Female contraception policies at US prisons and jails

The study surveyed a sample of 22 state prison systems and 6 county jails in 2016 and 2017 about female permanent contraception and reversible contraception policies.¹

The institutions had a varied geographic distribution and population size, with half of the prisons privately contracting health care.

Ten of the prisons and 4 of the jails also reported 6 months of monthly data on the number of postpartum permanent contraception procedures performed on women who gave birth in custody.

Overall, 7 of the prisons and 3 of the jails that permitted permanent contraception did not have a written policy about it.

Likewise, 6 prisons and no jails provided access to permanent but not reversible contraception.

Only 2 prison and one jail offered interval permanent contraception.

Patient consent for permanent contraception was obtained by a variety of providers, including prenatal providers inside or outside the jail or prison, or a hospital provider unrelated to the site.

Three women had permanent contraception procedures at 2 prisons and 4 women at 2 jails. “This corresponds to 3% of birthing people from prison and 8% of from jail within the same 6-month timeframe who received immediate postpartum permanent contraception,” wrote the authors.

However, all 3 permanent contraception procedures in prisons occurred at sites that did not allow initiation of long-acting reversible contraception (LARC) methods.

Of the 3 jails that allowed both permanent contraception and access to LARC, all three permanent contraception procedures occurred at the same jail.

For the 2 jails that did not allow LARC initiation, 1 jail performed 1 permanent contraception procedure.

None of the 11 prisons and the 5 jails that allowed permanent contraception required the incarcerated person to pay for it. Nine prisons (82%) and 1 jail (20%) paid for the procedure. But 2 prisons reported alternative payment systems: 1 pregnant woman give birth at a state hospital that absorbed the cost, and another reported medical services that were subcontracted to a private company.

Four jails also reported alternative payment systems for permanent contraception, including options of Medicaid, a person’s private insurance, or the hospital.

Although only a small number of postpartum permanent contraception procedures were detected in the study, the authors stressed that any which occurred without offering LARC poses concerns about the balance between access and avoiding coercion.

Nonetheless, postpartum hospitalization is a convenient and safe time for many women to use permanent contraception, particularly those who have limited access to health care like incarcerated individuals.

It is also a vulnerable time with documented cases of abuses, according to the authors, especially for women who give birth while incarcerated because they neither select a birth hospital nor their own health care professional, thus limiting autonomy and self-advocacy.

“Given the inherent lack of autonomy of incarceration and history of sterilization abuses in this marginalized group, policy-makers should advance policies that avoid coercive permanent contraception and increase access to reversible contraception in carceral settings,” wrote the authors.

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Reference

1. Pan YL, Beal L, Espino K, et al. Female permanent contraception policies and occurrence at a sample of U.S. prisons and jails. Menopause. December 2021. Volume 104, Issue 6; 618-622. doi:org/10/1016/j.contraception.2021.08.005