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Why are pregnant women in prison?

In this article Maria Garcia de Frutos (main author)**, Dr Rona Epstein and Dr Geraldine Brown discuss the question of those who are pregnant being placed in prisons. They present their new research report and argue for different services to be provided.

Why are pregnant women in prison?

About 600 pregnant women enter prison in England each year, with about 50 pregnant at any one time, and about 100 births occur annually. Davies’ (2020) research shows that even before the Covid-19 outbreak, pregnant women in prison faced significant risks. In 2017-18 roughly one in ten pregnant women gave birth either in their prison cell or en route to hospital, raising questions about their ability to access the right care. Abbot’s study explored the experiences of pregnant prisoners highlighting the additional physical and emotional difficulties they faced in comparison with the non-pregnant prisoner. Women experienced frustration and stress which impacted upon their emotional wellbeing and reported being unable to access basic comfort, adequate nutrition and fresh air.

The question is, Why are pregnant women in prison?

On the 19th January 2022, Dr Rona Epstein and Dr Geraldine Brown, from Coventry University, and I published a report where we aimed to provide an answer to that question and add to a body of evidence that indicates that prison is not a safe place to be pregnant.

Our research began with the death of a baby in a prison cell in Surrey in 2019. A young woman was left to give birth alone in her cell. A few months later, in 2020 a stillbirth was reported in HMP  Styal in Cheshire. Investigations conducted for both cases concluded multiple failures in the system. In the UK, research identifies that pregnant women in prison are five times more likely to suffer a stillbirth.

With help from Birth Companions, we set up an online survey asking women who had spent part or all of their pregnancy in prison about their offence and their experiences. We collected information from 19 questionnaires and three further case studies from women who had been pregnant in an English prison.

Participants in our research were sentenced for offences including robbery, drug offences, burglary, fraud and shoplifting. All but two of the offences were non-violent. Six of the women were sent to prison at 28 weeks pregnant or later and three were 36 weeks pregnant. This was a group of extremely vulnerable women, with most of them reporting complex physical and psycho- social issues prior to entering prison. Half of them suffered a history of mental ill-health, one third had drug misuse issues, three had been homeless and four were victims of domestic abuse and coercion.

Some of the stories these women told us were disheartening. They shed light on the system’s structural failures and how  inequalities shape and disadvantage the lives of some women  (and those of their babies and families).

I had nobody, so from the start I was set to ‘fail’… Pregnant women should be in a safe environment with support/help. Putting us in prison does not make things better… I hope things get better and nobody else suffers ever again.

Olwen* had a previous history of mental ill-health and substance misuse. The lack of appropriate  support contributed to her mental health deteriorating during her time in prison. Early engagement with maternity services and a multi-agency approach could have potentially avoided some of the adverse events she experienced during her pregnancy and after the birth. These contributed to her child being adopted and Olwen being sterilised.

In line with Olwen’s experience, other women reported feeling unsupported during their pregnancies and anxiety for the fate of their babies after birth. Ursula* recalled that “inadequate maternity services and not having her needs met, left her feeling ‘constantly worried about my safety and if I would be released before the birth. Petrified he would be taken from me”. A multi-agency approach and specialist midwifery services would have improved her pregnancy experience, and potentially facilitated her baby’s best start in life.

Couldn’t bond with my baby as I was constantly told by staff there were no beds in the mother and baby unit so my baby would be taken. Wasn’t supported in preparing for the birth.

Another account of stress and lack of support came from Franny* who suffered from depression and anxiety. She reported emotional domestic abuse resulting in the loss of her social network and support. She stated: I had to make a “handing my baby over plan’ prior to before him being born” – which reinforces the need for support from specialist midwifery services.

Mandie* was in prison during the last trimester of pregnancy. Adequate specialist midwifery services could perhaps have prevented the separation of mother and baby, which had a detrimental impact on the wellbeing of both. Mandie’s newborn baby was placed in foster care.

“I just don’t understand why they have done this to me…. I feel I was punished for being pregnant… now they have taken my son, which I only get to see twice a week on a video call. It’s not good enough!”

Poor access to maternity services and inadequate care was also a common theme. Nesta* told us that she missed some midwifery appointments due to staff shortages in the prison. Other reports referred to dismissal of concerns from prison staff and delays in getting care. Tess* suffered from anxiety and depression and had a miscarriage in prison before she could access maternity services. She reported that the treatment she received during her attendance to hospital lacked dignity and respect.

The stories shared suggested limited access to specialist midwifery services, either for those with perinatal mental health needs or those with a background in substance misuse. Poor support has potentially detrimental effects on women with many resorting to self harm – sometimes for the first time. Baldwin found this is either out of frustration or not knowing how to manage the pain of being separated from their children. She adds “It is a life threatening situation for many mothers in prison”.

In view of the reported vulnerabilities and the reasons women entered the criminal system, we could suggest that the right support at the right time may have prevented most of these pregnant women entering prison in the first place. Early access to community support services (including mental health and substance misuse), past engagement with social care and adequate support from maternity services (multi agency approach including health visiting and family support teams) could have led to very different stories.

The evidence in our report points to a need for  a complete rethink with the starting position being that no pregnant woman should be in custody. Some countries do not permit the imprisonment of pregnant women. Community support and non-punitive residential options, on the lines of the therapeutic communities like the Jasmine Mothers’ Recovery in Plymouth and Phoenix Futures in Sheffield, need to be created and sustained. To respect and protect the unborn child is of paramount importance in the criminal justice system of any civilised society.

We urge governmental agencies to scrap the plans to build 500 new prison places. Some of the £150 million set aside to build them should instead be used to increase funding for Women’s Centres and the probation service and to establish a network of non-punitive, supportive, caring residential facilities. The health and wellbeing of pregnant women and their babies should be led by and remain within maternity services and there is a need for alternative ways of dealing with women who come to the attention of the criminal justice system. We need to move to a model of care that is fair, respectful and safe for all.

It’s time for change.  There should be alternatives to prison for pregnant women, Level UpBirth Companions, and Women in Prison are campaigning to change sentencing laws so that no pregnant woman will be sent to prison. Please support this call for change and consider  signing the petition.

Acknowledgement: We thank the Oakdale Trust who funded this research.


*All the names in our report were changed to preserve the anonymity of the participants

** Midwifery lecturer, City, University of London