Pregnant inmates are getting prenatal care far below health standards, study shows

Prenatal care for pregnant women in Ontario jails falls far short of international standards, says a new study from McMaster University.

A team led by Dr. Dustin Costescu, an associate professor in the Department of Obstetrics and Gynecology, pored over correctional and health administrative data and found that incarcerated women — and even women who had been in jail at some point and weren't anymore — were less likely to receive prenatal care that was up to par.

And in some cases, they didn't see doctors until just before they gave birth.

The team looked at 626 women who were pregnant behind bars, 2,327 who were previously incarcerated, and 1.3 million Ontario women in the general population between 2005 and 2015.

Only 48 per cent of the imprisoned women, and 59 per cent of the women who'd ever been incarcerated, received eight or more prenatal visits while they were pregnant, Costescu said. Eighty-five per cent of women in the general population did.

In the worst cases, Costescu said, this means mothers and babies are sick, sometimes with potentially fatal illnesses, and no one is catching them in order to treat them. Sometimes, women aren't even sure how many babies they're having.

"The diagnosis of pregnancy is vitally important to rule out complications like an ectopic pregnancy, which is the leading cause of death in the first trimester, to diagnosing multiple pregnancies, which becomes potentially very high risk," he said.

Costescu's study was recently published in JAMA Network Open. 

The study says only 38 per cent of women in prison during pregnancy had prenatal care visits during the first trimester, compared to 80 per cent of women in the general population. The first trimester, he said, is "a critical time during fetal development."

The findings are "deeply distressing" but not surprising, said Emilie Coyle, executive director for the Canadian Association of Elizabeth Fry Societies.

Jails and prisons are supposed to offer health care consistent with what's in the community, she said, but that usually doesn't happen. That's especially true with preventative care. 

"Pregnant women have reported being denied prenatal care appointments, or missing appointments because there are no staff available to accompany them," she said in an email. "In prison, security always outweighs adequate care. When appointments do happen, it is often the result of the woman's own advocacy."

When appointments do happen, she said, there's often a "lack of dignity," including women being shackled during examinations.

The study was funded by the Regional Medical Associates of Hamilton and ICES, a non-profit research institute.