Senior midwives and researchers with experience in criminal and social justice are among those calling for improved maternity provision for pregnant women in UK prisons.
In an article published by The BMJ today, Laura Abbott and colleagues highlight gaps in clinical care for pregnant women and say the systemic problems need tackling urgently to protect the health of pregnant women, new mothers, and babies while in criminal justice settings.
Figures from April 2023 to March 2024 show that 229 pregnant women were held in prison in England and 53 gave birth during this time.
Research on the care of pregnant women in prison in the UK is sparse, but shows that pregnant women in prison are less likely to receive antenatal appointments and face heightened risks of complications and mental health difficulties than the general population.
This was highlighted by the suicide of Michelle Barnes in 2015, five days after she learnt she was to be separated from her baby, and ombudsman investigations into the deaths of two babies born in prison. These tragedies and the campaigns of organisations including Birth Companions has led to new sentencing guidance acknowledging pregnancy and the post-birth period as mitigating factors and the need for specialised support for women who are separated from their babies.
"Whenever possible, we should avoid incarceration for pregnant women and prioritise viable community based alternatives," say Abbott and colleagues. However, they state that as long as pregnant women remain in prison, the maternity care they receive must be appropriate and of high and consistent quality.
They note that improvements have been made in response to recent reports, including in-cell telephones, assigned pregnancy mother and baby liaison officers, and increased maternity cover, but stress that prison services do not match the accessibility of NHS services.
Until alternatives to imprisonment become routinely used for pregnant women, they suggest several actions to enhance maternity care within prison settings.
These include protected midwife time, obstetric clinics within prisons, and multidisciplinary training of care providers. Specialised support should also be provided to help mitigate adverse effects of mandatory separation in the critical 1001 days of life.
They also point to several community initiatives as examples of how, with funding, alternatives to imprisonment can be transformative for women and their babies.
"The deaths of mothers and babies within the prison system highlight the urgency of addressing current deficiencies and continue to galvanise our collaborative endeavours to advance maternity care provision in prison while also working to avoid the incarceration of perinatal women in all but the most exceptional of circumstances," they write.
"Concerted efforts are needed from healthcare providers, policy makers, third sector organisations, and prison authorities to effect positive changes."
Finally, they say it is important not to view prison as a place of safety for vulnerable pregnant women. "The challenge lies in creating alternatives that offer the same level of support for their complex needs," they conclude.
