rachel Roth systematically investigated correctional facilities' abortion policies (14) and discovered vast inconsistencies and lack of standardization. However, her study did not explore how health care providers who work under these policies translate them into practice.

Because published information addressing the availability of abortion services to incarcerated women is limited, we sought to obtain this information by surveying correctional health care providers. Our objectives were to describe abortion access at correctional facilities and to identify potential barriers to incarcerated women's obtaining pregnancy termination.

METHODS

We mailed questionnaires to 951 correctional health professionals across the United States. Potential respondents were drawn from the membership of...

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