An Exploration of Pregnancy and Postpartum Healthcare in Washington State Jails

Abstract

Background: The number of women incarcerated in local jails has been steadily increasing for decades. Jails, originally designed to house mainly men and treat men’s health issues, are now responsible for handling the healthcare needs of pregnant and postpartum women. Despite the large and growing number of women in local jails, this facet of jail healthcare remains understudied. We know very little about how many women are pregnant or have recently given birth when they are taken into custody, nor about the care they receive. Research aim: This thesis was exploratory and formative in nature, aiming to learn more about pregnancy and postpartum healthcare in jail in Washington State. Specifically, this project focused on the policy that dictates healthcare, how that policy is decided, and what its implementation looks like. Methods: I conducted semi-structured in-depth interviews with jail administrators, jail healthcare providers, and pregnant and postpartum incarcerated women in four jails in Washington State. I then conducted a qualitative analysis on the interview data using the constant comparative method. Results: All jail administrators and healthcare providers had interacted with pregnant women in custody before and recognized the group’s unique health needs. Jails were all controlled by the city or the county in which they were located, and as such they had a large degree of freedom when making and implementing policy. All jails were motivated to provide adequate care to women in their custody, but they encountered constraints such as financial and staffing resource shortages. The jails were all interconnected with the larger community, utilizing outside specialized services or trying to provide linkages to care for women. Women reported adequate care that met most established guidelines, but there are areas with potential for improvement and optimization. Conclusion: Providing healthcare in jail is different than providing it in a typical clinical setting. There are additional challenges that must be considered when developing potential interventional programs. However, these programs have been shown to work for pregnancy and other health issues within jails when implemented thoughtfully. More research on the topic and a greater focus on this important issue is necessary.