Pregnancy and New Motherhood in U.S. State Prisons: Understanding State Variation in Prison Maternal Health Care Policies

Abstract

In 2017, the United States incarcerated approximately 219,000 women and girls, an increase in this segment of the prison population of over 700% since 1980. The dramatic increase in the number of women behind bars has posed challenges for U.S. correctional facilities given that incarcerated women have different needs than their male counterparts, and prison systems in the U.S. were historically designed to serve men. At any one time, about 6-10% of incarcerated women are pregnant, and both pregnant and postpartum women have specific maternal health care needs. The proper treatment of these women is of critical importance because correctional facilities have legal and moral obligations to provide appropriate health care to pregnant women in prison. Furthermore, doing so may prevent the exacerbation of adverse health conditions amongst an already disadvantaged population and may strengthen the rehabilitative side of the criminal justice system. The limited research conducted on correctional maternal health care to date has found that facilities overwhelmingly fail to meet women’s needs and that there is significant state-to-state variation in policies on maternal health care for incarcerated women. This thesis aims to contribute to an understanding of what accounts for the variation in state policies. I examined four factors that could impact states’ correctional maternal health care policies: select demographics of states’ prison systems, the methods states use to provide correctional health care, the role of federal court cases contesting correctional health care, and the presence of prisoners’ rights advocacy groups. This study’s key findings suggest that higher quality state prison maternal health care policies are correlated with having correctional health care systems that deploy divisions or committees explicitly charged with developing constitutionally adequate correctional health care policies, having faced a higher volume of federal court cases challenging the provision of health care in state prisons, and the presence of a relatively high number of prisoners’ rights advocacy groups in the state. Poor performance was strongly correlated with reliance on a private correctional health care company for the provision of all care. States with lower quality policies also tended to lack accreditation from national oversight organizations, such as the American Correctional Association. Notably, the study did not reveal any correlation between policy quality and a state’s average annual cost per inmate or the proportion of women in a state’s prison population. This thesis concludes by pointing to several policy implications for states failing to provide incarcerated pregnant and postpartum women with adequate maternal health care. Mainly, the findings suggest that states could develop higher quality maternal health care policies by limiting reliance on private correctional health care companies and deploying bodies specifically focused on developing policies that meet constitutional standards of care.