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Prison Nurseries: a Review of Maternal and Infant Rooming in Outcomes for Incarcerated Mothers

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Prison Nurseries: a Review of Maternal and Infant Rooming in Outcomes for Incarcerated Mothers Prison Nurseries: A Review of Maternal and Infant Rooming in Outcomes for Incarcerated Mothers Amanda Dowling, BA, BMW, RM and Colleen Fulton, MA, BMW RM ABSTRACT Women are the fastest growing prison population in Canada, and at incarceration, 4-10 percent of women are pregnant. These women, their correctional facilities, and Canadian health care services are increasingly forced to address the issues of motherhood and Amanda Dowling, BA, reproductive health care during incarceration. Most incarcerated BMW, RM is a practicing women are separated from their infants soon after birth. The authors midwife serving the East claim that prison nurseries, as a harm reduction strategy, are a positive Vancouver area. She alternative to this separation. Midwives could play a valuable role in has a BA in History and these health care units. Women’s Studies from the Methods: This paper is a literature review examining the outcomes University of Victoria, and a of mother-infant dyads who have access to prison nurseries. The Bachelor of Midwifery from search strategy included 15 health research databases, applying similar the University of British search terms to all databases. Columbia. KEYWORDS Colleen Fulton, MA, BMW, prison nursery, rooming in, women, pregnancy, incarceration, infants RM isa practicing midwife in Vancouver, British This article has been peer reviewed. Columbia. Canadian Journal of Midwifery Research and Practice Volume 16, Number 2, 2017 35 BACKGROUND incarcerated fathers are primary care providers. In 2013, the Alouette Correctional Centre Furthermore, up to 52% of incarcerated mothers reopened its prison nursery program after the report being the sole parent of the household, while Supreme Court of British Columbia ruled in “Inglis only 19% of incarcerated fathers are single parents.9 v British Columbia” (Minister of Public Safety) that Therefore, continuity of care is disproportionately “the decision to cancel the Program violated the disrupted by a maternal imprisonment, and families rights to security of the person and liberty contrary are much more likely to become unstable as a result to the principles of fundamental justice under s. 7, of such incarceration. and violated the right to equality under s. 15”.1 In The scarcity of women’s prisons and prison his ruling, Judge Ross concluded that infants’ and nursery programs means that most infants born to mothers’ charter rights outweigh the Government’s pregnant women are separated from their mothers claim that because infants are not under the mandate shortly after birth and placed in foster care or of prison system the province has no responsibility under the custody of a family member.4 When this to accommodate them within this system.1 separation occurs, it is not inconsequential, and No formal review of the Alouette prison nursery for many families it is permanent.4.The ruling of system had occurred prior to closure, and empirical “Inglis v. British Columbia” agreed that separation data examining nursery programs is limited. These after birth restricts mother-infant bonding, disrupts programs are rare, and historically the bulk of breastfeeding, and restricts the many known health prison research has focused on male imprisonment. and social benefits for both mothers and their However, expert witnesses at trial attested to the infants (1). They further claim immediate separation strong social and health benefits for both mothers limits a prisoner’s experience of “motherhood” and and infants who remain together in the post-partum purportedly impacts her long term relationship with period, despite their incarceration. The purpose her child.4 of this review is to examine the the existing data on prison nurseries to determine whether their Incarceration and Pregnancy outcomes support mother infant rooming in, and In “Inglis v British Columbia” both parties agreed if so, how midwifery care may complement these that incarcerated women tend to be less violent than programs. their male offenders. They are more vulnerable, with low levels of education and employment, and often Demographics of Incarcerated Women have concurrent mental health issues and histories In Canada and internationally, women are the of abuse.1 The most common crime for women to fastest growing prison population2,3,4 Intersecting commit is theft under 5,000 dollars (47%), followed struggles of race, gender, poverty, sexuality, by minor assault (28%), and offences against the addiction, violence, and colonialism have led to an administration of justice, such as failure to appear overrepresentation of incarcerated impoverished (17%).1 Sex trade offences and narcotics possession women of colour. In Canada, indigenous women make account for the remainder of the Canadian female up 1-2% of the Canadian population, yet constitute prisoner population (7%).10 Major offences such as 34% of the federal female prison population5 and homicide, attempted murder, and sexual assault 29% of British Columbia’s female prison population.6 are rare (1%) and in Canada these offenders are Many incarcerated women are in their segregated out of provincial level prisons.10 childbearing years, with 58% under the age of At incarceration, between 4-10% of women are thirty-five.7 Two-thirds of incarcerated women have pregnant and need access to reproductive health one or more dependent children, and the majority care, obstetrical care, perinatal education, childbirth of these women are primary caregivers prior to support, and postpartum care.11 Yet, obstetrical imprisonment. Approximately 85% intend to reunite care is inconsistent among correctional facilities, with their children upon release.8 US data suggest and these services are often inadequate.12,13 In that 77% of incarcerated mothers provide the bulk addition to disproportionately suffering from mental of daily care for their children, while only 26% of health issues, incarcerated women’s pregnancies 36 Volume I6, Numéro 2, 2017 Revue Canadienne de la recherche et de la pratique sage-femme are often complicated by illicit drug and alcohol iterative search using citation chaining identified misuse and smoking. They often have concurrent additional studies not captured by our initial search comorbidities such as HIV/AIDs or other sexually terms. Three additional papers were found, of which transmitted infections, tuberculosis, hepatitis B and two were excluded, bringing the total number C, hypertension, respiratory problems, and lack of of studies reviewed to 90. After applying a final nutrition.13 While these women often need complex inclusion/exclusion criteria these studies were care and consultations with several different health reduced to 31 applicable studies, with only 10 studies care providers, they often receive only the very basic appropriate for inclusion for this review (See Table 2). maternity care and no continuity of care. 12,13 As a result of delays in accessing adequate prenatal care, Inclusion/Exclusion Criteria pregnant inmates have higher rates of perinatal Studies were limited to peer-reviewed morbidity and mortality.12,1 3 publications in English, published after 1990, and examined outcomes specifically related mother Prison Nurseries and/or infant, or child and/or pregnancy, outcomes The prison nursery program allows mothers in prison nurseries, or rooming in, programs during to receive prenatal and postpartum care, and after the incarceration period. Only countries with similar delivery care for their own infants, some for as long criminal justice systems to Canada’s and/or countries as two years of age.12. An inmate eligibility protocol with studies generalizable to Canadian prison excludes women with a history of violent crimes, populations were included. Our initial exclusions particularly violence against children, and excludes removed any articles related to other other uses women with sentences longer than 24 months.14 of “prison nursery*” such as “gardens” or “geriatric These nurseries are often housed in a separate prison care.” One randomized control trial was unit or facility, where only pregnant inmates and excluded because its intervention only examined mothers of infants live and work together.14 Nursery an educational program introduced to the infants of programs typically offer women and their infants one prison nursery and not to another, and did not immediate access to healthcare workers, drug and include mother-infant outcomes. alcohol counseling, parenting classes, prenatal and In addition to limited data, synthesizing the life skills classes.14 data into a review was challenging as the study designs employed both qualitative and quantitative METHODS methodologies, several different outcomes/ Search Strategy interventions were measured, and no single Our initial search included Medline(Ovid), outcome was measured by all the studies (See Table Cinahl, EMBASE(ovid), EBSCO, Web of Science, 3). Grouping the findings into four themes produced Trip Database, Proquest, ClinicalTrial.gov, ISRCTN, the most robust analysis, and these themes were: National Guidelines Clearing House, Google Scholar, delivery and neonatal outcomes, bonding and and NCJRS (National Criminal Justice Reference attachment, recidivism, and child behaviour. Most of Service Abstracts) (See Table 1). The search string the studies reported outcomes for one or more of applied to Medline included the terms Nursery* or these themes. *Infant, Newborn or *Infant, Newborn, Diseases or *Nurseries, Hospital or *Intensive Care Units, THEMES Neonatal and*Prisoners/ or *Prisons/
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