Incarcerated New York Women Denied Access to Reproductive Health Care
by Gary Hunter
According to a March 4, 2008 study by the New York Civil Liberties Union (NYCLU) female prisoners in New York county jails consistently were given little or no assistance in terms of gender-specific health care despite state law guaranteeing such assistance.
Most New York county jails did not even have written policies to deal with such areas as abortion, prenatal care, gynecological exams, contraception or sexually transmitted infections (STIs). Of the few counties that did outline some care in these areas none were uniform with each other or with state law.
Over 25,000 women find their way into the New York county jail system each year. Of that total at least 3,000 remain incarcerated in 50 counties at any given time. Most are locked up for non-violent crimes; most are at reproductive age. The study found that most of these women “suffer disproportionately from poor health and lack of access to primary health care, and are at high risk for gender-specific health conditions.” Each of these areas, concluded researchers, could be curbed during the time spent in jail.
Policy for county jails is established by the State Commission of Corrections. (SCOC) The study immediately observed that the minimal standards set forth by the SCOC are too open- ended to be effective. For instance, while the SCOC requires county jails to do an initial health screening upon admittance it does not establish a minimal time frame for that screening. Neither does it specify what areas should be screened. Moreover, SCOC policy does not distinguish between male and female prisoners in its guidelines.
Of the 58 NY county jails covered in the study most conveyed this same “one size fits all” mentality with respect to prisoner health care. As a result the standard of care given to a female prisoner depends directly on where she is incarcerated.
Incarcerated women are higher health risks than women who have never been locked up. Breast cancer, cervical cancer, STIs, and pelvic inflammatory diseases occur more frequently in incarcerated women. Many of these diseases are treatable and most are preventable and detectable with a routine gynecological exam. Yet no county in the entire state of New York had a written policy that covered gynecological examinations.
Routine contraception is also a problem. Upon entering county jails most women were forced to discontinue using hormonal contraception. While the study itself recognized that this practice is not inherently harmful it does incur certain risks and is often accompanied by physical discomfort.
According to the American Public Health Association’s Standards for Health Services in Correctional institutions (APHA) “[w]omen should be allowed to continue hormonal contraception to maintain protection for the current menstrual cycle. They should also be allowed to begin hormonal contraception a month before their release.”
Health services organizations have also recommended that incarcerated women have access to emergency contraception (EC), also known as the morning after pill, as a precautionary measure. Researchers also found that antiquated policies presently in place assume that sexual activity and even sexual assaults do not occur in the jails.
But by far, the major concern addressed by the NYCLU study was the routine denial of access to abortion for pregnant prisoners. Easily 6 percent of women are pregnant when they are admitted to jail. Several have filed suit after the jail has refused them access to abortion. Even though state law guarantees incarcerated women the right to abortion only 13 counties had policies in place that ensured that right.
Several factors determine whether or not a county adheres to state law on this issue. Many counties adopted an interpretation of the law that deemed abortion to be an elective procedure as opposed to being “medically necessary.”
Other county jails balk at abortion laws based on personal biases of the caregivers working at the jail. One nurse is quoted as saying, “If they are saying they want an abortion the same day they are sentenced, for example, I usually tell them to think about it and I’ll follow up with them in a few days. They have to request it from me.”
Since a female prisoner retains the right to terminate her pregnancy under the Eighth and Fourteenth Amendments an absence of hard and fast guidelines could create delays that violate her constitutional rights. Of particular concern was the practice of some county jails to require prisoners to obtain a court order before being allowed an abortion. The study identified this practice as illegal and county jails that practice this policy at risk for litigation.
Definitive authorities, listed by the study, on the abortion issue included Turner v. Safely, 482 U.S. 78 (1987); Planned Parenthood v. Casey, 909 U.S. 833 (1992); and Monmouth County Corr. Inst. Inmates v. Lanzaro, 834 F.2d 326 (3rd Cir. 1987).
The NYCLU report points out that the number of women being jailed in the U.S. is rapidly increasing. PLN believes that the results of this localized sample can be readily generalized to female prisoners across the country. See: Access to Reproductive Health Care in New York State Jails by the NYCLU. The report is posted on PLN’s website.
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