reproductive health care for incarcerated women in the united states reproductive health care for incarcerated women in the united states in the united states, prisons are obligated to provide health care to prisoners. such health care is sometimes called correctional medicine. in women's prisons, correctional medicine includes attention to reproductive health. the number of women incarcerated in the united states has increased greatly over the last few decades, and at a faster rate than the number of incarcerated men. many of the same factors that increase women's likelihood of incarceration also put them at a higher risk for contracting hiv/aids and other sexually transmitted infections, and for having high-risk pregnancies. the majority of incarcerated women are economically disadvantaged and poorly educated, and have not had adequate access to preventive healthcare prior to their imprisonment, such as pap tests, sti screening, and pregnancy counseling. legal standards for health care availability estelle v. gamble (1976) estelle v. gamble obligates prisons to provide for the serious medical needs of their inmates. however, it also requires that an incarcerated person must demonstrate that they had a serious medical need, and that they didn't receive adequate medical care because officials showed "deliberate indifference." due to the difficulty inherent in proving that a prison official knew about a medical condition, yet failed to respond to it, this standard makes it difficult to hold correctional facilities accountable for their mistakes. todaro v. ward (1977) todaro v. ward argued that women within a new york prison did not have adequate, constitutional access to healthcare. since todaro v. ward was the first major court case that called into question incarcerated women's actual access to health care, it spurred organizations such as the american medical association, american correctional association, and the american public health association to start creating standards for health care within prisons. brown v. beck (1980) with this ruling, the court determined that the medical care provided to prisoners must only be "reasonable," not necessarily "perfect, the best obtainable, or even very good." relevant federal legislation and standards currently, no national agency monitors the treatment of prisoners, although a few governmental and non-governmental agencies do provide monitoring standards that facilities may use if they wish to become accredited (about thirty percent of prisons are accredited), and some federal legislation has been passed regarding correctional health care. federal prisoner co-payment act (1999) this legislation required that incarcerated individuals pay for some of their health care bill while in prison. prison litigation reform act (1996) the prison litigation reform act made it much more difficult for prisoners to file class action and individual lawsuits against a prison. the prison litigation reform act (prla) requires that prisoners exhaust a facility's own administrative resources and solutions before attempting to file a lawsuit. this can be detrimental because prisoners' health problems are often time-sensitive. prla also includes a cap on attorney fees, which has made fewer attorneys willing to represent prisoners. although prla applies to all lawsuits filed by incarcerated people, it is particularly relevant for women's health because most lawsuits filed by incarcerated women concern substandard health care. policies: act’s and bill’s healthy start act according to patrice gaines, from nbc news article titled one state is trying to make pregnancy in prison slightly more bearable there is change happening right now. one of the new programs introduced into the prison system in minnesota is the healthy start act. this act allows pregnant mothers to continue to serve their current sentences in an alternative community. this kind of alternative community would be a halfway house for example or a rehab treatment center. the healthy start act will give mothers the opportunity to form bonds with their newborns. previously women gave birth, and their children were taken away automatically. by allowing the mothers to form a connection right away after birth they will help the child with their development. minnesota has also banned the use of shackling pregnant woman during birth. other states have also followed like new york and georgia. another improvement was also the addition of conditional release. this minnesota act was very significant in history. the act was led by state representative jamie becker-finn and was also supported by all women. it was considered to be an all-women bill. this legislation has been in the making for about 10 years now. over the course of this time, the minnesota prison doula project would interview women to find out what kind of care they needed in the prisons. this information was gathered and used to create this act. the house bill 608 after years of unfair treatment another bill was enacted and is addressing discrepancies in woman’s healthcare in prisons. the house bill 608 signed in north carolina focuses on women’s healthcare in prisons and improving overall conditions. according to the port city daily staff, the new bill will protect pregnant prisoners specifically. these women will be guaranteed proper medical care at no cost and would be allowing for mother-child bonding as well right after birth. this bill also includes banning cavity searches of pregnant women unless there is a threat or harm presented. another addition to this bill is that pregnant prisoners are required to be provided with proper nutrition and supplements for the baby. finally, these women are to be held in prisons that are about 250 miles or less away from their children and families. this also includes mothers and children meeting every other week in person. the dignity for incarcerated women act of 2017 the dignity for incarcerated women act of 2017, dignity act, enacted on july 11, 2017 by senator cory booker of new jersey also focuses on improving healthcare and conditions for incarcerated women in prisons in the united states. according to the american progress, the officials wanted to improve the overall treatment of women in prison and jails. they hope to provide more help with their children during their incarceration period, helping with reentry into the society and also providing inmates with more health care resources and products. the act also includes a program that would support women in prison providing them with free menstrual products. many prisons all over the us do not provide feminine products to all inmates. these women have to choose between buying deodorant or a pack of pads during the week. the dignity act also focuses on mental health problems that women face in prison as well as focusing on the trauma that these women face in and out of prison. according to the american psychological association, about 75% percent of women in prisons and jails suffer from substance abuse issues. about 68% of women incarcerated in the us have experiences sexual abuse and physical abuse. (american psychological association) it is also known that women of color are more likely to enter the criminal justice system than white women. women of color also experience higher levels of abuse than white women. this dignity act will mandate that correctional officers be required to complete trauma identification training. this will help those officers understand and actually allow them to help with prisoners with families, children and those who are pregnant. correctional reproductive health care pregnancy and prenatal care as of 2005, about five to ten percent of incarcerated women were pregnant (most upon intake), and about 2,000 incarcerated women give birth every year. incarcerated women already tend to have more high-risk pregnancies, due to possible complications by drug and alcohol abuse and stis, histories of victimization and abuse, and poor support networks, so they are particularly in need of quality prenatal care as compared to non-incarcerated women. studies have found mixed results when it comes to the effects of incarceration on pregnancy outcomes. some studies have found that incarceration correlates to lower birth weight, and an increased chance of complications in the pregnancy; others have found the opposite: that incarceration is associated with higher birth weight and a decreased likelihood of premature delivery. however, the latter finding may simply speak to the low level of medical care available to women in poverty in the free world. a 1996 study conducted by the national council on crime and delinquency (nccd) on women in california, connecticut, and florida state prisons found a lack of adequate prenatal and postnatal medical care, prenatal nutrition, level of methadone maintenance for opiate-dependent pregnant inmates, education regarding childbirth and parenting, and preparation for the mother's separation from her child. often, inmates report receiving no regular pelvic exams or sonograms, and little to no information about proper prenatal care and nutrition. prison diets often lack proper nutrition, particularly for the changing and special dietary needs of pregnant women, and many women prisoners report not being allowed to alter their diets during their pregnancy. despite the lack or low quality of prenatal care in most institutions, many correctional facilities have made strides to provide adequate care. for example, washington state has a program called the birth attendants prison doula project, which provides support to incarcerated pregnant and postpartum women. when asked about her prison's response to pregnancy, boo, an inmate in an arizona correctional facility, said: they're real good people to me... i get taken care of in here very well. they give us three pregnancy bags a day which contain two cartons of milk, two orange juices, and two fruits, and you get three pills three times a day during breakfast, lunch, and dinner. in general, pregnant inmates are transported to outside medical facilities to give birth, because most correctional facilities are not medically equipped to provide such services. these transports often result in complications due to the risk of injury to both the mother and the child, and due to the additional stress. the practice of shackling inmates, both in transit to the hospital and during labor, is also common at many facilities. forty-one states permit the use of restraints during transport to the hospital, and twenty-three states and the federal government permit the use of restraints during labor. these restraints may include belly chains, shackles, handcuffs, or nylon "soft restraints." the use of restraints on women so far into their pregnancy and during labor poses many health risks. restraints inhibit the movement of a woman, something that aids the progression of the labor and alleviates some of her discomfort. they may also hinder the ability of health care professionals to respond quickly to emergencies during the labor. organizations such as amnesty international have pressured correctional facilities to stop the use of shackles on pregnant women, pointing out the fact that most pregnant women are incarcerated for nonviolent offenses and pose no risk (especially during childbirth), so the restraints are unnecessary. maria jones, a pregnant inmate, described her experience being shackled during labor: because i was shackled to the bed, they couldn't remove the lower part of the bed for the delivery, and they couldn't put my feet in the stirrups. my feet were still shackled together, and i couldn't get my legs apart. the doctor called for the officer, but the officer had gone down the hall. no one else could unlock the shackles, and my baby was coming but i couldn't open my legs. hiv/aids incarcerated women are 15 times more likely to be infected with hiv than are women who are free, and are also more than twice as likely than incarcerated men to be infected with hiv. for example, in new york, a state which does blind testing, 14.6% of incarcerated women and 7.3% of incarcerated men tested positive for hiv. the 1996 nccd study found that female african american and hispanic/latina inmates were significantly more likely than their white counterparts to report testing positive for hiv. many of the same social factors that increase the likelihood of incarceration for women, such as poverty, race, gender, and a history of victimization, are also correlated to hiv infection. a 2000 study by the american correctional association found that mandatory hiv testing is conducted upon intake in 23 states, and that a few also provide 6-month follow-up testing. most prisons test inmates who either ask to be tested, or display symptoms of hiv (this is the policy in 44 out of 51 jurisdictions), and fifteen states also specifically test inmates that are in high-risk groups. three states, the district of columbia, and the federal