Washington, D.C. — Obstetrician–gynecologists can help address the legacies of racism that amplify harm to incarcerated people, according to a Committee Opinion released by the American College of Obstetricians and Gynecologists (ACOG). The organization calls on women’s health care professionals to advocate for alternatives to incarceration, especially for pregnant and parenting people, while supporting efforts to improve reproductive health care in prisons, jails, and detention centers.
The updated Committee Opinion, Reproductive Health Care for Incarcerated Pregnant, Postpartum, and Nonpregnant Individuals, by ACOG’s Committee on Health Care for Underserved Women, was published in the July edition of Obstetrics & Gynecology. It is intended to guide clinical practice and physician advocacy.
“The long-term goal would be to not incarcerate so many people in the first place and support decarceration and alternatives to incarceration,” said Carolyn Sufrin, MD, PhD, lead author of the opinion and ACOG liaison to the National Commission on Correctional Health Care, which operates a voluntary accreditation program for standards of health care in correctional facilities. “While working toward that goal, we need to make sure that people who are incarcerated get quality, comprehensive reproductive health care.”
The often inadequate or harmful health care experienced by incarcerated people is a burden that falls disproportionately on marginalized communities. The document observes that people entering the carceral system are often affected by poverty, institutionalized racism, limited educational and employment opportunities, and other structural determinants of health. Chronic disease, mental illness, substance use disorders, and physical and sexual abuse are also relatively common. Because of this convergence of unmet needs, incarcerated people’s health care is an issue of reproductive justice. “Ensuring that incarcerated individuals receive respectful, consistent, high-quality reproductive health, pregnancy, and postpartum care is essential for ameliorating inequities and affirming these individuals’ dignity,” the opinion states.
Since the 1980s, women have been the fastest growing segment of the incarcerated population in the United States. Most are held on drug or property charges. Black women are incarcerated at disproportionately higher rates than white women. In 2019, 218,000 women were in prisons and jails, behind bars, making up 10% of the overall incarcerated population, and girls accounted for 30% of youth arrests. The majority of incarcerated women are parents and are of reproductive age, with approximately 55,000 pregnant people put into U.S. jails each year.
No mandatory standards or oversight safeguards the medical care of incarcerated people. Systems vary widely, and data collection on quality and outcomes is limited. The opinion encourages obstetrician–gynecologists to work in or with correctional and detention facilities to provide and promote comprehensive reproductive health care, including prenatal, birthing, and postnatal care, contraception, cancer screening, abortion services, treatment of mental illness and substance use disorders, and support for breastfeeding. Health care should be trauma informed, the guidance states, including avoiding the use of restraints during pregnancy and labor and allowing parents to bond with their newborns.
Following their release, people who have been incarcerated describe ongoing trauma and strained family relationships, says Dr. Sufrin, who is an assistant professor of gynecology and obstetrics at the Johns Hopkins University School of Medicine, in Baltimore, Maryland, and the author of Jailcare: Finding the Safety Net for Women Behind Bars (University of California Press, 2017). “It’s hard to fully describe the long-term costs, but we can ask what it says about us as a society that we’re doing this to birthing people and to children and families.”
The Committee Opinion urges physicians to advocate that prisons, jails, and detention centers provide health care according to accepted clinical guidelines and evidence-based protocols. It also calls for the elimination of medical copays; the availability of menstrual products, continuity of care after release; and community-based alternatives to prison, jail, and detention.
Obstetrician–gynecologists can be advocates within their own hospitals, the opinion states, by helping to ensure that care for incarcerated people is evidence based and patient centered. ACOG’s physician advocates in states across the country have prioritized legislation to advance the health care and dignity of incarcerated people, including passing and strengthening anti-shackling laws.