Many women are received into custody experiencing a range of chronic health issues, including substance withdrawal, undiagnosed health conditions or untreated mental health conditions (Australian Institute of Health and Welfare, 2023). And it is recognised that incarcerated women have increased incidence of health conditions (DOJ, 2022; OICS, 2024; OICS, 2021). A number of these women may also be pregnant, which further increases the demand for sufficient health services.
Women in custody are a vulnerable cohort, who are exposed to complex risk factors. For some women, imprisonment during pregnancy can provide greater access to medical care than what they may have received in the community. However, for others, prison can disrupt a woman’s antenatal care and sense of agency around their pregnancy journey and planning. In particular, pregnant women on short periods of remand may experience greater challenges of receiving maternal services (Sapkota, et al., 2022).
Maternal imprisonment has been associated with poorer health outcomes for the mother and infant. These include, a greater risk of adverse outcomes such as preterm birth, still birth, low birth weight and admission to special care nurseries (Bell, et al., 2023). Mother’s often experience distress and isolation during pregnancy and are more likely to have mental-ill health. The use of tobacco and substance abuse while pregnant prior to (and sometimes during) incarceration is also common (Dowell, Mejia, Preen, & Segal, 2018; Dowell, Mejia, Preen, & Segal, 2019).
Previous OICS inspection reports have found a lack of suitable accommodation options for pregnant women (OICS, 2018; OICS , 2020; OICS, 2024). In particular, pregnant women in regional facilities often do not have access to obstetric health care and are subsequently transferred out of their community to metropolitan facilities (DOJ, 2022). This is despite some regional facilities having dedicated mother and baby units, which have not been utilised for their intended purpose (OICS, 2024). Where this type of accommodation is available, it is limited to metropolitan facilities.
Previously, we have found inconsistencies in the services available to pregnant women across the Western Australian custodial estate (OICS, 2021; OICS, 2018). This often results in inequitable access to support and healthcare based on location.
Over the last decade, the number of pregnant women in custody has increased. This is disproportionate to the daily average population for adult women. In 2013, there were 14 identified pregnancies, in 2023, there were 120 pregnancies reported. This increase would require additional resources to manage these prisoners and increases the risk on the Department of Justice to ensure pregnancies are managed safely, effectively, and in accordance with relevant health standards. As such, this warrants a review to identify concerns and areas of improvement, to improve health outcomes for incarcerated pregnant women and infants.
This review will not examine supports and health care available post birth. This review will also not include the support and healthcare available to pregnant young women and girls in youth detention.
This review will examine the management and supports available to pregnant women in the adult custodial estate.
- Does the department provide pregnant women in custody support and antenatal care equivalent to community standards of care?
- What is the experience of pregnant women in custody?
