The Contraceptive Needs of Incarcerated Women: A Case Report

Ami Rice, MD

Indiana Women’s Prison

This project evaluated the use of the website in a contraceptive education program for women prior to release from the maximum security Indiana Women’s Prison (IWP). Findings from the project highlight the need for education and access to contraceptive options among incarcerated women. The project also provides insight regarding obstacles to contraceptive education and clinical care in detention settings.

Results of a survey of program participants indicated both the need for and interest in contraception among this population. Prior unintended pregnancy was reported by 51% of the 81 offenders who participated in the Bedsider educational program, and 46% currently desired contraception, with 16% reporting an interest in using a LARC method.

Small group teaching sessions for up to 15 participants, lasting 2–3 hours were provided by an ob–gyn. The contraceptive support website and related videos were used to facilitate discussion of contraceptive methods, and there was ample time for discussion and Q &A. Participants praised the user-friendly interface and easy-to-understand language used by Bedsider and its videos that highlight individual women’s experiences, in their own words, with different contraceptive methods. Participants also noted two areas needing improvement, suggesting that additional information about STIs and basic female anatomy be added to Bedsider.

This project overcame a technological challenge that educators and clinicians in other detention facilities may also encounter when attempting to use online or mobile educational tools: IWP does not allow offenders web access. To overcome this obstacle, Bedsider staff duplicated the website’s content on a private intranet server. Program participants were then able to easily access Bedsider educational information wirelessly via this private intranet server using iPads.

Limited contraceptive care is provided onsite at IWP by visiting staff from a nearby Title X federally-funded family planning clinic. The Title X clinic is able to offer a three-month supply of one of two available formulations of oral contraceptive pills, depot medroxyprogesterone acetate injections, or male condoms. The visiting Title X staff provides 3 hours of clinic time every 1–2 months when staffing is available. There is often insufficient time to serve all women desiring contraception prior to their release. Given the circumstances, timing and luck are often the determinants of onsite contraceptive care, rather than need and interest. Attempts were made to create a contraception clinic at IWP that could provide consistent services and expand options to include IUD placement, among other options. IWP staff and administrative leadership were uniformly in favor of this plan. However, the insurance provider for IWP offenders was unwilling to cover the expense of contraception, viewing it as “non-essential” care. Plans to expand contraceptive provision to exiting female inmates were ultimately derailed due to the lack of financial support of the IWP insurance provider. How the Affordable Care Act mandate regarding private insurance plan coverage for contraception will impact incarcerated women remains unclear.