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The Incarcerated Pregnancy: an Ethnographic Study of Perinatal Women in English Prisons

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The Incarcerated Pregnancy: an Ethnographic Study of Perinatal Women in English Prisons The Incarcerated Pregnancy: An Ethnographic Study of Perinatal Women in English Prisons Laura Jane Abbott Submitted to the University of Hertfordshire in partial fulfilment of the requirements of the degree of Doctor of Health Research (DHRes) February 2018 Contents Page Contents ………………………………………………………………………………………….. i Abstract …………………………………………………………………………………………… vi Acknowledgements ……………………………………………………………………………… vii Abbreviations …………………………………………………………………………………….. viii Glossary ………………………………………………………………………………………….. ix List of Tables and Figures ………………………………………………………………………. x 1: Introduction and Background …………………………………………………………… 1 Demographics of female prisoners in the UK ….………………………………………… 1 Historical perspective ………………………………………………………………………. 3 Women in current UK prisons ……………………………………………………………... 3 Existing knowledge about pregnant women in prison …………………………………... 4 Theoretical perspectives: Criminology ……………………………………………………. 4 Minor disorders of pregnancy: normal physiological response ………………………... 7 Rights of the pregnant woman ……………………………………………………………... 8 Midwifery care in prison ……………………………………………………………………. 10 Personal motivation ………………………………………………………………………... 10 Research aim ……………………………………………………………………………….. 11 Chosen methodology ………………………………………………………………………. 11 Summary ……………………………………………………………………………...…….. 11 Chapter one: introduction and background ………………………………...……... 11 Chapter two: literature review ………………………………...…………………….. 11 Chapter three: methodology ………………………………………………………… 12 Chapter four: findings ………………………………………………………………… 12 Chapter five: discussion ……………………………………………………………... 12 Chapter six: conclusion ……………………………………………………………… 12 2. Literature Review ………………………………...…….……………………………….... 13 Introduction ……………………………………………………………………...………….. 13 Literature search strategies ………………………………………………………………. 13 i Inclusion and exclusion criteria …………………………………………………………… 14 Results ………………………………………………………………………………………. 15 The demography of the pregnant woman in prison …………………………………….. 16 Measuring the health outcomes of pregnant women in prison through systematic review ………………………………...…….………………………………...……….. 17 Scoping reviews: adding to the evidence ……………………………………………….. 19 Retrospective health outcomes for pregnant women in prison ……………………….. 21 Staff views on pregnant women in prison ……………………………………………….. 22 Intervention programs for pregnant women in prison ………………………………….. 23 Qualitative research into pregnant women’s experience of prison …………………… 24 Connectedness with the unborn baby ……………………………………….................. 25 Loss and grief ………………………………………………………………………………. 25 Psychological findings ……………………………………………………………………... 26 Separation trauma ……………………………………………………………………..…... 27 Loss of control ……………………………………………………………………………… 27 Grey literature ………………………………………………………………………………. 28 Research from doctoral studies ………………………………………………………….. 28 Conclusion ………………………………………………………………………………….. 30 Research question …………………………………………………………………………. 33 Summary of chapter ……………………………………………………………………….. 33 3. Methodology ………………………………………………………………………………. 34 Research aim ………………………………………………………………………………. 34 Research methods: a naturalistic approach ……………………………………………. 34 Institutional ethnography ………………………………………………………………….. 35 Feminist theories …………………………………………………………………………… 36 Ethical approval and access………………………………………………………………. 37 Storage of data …………………………………………………………………………….. 38 Issues of consent ………………………………………………………………………….. 38 Negotiating entry …………………………………………………………………………... 39 Prison research approach ………………………………………………………………… 40 Self-presentation …………………………………………………………………………… 41 To hold keys or not to hold keys? ………………………………………………………... 41 Pilot study …………………………………………………………………………………… 42 Population and sampling techniques …………………………………………………….. 42 Sample ………………………………………………………………………………………. 43 Incentives ..………………………………...…….………………………………...………... 44 ii Sample characteristics ………………………………...…….……………………………. 44 Snowball sampling ………………………………...…….……………………………….... 47 Data collection ………………………………………………..……………………………. 47 Fieldnote books ………………………………...…….………………………………. 47 Audio-recording ………………………………...…….………………………………. 49 Non-participant observation …………………………………………………………. 50 Prison life …………………………………………………………………………………… 51 Experiences of being an outsider ………………………………………………………… 52 Reflexivity ………………………………...…….………………………………...………… 53 Interview arrangements …………………………………………………………………… 56 Interviewer approach ………………………………...…….……………………………… 57 Rapport and empathy ………………………………...…….…………………………….. 58 Follow-up interviews with women ………………………………...……………………… 59 Prison staff interviews ………………………………...…….…………………………….. 59 Interview transcription ………………………………...…….…………………………….. 60 Coding data ………………………………………………………………………………… 60 Data analysis ………………………………………………………………………………. 61 Chapter summary …………………………………………………….............................. 64 4. Findings ……………………………………………………………………………………. 66 Introduction to findings ………………………………...…….……………………………. 66 4.1 The prison environment and the pregnant prisoner: ……………………………… 67 a) Initiation to prison life ……………………………………………………………... 68 b) Deprivations ……………………………………………………………………….. 75 c) Expectations versus reality ………………………………………………………… 82 d) Impact of deprivations on health ………………………………………………… 83 e) Coping strategies …………………………………………………………………. 92 f) Experiences of the MBU environment …………………………………………… 100 4.2 Equivalence of health care: ……………………………….….……………………… 101 a) Women’s expectations …………………………………………………………… 101 b) The reality of health care provision inside ……………………………………… 101 c) Lack of access to trained professionals ………………………………………… 102 d) Lack of access to medication …………………………………………………... 103 e) Lack of basic provisions ………………………………………………………… 104 f) Lack of access to antenatal classes and resources ………………………….. 107 4.3 Giving birth and anticipatory anxiety: ………………………………...…………… 108 a) Desire for control ………………………………………………………………… 108 iii b) Desire for support ……………………………………………………………….. 110 c) Desire for information ……………………………………………………………. 111 d) Staff responses to pregnant women …………………………………………… 111 e) Fear of separation from the baby ………………………………………………. 118 f) Degradation of the pregnant prisoner ………………………………………….. 122 4.4 Cell Births: ………………………………...…….………………………………........ 128 a) Layla’s story …………………………………………………………………….... 129 b) Staff experiences of cell births ………………………………………………….. 131 c) Staff encounters ………………………………………………………………….. 134 4.5 Staff and pregnant prisoner relationships …………………………………………. 136 4.6 Looking ahead: resilience and strength …………………………………………… 141 Summary of findings ……………………………………………………………………… 146 5. Discussion ……………………………………………………………………………….. 148 Introduction ………………………………...…….………………………………...……... 148 Conceptual frameworks: ………………………………...…….………………………… 148 • Pains of imprisonment and mortification ………………………………...……….. 149 • Institutional thoughtlessness: ……………………………………………………… 150 Deprivation of food, comfort, fresh air and basic provisions ……….……… 152 Embodiment, security and deprivation of liberty ……………………………. 154 • Institutional ignominy: ……………………………………………………………….. 157 Dehumanisation ………….……………………………...……………………… 160 Anticipating separation from the baby ……………..…..…………………….. 161 Cell births: mortification of self ……………………………………………….. 163 • Coping: ……………………………………………………………………………….. 164 Resilience ………………………………………………………………………. 166 • Bureaucratic layers: ………………………………………………………………… 167 Staff experiences ………………………………………………………………. 168 Midwifery relationship …………………………………………………………. 169 Summary ………………………………………………………………………………….. 170 6 Conclusion ………………………………………………………………………………. 174 Building on existing knowledge …………………………………………………………. 174 Original contributions to knowledge ……………………………………………………. 175 The pregnant woman as an anomaly in a patriarchal system …………………. 175 The pregnant prisoner as a public spectacle of shame …………………………. 176 Pregnant women’s layering of identity as a way of coping ……………………… 176 iv ‘Red tape’ disguising the rights and entitlements for pregnant women in prison ………………………………...…….………………………………....... 176 Unexpected findings ……………………………………………………………………… 177 Personal Growth ………………………………………................................................. 178 Impact ……………………………………………………………………………………… 178 Recommendations for future research …………………………………………………. 179 Broad recommendations from findings of this study ………………………………….. 181 Recommendations for the Ministry of Justice and implications for policy ………….. 181 Recommendations for the Prison Inspectorate ………………………………………... 183 Recommendations for health care, midwives and maternity services ……………… 183 References ……………………………………………………………………………………... 185 Appendices: …………………………………………………………………………………….. 210 1.1 Ethics approval – National Offenders Management Services ………………… 210 1.2 Ethics approval – University of Hertfordshire ………………………………...…. 214 1.3 Application to bring a prohibited article into prison …………………………….. 215 1.4 Information sheet ………………………………...…….………………………..… 216 1.5 Consent form ………………………………...…….………………………………. 219 1.6 Timeline of accessing prisons ………………………………...…….…………… 221 1.7 Interview schedule – woman ………………………………...…….……………. 222 1.8 Participants’ demographics in table format………………………………...……. 223 1.9 Iolanthe Midwifery Trust Award details ………………………………...……….. 225 1.10 Staff interview schedule ………………………………...………………………… 226 1.11 Early jottings from fieldnotes ………………………………...…………………… 227 1.12 Prison routine (Prison A) ………………………………...…….…………………. 228 1.13 Confidentiality agreement with transcriber ………………………………...…… 229 1.14 Early coding
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