Women in Prison

February 13, 2015; The Nation

In what is being considered the most extensive investigation into women’s reproductive healthcare in New York’s state prisons, an eye-opening series of allegations of human rights abuses and neglect are coming to light.

The results are staggering: shackling inmates after delivery—despite a state law forbidding restraints during or after labor; delayed trips (or none at all) to medical examiners, leading to sexually transmitted infections and other conditions to worsen; a limited supply of tampons and pads that led to women improvising with magazines and newspapers.

Initiated through an independent nonprofit, the Correctional Association of New York, the investigative report is a culmination of five years of studies into the state’s prison reproductive healthcare system, compiled in large part through in-person interviews with inmates and staff at the prison facilities, along with surveys conducted of the inmates.

Among the recommendations put forward, the report charges the New York Department of Corrections and Community Supervision with a lack of oversight, given the state department is “responsible for providing reproductive health care to more than 2,300 women on any given day, and to nearly 4,000 women over the course of one year, about 40 of whom are pregnant.” Indeed, the report that recommends pregnant women, the elderly, and women with HIV should not be incarcerated due to the multitudes of issues that have been found.

Of the 54 prisons under the oversight of the DOCCS, only three are women’s prisons, while another three house both male and female inmates. Each of these prisons and their healthcare capabilities is outlined in the report, illustrating the disparities in the level of care between the facilities. Some house pregnant women, some don’t. Only one prison has a nursery where women can live with their babies from a year to 18 months after giving birth.

Out of the 950 incarcerated women that were interviewed for the report, many reported the same issues that surveyors themselves found concerning:

  • DOCCS has little to no oversight of the written reproductive health policies or data collection within prisons. “Some prisons could not supply data for certain years, other prisons gave data that the CA found to be inaccurate after conducting medical chart reviews, and other prisons said they did not collect data on the incidence of pregnancy.” Other details of women’s reproductive health histories were not kept track of at all, such as the number of sick calls for gynecological-related reasons, the number of vaginal births versus caesarians, and the reasons inmates may have received hysterectomies—any of which would be included in a medical file. In addition, DOCCS has no written policies for administering “pregnancy tests, pregnancy options counseling, any pregnancy outcome other than live birth, including abortion, ectopic pregnancy, miscarriage and stillbirth, nutrition for pregnant women and nursing women,” among other areas.
  • Limited access to health education and GYN care: As noted by the report, unlike us, women in prison cannot simply make an appointment with a doctor. “Instead, there are multiple procedural hurdles a woman must overcome to access medical care in DOCCS.” Accessing specialty care is even more difficult. Fifty-four percent of 798 survey respondents said they could not see a gynecologist when it was necessary. Sixty-six percent of 151 respondents said that it took more than 28 days to see a doctor after they had requested an appointment. The report includes one horrifying story of a 55-year-old woman who waited nearly seven months for her eventual diagnosis—an aggressive cancer that soon took her life. Fifty out of 106 respondents reported than their symptoms became worse while they waited to see a doctor.
  • “Trauma-informed” gynecological care and quality of care: Nearly 90 percent of women incarcerated in New York state prisons have experienced either sexual or physical abuse during their lifetimes, and 80 percent were severely sexually abused as a child. Many inmates reported to the surveyors feeling violated or powerless after their exams, particularly gynecological exams, which would understandably be difficult for an abuse victim to bear. One particular issue reported by women was having to be examined by a male doctor after explicitly asking for a female one. Seventy-two out of 162 respondents said speaking to a male gynecologist made them uncomfortable, while others were in “full blown panic.” One positive of the report noted that 72 percent of 672 respondents said the gynecologists in their facilities were “caring and respectful” and another three-quarters said the doctor spoke “clearly and in a way that you can understand” during their appointments.
  • At times limited access to sanitary supplies: According to the report, the majority of the women surveyed (514 of 957) said the monthly supply of sanitary items did not meet their needs. DOCCS only distributes 24 sanitary napkins to women each month. In order to receive additional pads, inmates must obtain a special permit from the medical department.
  • Poor treatment of pregnant women: Pregnant women are essentially treated the same or worse than other inmates. According to the report, pregnant inmates are often not fed enough food, must sometimes endure abusive treatment from correctional officers, and are routinely separated from their newborns upon giving birth. Particularly troubling is the illegal use of shackling on pregnant women, an action forbidden by a 2009 New York state law. In the report, 85 percent of women between 2009 and 2013 reported being shackled at least once. One inmate describes her experiencing giving birth in prison:

    “My ankles were shackled during the whole trip to the hospital when I was in labor. They pushed me in a wheelchair from the van to the hospital and at one point the wheelchair almost tipped over. I would not have been able to catch myself very well. […] I was shackled until I got to the delivery room, but even then they kept one of my ankles shackled to the bed. [They] only took it off when it was time to start pushing. […] I couldn’t rotate the way I needed to and I had to sit in one spot the whole time I was in labor. The baby was pushing and I was going through contractions and I wanted to lie on my side but I couldn’t because I couldn’t move my leg.”

  • Severely limited access to contraception: DOCCS prohibits doctors from prescribing contraceptives, with the few exceptions made to those inmates participating in the Family Reunion Program, where families visit the inmate. Further, from 2009 to 2013, Planned Parenthood was contracted with DOCCS to supply contraceptives to inmates who were within two weeks of being released. However, after the program ended, no new funding initiatives have been put in place. While the report conjectures DOCCS’ reluctance to provide contraceptives comes from not wanting to condone sexual activity in prison, the department is also effectively preventing women from using birth control as a form of hormonal treatment, which many do. From irregular periods and ovarian cysts to abnormal uterine bleeding, many reported health reasons unrelated to pregnancy prevention that are real reproductive issues are not being taken into consideration.

Of course, this is just a snippet of the numerous violations or concerns found in the five-year investigation. Largely, as discussed in the report, these issues are not exclusive to New York but mirror what is happening in prisons nationwide. The report makes several recommendations, both for the DOCCS in increasing its oversight to fix these issues as well as for legislators and courts. Perhaps the most bold and reasonable recommendation the report makes is to avoid sending pregnant women, women with small children, the elderly, and women with HIV to prison, and instead finding a community-based initiative for reform.

“This fundamental conflict between reproductive justice and mass incarceration is not something that’s unique to New York,” said Tamar Kraft-Stolar, the director of the Women in Prison Project at the Correctional Association, who also wrote the report. “We’re hoping that this report contributes to the national conversation that’s happening right now about over-incarceration.”—Shafaq Hasan