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State Standards for Pregnancy-Related Health Care in Prison
(Click on states for more details)
Introduction
I. National Standards for Pregnancy-Related Health Care in Correctional Settings
II. How The States Measure Up
III. State-by-State Directory
Introduction
On any given day, more than 200,000 women are living behind prison or jail walls. Thousands of these women are pregnant and dependent on correctional authorities for their health care, and correctional authorities are legally obligated to meet those needs. Whether an incarcerated woman decides to continue her pregnancy to term or have an abortion, she has a constitutionally protected right to obtain appropriate medical care.
To what extent, if any, a prison's policies address pregnancy-related services is one important indicator of how that facility treats pregnant women in its custody. Presented here are the results of research to identify pregnancy-specific correctional policies posted on state department of corrections websites, or contained in databases of state laws and regulations. This is not an exhaustive survey of all state standards that may relate to the treatment of pregnant inmates, but a resource guide identifying such standards as are readily available online.
This resource guide includes three sections: First, it provides a short summary of minimum national standards that correctional facilities should meet as one important step for addressing the health needs of pregnant inmates. Second, it offers a general overview of the ways that the state policies located meet or fail to meet those national standards. Third, it provides a state-by-state directory to help you directly retrieve online, or request by phone or mail, individual state department of corrections' policies addressing pregnancy-related care, including abortion.
I. National Standards for Pregnancy-Related Health Care in Correctional Settings
Two well known sets of standards for correctional health care come from the National Commission on Correctional Health Care (NCCHC) and the American Public Health Association (APHA). The NCCHC publishes Standards for Health Services as a set of best practices for the provision of health services in correctional settings and to govern its accreditation program for prisons and jails. The APHA is not, as is NCCHC, an accreditation program. However, it is the oldest national organization of public health professionals, it has long led the movement to establish prisoners' right to adequate and humane medical care, and it publishes its own comprehensive Standards for Health Services in Correctional Institutions (2003).
Both the NCCHC and APHA standards specifically address the care and treatment of pregnant inmates. Along with other sources [1], these standards provide some guidance on minimum policies and practices correctional facilities should implement in order to meet the needs of pregnant inmates.
The NCCHC standard titled "P-G-O7: Care of the Pregnant Inmate" directs that "[p]regnant inmates receive timely and appropriate prenatal care, specialized obstetrical services when indicated, and postpartum care." [2] This standard also discusses the need for facilities to be prepared to handle the prevalence of high-risk pregnancies among incarcerated women, and sets forth specific compliance indicators for pregnancy care generally, including:
- Prenatal medical examinations
- Prenatal laboratory and diagnostic tests, including HIV testing and prophylaxis when indicated
- Advising inmates on levels of activity and safety precautions during pregnancy
- Prenatal nutritional guidance and counseling
- Maintaining a list of specialized obstetrical services
- Written agreement with a community facility for delivery
- Documented, appropriate postnatal care
- Keeping a list of all pregnancies and their outcomes
- Having a written policy and defined procedures addressing compliance with this standard
The NCCHC standard titled "P-G-09: Pregnancy Counseling," additionally recommends that a pregnant inmate receive counseling and assistance appropriate to her intentions, whether she wants to continue to term and then keep her child, place the baby in an adoption home, or have an abortion.
The APHA standards for the care of pregnant women overlap in some respects with those set forth by NCCHC, but also address important issues not mentioned in the NCCHC standards. For instance, APHA standards prohibit the use of restraints during labor and delivery, while the NCCHC standards are silent on this issue. The APHA standards include:
- A "sensitive and dignified" reproductive system examination as part of initial health screening
- Prenatal screening tests
- Prenatal health education
- Special housing and diet when necessary
- Identification and proper referral of high-risk pregnancies
- Treatment to prevent perinatal transmission of HIV for HIV-positive women
- Prohibition of shackling during labor and delivery
- Training of health care staff in jails and prisons for labor and delivery in case of emergency
- Standing arrangement for deliveries that allow mother and infant to spend time together after birth
- Ongoing access to newborns after delivery
- Access to family planning services, including abortion counseling and services
For more information about the NCCHC and APHA standards, or to obtain their most current publications, you can find more information at each organization's website:
http://www.apha.org/publications/bookstore/
http://www.ncchc.org/pubs/catalog.html#standards
NCCHC has also posted online its position statement on "Women's Health Care in Correctional Settings," available at:
http://www.ncchc.org/resources/statements/womenshealth2005.html.
II. How The States Measure Up
We found pregnancy-specific laws or correctional policies for over half of the states and the District of Columbia. We could not locate relevant pregnancy or reproductive health care correctional standards for sixteen states.[3] Of the policies or laws located for thirty-four states plus the District of Columbia:
- Twenty have standards that mention both health care for pregnant inmates planning to carry to term and for those who seek an abortion; [4]
- Fourteen have standards that mention prenatal health care but not abortion access. [5] However, three of those fourteen merely note that inmates do not have to pay for pregnancy testing and/or pregnancy care, without any further details regarding what that care entails; [6]
- One has an administrative regulation on correctional health care that addresses abortion access, but not other pregnancy-related health care; [7]
Of the thirty-five jurisdictions for which we found some type of law or policy regarding pregnancy or reproductive health care for inmates, very few included standards that closely tracked the NCCHC or APHA standards and recommendations. More often, the law or policy we found failed to specifically address most of those standards. For example, out of these 35 jurisdictions, only:
- Eight explicitly state that medical examinations shall be included as a component of prenatal care. [8]
- Four mention HIV testing. [9]
- Six include advice on appropriate levels of activity and safety. [10]
- Nineteen mention prenatal nutrition counseling or the provision of appropriate nutrition. [11] However, only ten of those require the actual provision of appropriate nutrition to pregnant inmates. [12]
- Seven explicitly require an agreement with a specific community facility for delivery. [13]
- Two require that institutions keep a list of all pregnancies and their outcomes. [14]
- Seventeen explicitly provide for screening or special treatment for high-risk pregnancies. [15]
- Ten follow the NCCHC standard that recommends counseling for pregnant women "whether they elect to keep the child, use adoption services, or have an abortion." [16]
- Three, as a matter of statute, restrict the use of restraints on pregnant women during labor and delivery. [17] For Amnesty International's survey of each state department of corrections policy on shackling women during pregnancy go to: http://www.amnestyusa.org/violence-against-women/abuse-of-women-in-custody/page.do?id=1108288&n1=3&n2=39&n3=720".
To learn more about how your state measures up, use the state-by-state directory to find information and resources for each state department of corrections and its policies.
III. State-by-State Directory
You can access laws and policies referenced below either by downloading them directly from the url link provided, or by looking up the state law citation provided. For a few states, there are additional instructions on how to retrieve a policy from a linked site. This is a directory of information publicly available online or in legal databases. Because much information is not posted online, we have provided other helpful contacts and resources for each state department of corrections. Another useful resource for locating and contacting women's prison facilities in each state is the Amnesty International survey at http://www.amnestyusa.org/violence-against-women/abuse-of-women-in-custody/page.do?id=1108288&n1=3&n2=39&n3=720.
For more information, please contact the Reproductive Freedom Project at 212-549-2633.
Information provided here was last updated in October 2008.
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ALABAMA
DOC Website:
DOC Policies and/or State Laws Related to Pregnant Inmates:
Contact Information and Resources:
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ALASKA
Doc Website:
DOC Policies and/or State Laws Related to Pregnant Inmates:
Contact Information and Resources:
- Assistant Medical Director
Inmate Health Care
4500 Diplomacy Dr.
Suite 207
Anchorage, AK 99508-5918
(907) 268-7350
- State Employee Directory: http://www.state.ak.us/local/whtpage1.html (Type "director inmate health" into the search box to view more detailed contact information for current director).
- General Contact Information: http://www.correct.state.ak.us/ (Contact information for the central offices located at the bottom of the page)
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ARIZONA
Doc Website:
DOC Policies and/or State Laws Related to Pregnant Inmates:
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ARKANSAS
Doc Website:
DOC Policies and/or State Laws Related to Pregnant Inmates:
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CALIFORNIA
Doc Website:
DOC Policies and/or State Laws Related to Pregnant Inmates:
- Prisons:
- California Penal Code §§ 3405, 3406, 3409, 3423, 3424, 5007.7, 6030
- California Code of Regulations
- Title 15, § 3030: Issuance and Possession of State Clothing and Linen
- Title 15, § 3050: Regular Meals
- Title 15, § 3268.2: Use of Restraints
- Title 15, § 3355: Health Care Examinations
- Title 15, § 3355.1: Dental Examinations
- Title 15, § 3355.2: Treatment for Pregnant Inmates
- Operations Manual Chapter 5, Article 45: Care, Treatment, and Security of Pregnant Offenders (Note especially § 54045.3, .4, .7, .9)
- Jails:
- California Penal Code §§ 4023.5, 4023.6, 4028
Contact Information and Resources:
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COLORADO
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CONNECTICUT
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DELAWARE
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DISTRICT OF COLUMBIA
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FLORIDA
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GEORGIA
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HAWAII
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IDAHO
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ILLINOIS
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INDIANA
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IOWA
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KANSAS
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KENTUCKY
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LOUISIANA
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MAINE
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MARYLAND
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DOC Policies and/or State Laws Related to Pregnant Inmates:
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MASSACHUSETTS
Doc Website:
DOC Policies and/or State Laws Related to Pregnant Inmates:
Contact Information and Resources:
- General Contact Information:
DOC Central Headquarters
50 Maple Street, Suite 3
Milford, MA 01757
(508) 422-3300
http://mass.gov/doc
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MICHIGAN
Doc Website:
DOC Policies and/or State Laws Related to Pregnant Inmates:
Contact Information and Resources:
- General Contact Information:
Michigan Department of Corrections
206 E. Michigan Ave.
Grandview Plaza
PO Box 30003
Lansing, MI 48909
(517) 335-1426
http://www.mdoc.state.mi.us/edoc/
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MINNESOTA
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MISSISSIPPI
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MISSOURI
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NEBRASKA
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NEVADA
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NEW HAMPSHIRE
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NEW JERSEY
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NEW MEXICO
Doc Website:
http://corrections.state.nm.us/
DOCPolicies and/or State Laws Related to Pregnant Inmates:
Contact Information and Resources:
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NEW YORK
Doc Website:
DOC Policies and/or State Laws Related to Pregnant Inmates:
- N.Y. Comp. Codes R. & Regs. tit. 9, § 7651.17
Available at: http://government.westlaw.com/linkedslice/default.asp?SP=nycrr-1000
(Select: Title 9 Executive Department. Select: Subtitle AA State Commission of Correction. Select: Chapter V Minimum Standards and Regulations for Management of State Correctional Facilities. Select: Part 7651 Health Services. Select: Section 7651.17: Prenatal and infant care services)
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NORTH CAROLINA
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NORTH DAKOTA
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OHIO
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DOC Policies and/or State Laws Related to Pregnant Inmates:
- For Information on Prisons:
- For Information on Jails:
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OKLAHOMA
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OREGON
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PENNSYLVANIA
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RHODE ISLAND
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SOUTH CAROLINA
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SOUTH DAKOTA
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TENNESSEE
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TEXAS
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DOC Policies and/or State Laws Related to Pregnant Inmates:
- http://www.cmhcc.state.tx.us/CMHC_Policy_Manual/G-55.1%20(0707).doc
(Correctional Managed Health Care Policy Manual G-55.1: Pregnant Offenders)
- Texas Government Code § 501.059 (Screening for and Education Concerning Fetal Alcohol Exposure During Pregnancy)
- Texas Government Code § 501.063 (Inmate Copayments for Certain Health Care Visits)
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UTAH
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VERMONT
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VIRGINIA
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WASHINGTON
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WEST VIRGINIA
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WISCONSIN
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WYOMING
Doc Website:
DOC Policies and/or State Laws Related to Pregnant Inmates:
Contact Information and Resources:
- General Contact Information ("Contact Us"):
Department of Corrections – Central Office
700 West 21st Street
Cheyenne, WY 82002-3427
Main: (307) 777-7208
Fax: (307) 777-7479
http://doc.state.wy.us/doc/contact.html
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1. For example, the American College of Obstetricians and Gynecologists publication, Special Issues in Women's Health (2005), provides its guidelines for "Health and Health Care of Incarcerated Adult and Adolescent Females."
2. This standard also cross-references three other standards that are not focused specifically on pregnancy care but address general medical issues and services of particular importance for pregnant inmates. Those are: "P-A-08 Communication on Patients' Health Needs," "P-G-02 Patients With Special Health Needs," and "P-G-06 Intoxication and Withdrawal."
3. Alabama, Georgia, Hawaii, Iowa, Kentucky, Louisiana, Mississippi, Missouri, Montana, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, Wisconsin, Wyoming
4. Alaska, Arkansas, California, Colorado, Delaware, District of Columbia, Idaho, Kansas, Maryland, Massachusetts, Minnesota, Nebraska, Nevada, New Hampshire, New Jersey, Ohio, Oklahoma, Oregon, Pennsylvania, Texas
5. Arizona, Connecticut, Florida, Indiana, Maine, Michigan, New Mexico, New York, North Carolina, Tennessee, Utah, Vermont, Virginia, Washington
6. Arizona, Maine, Tennessee
7. Illinois
8. California, Massachusetts, New Hampshire, New York, North Carolina, Oklahoma, Pennsylvania, Texas
9. California, Oklahoma, Pennsylvania, Texas
10. Delaware, Massachusetts, New Jersey, New York, Oklahoma, Oregon
11. California, Connecticut, Delaware, Florida, Idaho, Kansas, Massachusetts, Nebraska, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Texas, Washington
12. California, Connecticut, Florida, New Hampshire, New Jersey, New Mexico, North Carolina, Oklahoma, Pennsylvania, Washington
13. Connecticut, Delaware, Indiana, New Jersey, North Carolina, Oklahoma, Pennsylvania
14. Delaware, Oregon
15. Alaska, Colorado, Delaware, District of Columbia, Florida, Idaho, Kansas, Massachusetts, Nebraska, New Hampshire, New Mexico, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Washington
16. California, Delaware, District of Columbia, Idaho, Kansas, Massachusetts, New Hampshire, New Jersey, Oklahoma, Oregon
17. California, Illinois, Vermont
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