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Overview

Although there has been massive growth in the number of women in prison in the USA and other countries, women remain a significant minority within correctional systems. In the United States, the number of women in prison increased by more than 800 % in the 30-year period between 1977 and 2007. In the United Kingdom, the female prison population nearly tripled in just a 12-year period from 1992 to 2004. Despite these increases, in most countries, women still constitute less than 10 % of the prison population (Alejos 2005). There have long been concerns that the correctional system, which was built around a need to house large numbers of male offenders, ignores, minimizes, and marginalizes female inmates and their specific needs, including medical needs.

In particular, statistics find that a large proportion of female inmates are mothers. One recent study in the United Kingdom reported that more than half of women in prison have children under the age of 16 and one-third of women have children under 5 years old (Edge 2006). Similarly, in the United States, more than half of state and federal inmates have an estimated 1.7 million minor children (Glaze and Maruschak 2008). In most cases, the women are the primary caregivers and had been living with their children prior to incarceration. The children of men who are imprisoned typically stay with their mothers during the father’s incarceration; however, children whose mothers are incarcerated are much less likely to remain in their family home, often being placed with extended family. Additionally, incarcerated mothers are five times more likely than incarcerated fathers to report that their children were placed in foster care or other institutions during their incarceration (Glaze and Maruschak 2008). While the number of women who are pregnant, give birth, or have new infants while in prison is much smaller than the number who had children prior to incarceration, all of these women and their infants and children have specific needs that are often not addressed by prison policy, practice, or administration.

Legal Issues With Mothers And Children In Prison

In 1990, the United Nations Congress on the Prevention of Crime and Treatment of Offenders issued a resolution that the imprisonment of pregnant women should be avoided, stating that “the use of imprisonment for certain categories of offenders, such as pregnant women or mothers with infants or small children, should be restricted and a special effort made to avoid the extended use of imprisonment as a sanction for these categories” (Alejos 2005, p. 13). There are a number of issues that arise in dealing with convicted women who are either pregnant or are mothers, especially to young children. For women (and men) who have children, applicable legal considerations include the Convention on the Rights of the Child, which specifies that children should not be separated from their parents against their will except in a case where it is in the best interest of the child (Alejos 2005, p. 14). The African Union’s Charter on the Rights of Children, for example, specifies that noncustodial sentences should be considered first in cases of pregnant women and mothers of infants and young children and that the purpose of punishment should be reform and reintegration with family (Alejos 2005). In fact, the best interests of the child are indicated as the primary guiding factor, which raises the question of whether it is in a child’s best interests to remain with their mother in a prison or to be separated from their mother in order to remain in the community.

In terms of pregnancy and childbirth in prison, the United Nations standard minimum rules for the treatment of prisoners specify that women should receive all necessary prenatal and postnatal care, that birth should occur in a hospital outside of the institution, and that a child’s birth certificate should not list a prison as the place of birth. Additional criteria require that efforts should be made to maintain and improve relationships between prisoners and their family, which would presumably include children. While many international legal standards suggest that prison should only be used for pregnant women in extreme circumstances, for those women who are incarcerated while pregnant, additional legal considerations address the necessity of appropriate prenatal care, including nutrition, medical care, a healthy environment and exercise, and attention to any cultural or religious issues surrounding childbirth. Physical restraint of pregnant women should not be used except in extreme circumstances, and numerous international standards call for abolishing the practice of shackling or restraining women during labor and childbirth.

Children living with a parent in prison also present special legal challenges, and the management of these children varies widely by nation (Bastick and Townhead 2008). General international standards specify the need for monitoring mechanisms and the involvement of child welfare agencies in institutional decision-making that affects the child. Adequate accommodations should be available, including separate motherchild units that are removed from the general prison population, the provision of a safe and healthy environment, as well as appropriate facilities to house the children at times when their parent is participating in activities not appropriate for children. Underlying these general standards is a fundamental assumption that the child is not a prisoner and should never be treated as one.

Pregnant In Prison

Data compiled by the Bureau of Justice Statistics indicated that in 2004 in the USA, 4 % of female state inmates and 3 % of federal inmates were pregnant when they were admitted to prison. International standards require that pregnant inmates receive all appropriate medical care, nutrition, and assistance. In the USA, a number of medical organizations as well as the National Commission on Correctional Health Care have issued policy statements on appropriate health care for inmates in general and for pregnant inmates more specifically. These recommended guidelines include “timely and appropriate prenatal care, specialized obstetrical services when indicated, and postpartum care” (NCCHC). Specific issues that should be addressed among pregnant inmates include prenatal medical exams, nutrition, and counseling, along with diagnostic screening for high-risk pregnancies, including HIV testing. In addition, the NCCHC recommends that institutions should have written agreements with a local medical facility for delivery. Despite these policy guidelines and standards, research finds that pregnant women in prison do not receive adequate prenatal care and health screening (Edge 2006). Research with pregnant inmates in England finds that these women report being constantly hungry, being physically restrained with shackles and belly chains, and invasions of privacy with male guards present during medical exams and delivery.

In 2010, the Rebecca Project for Human Rights in conjunction with the National Women’s Law Center conducted a state-by-state analysis of policies and practices for dealing with pregnant and parenting women in prison in the USA. According to this study, three-quarters of states do not have adequate (or any) policies in place for providing prenatal care for women who are pregnant during their incarceration. This may be especially problematic because female inmates typically are less likely than other women to have had routine health care prior to their incarceration. These women may have undiagnosed health conditions as well as higher levels of drug use, sexually transmitted diseases, and risk factors for HIV, which may lead to a higher proportion of high-risk pregnancies in this population. Incarcerated women are also more likely to have histories of neglect and victimization, including sexual assault. Some research has noted that since many women in prison receive short sentences, the rapid turnover of the female prison population may interfere with the ability of institutions to ensure adequate prenatal care and aftercare (Edge 2006). The failure to provide a high level of prenatal care may have implications for the pregnancy as well as short-term effects on the infant, including low birth weight or other birth complications, and long-term consequences for the health of both mother and baby.

Despite a great deal of increased attention to the issue recently, the practice of shackling female inmates during pregnancy, labor, and delivery remains an area of concern. The National Commission on Correctional Health Care (NCCHC), the American Congress of Obstetricians and Gynecologists (ACOG), the American Medication Association (AMA), and the Association of Women’s Health, Obstetrics, and Neonatal Nurses (AWHONN) have all issued position statements arguing that the use of restraints for pregnant women should be avoided completely except in cases of extreme risk, and when restraints are judged to be necessary, the least restrictive method should be used.

For example, the AWHONN (2011, p. 817) “opposes the practice of shackling incarcerated pregnant women.. .[which] should only take place if prison officials reasonably believe, after an impartial and thorough evaluation, that a particular individual may attempt to harm herself or others or presents a legitimate flight risk.” In January 2012, the American Correctional Association (ACA) also issued a policy statement that pregnant women should be restrained in the least restrictive method possible, that waist and electronic restraints should never be used during pregnancy, and that leg restraints should never be used during labor and delivery. While efforts to restrict the use of physical restraints on pregnant and laboring women in prison are gaining momentum, more than half of the states do not have policies that comprehensively limit the use of restraints (The Rebecca Project 2010). As of 2012, only 17 states have adopted laws that limit the use of physical restraints for pregnant inmates, with four states addressing the issue in policy.

International Examples Of Prison-Based And Community-Based Programs

While it is more common outside of the USA for babies born in prison as well as other children to reside in prison with their mothers, there is little information available and even less consistency in how institutions and nations deal with mothers and their children. For example, in Australia, a mother or primary caregiver may submit a request to the superintendent of the institution that her baby live in the facility with her for up to 12 months. Requests may also be made for older children to stay overnight. In France, however, the decision to keep a child in prison is left up to the mother with no approval necessary except for the agreement of the father, and babies may stay in the prison until they are 18 months old (Alejos 2005). In Finland, legislation allows both mothers and fathers to bring their children into prison with them. While there is no specific age limit, this typically involves children younger than 2 or 3 years old. Some countries, like Germany and Spain, allow older children (in some cases, up to age 6) to live in prison with their mothers. In other countries, like Norway, children are not allowed in prisons at all.

There are a number of examples of the various ways that programs throughout the world manage babies, children, and their mothers in prisons and community-based alternatives. In England, the prison service has designated Mother-Baby Units (MBUs), which are described as separate living arrangements within a women’s prison where women and their children may live together during her incarceration (Edge 2006). These units are designed with the rights of the child as the primary consideration. Children can stay with their mothers in prison up to a maximum of 18 months of age. Women must apply to participate in the program, and admission is determined based on what is in the best interests of the child. Mothers must be and remain drug-free, must be willing to take primary parental care of the child, and must have no physical and/or mental health or other concerns that would interfere with their ability to care for the child. Applications are taken system-wide, and women may be transferred to another facility if they are accepted. Because of the geographic distribution and isolation of facilities, placement in a MotherBaby Unit may mean that a mother and baby are separated from the rest of their family, including any older children she may already have.

Canada also has an Institutional Mother-Child Program (Alejos 2005). Mothers who are categorized as either minimum or medium security and who are housed in institutions that provide the program are eligible to participate as long as the offense did not involve a child. In general, participants may request that their young children (up to 4 years old) live with them full time and that older children (up to 12 years old) may have part-time residence. Canadian policy specifies that the primary consideration in allowing women to participate should be what is in the best interests of the child, and the goal of allowing children to reside with their mothers is to maintain and support stable mother-child relationships. Interestingly, those reviewing applications for participation in the program are also directed, when feasible, to consider the wishes of the child in determining who will be accepted. If accepted into the program, mothers sign a parenting agreement, which may include parenting training, health-care plans, and other criteria. Program staff monitor a mother’s compliance with program requirements and review cases after the first month and then every 6 months.

While women have long been allowed to keep young children in prison with them in Spain, Feintuch (2010) describes an institutional program implemented in 2004 with the stated goal of removing all children from prisons by 2012. These “external mother units” are designed for those women with longer sentences, who committed a nonviolent offense. In these units, women are housed in separate apartments with their children, and the women are responsible for the feeding and care of their children. Efforts are made to maintain a homelike environment, including the language used to describe the units, referring to a woman’s “apartment” and “home.” During the day, the children attend a community preschool, while the women participate in programs focusing on parenting classes, education, and job training. The women may also work in the community as long as the job does not interfere with their child’s schedule. Cases are reviewed frequently to ensure the health and safety of the children, and as a child approaches 3 years of age, the mother’s case is reviewed to determine whether she could complete her sentence in the community. The units have an age limit of 3 for the children, so older children are not eligible to live with their mothers in the units. There are only a few facilities in the country, which means that mothers may be located in a facility some distance from their other family, and this may also interfere with the involvement of fathers. Interestingly, Spain does have one family unit where families can live if both parents are incarcerated. Finally, the external mother unit program is also heavily dependent on help from nongovernmental organizations, so continued funding may be an increasing concern. Community-based programs are also available for convicted parenting women and their children. In addition to the “external mother units” described, Spain is increasing the use of community-based alternatives for nonviolent, parenting women with shorter sentences.

Children In Prison: US Examples

In contrast to the numerous examples from the international perspective, it is uncommon for imprisoned mothers in the United States to keep their children with them while serving their sentence. In the USA, it is common for mothers who give birth while incarcerated to be separated from their babies within a few days. While the mother returns to the institution to finish serving her prison term, the baby is placed in the community with family or social services. Mothers who have children prior to incarceration simply leave those children behind when they begin serving their sentence. Support for the use of prison nursery programs in the United States has varied over the years, and few states operate programs. There are, however, a few notable examples of programs ranging from prison nurseries to community-based sanctions. There are generally two goals associated with these types of programs: that allowing mothers and babies to stay together will foster positive attachment and bonding and, relatedly, that this environment will be rehabilitative for the mother and will reduce her chances of recidivism.

Within the past two decades, a minority of states have developed prison nursery programs, which allow children born during their mother’s imprisonment to remain with the mother for a period of time following birth. The oldest program, operating since 1901, is located in New York. Other programs have been developed in Nebraska, Washington, Massachusetts, Illinois, Indiana, Ohio, California, West Virginia, and South Dakota. The Federal Bureau of Prisons also operates a program, Mothers and Infants Nurturing Together (MINT). Prison nursery programs in the USA are generally designed for women who give birth during their incarceration, who were convicted of a nonviolent offense, and who have no history of child abuse or neglect. The length of time that babies can stay with their mothers in the program varies from a low of 30 days in South Dakota to a maximum of 3 years in Washington. Most of the prison nursery programs in operation are housed in an area of the prison separated from the general population and incorporate parenting skills training.

The Bedford Hills Correctional Facility for Women in New York houses the nation’s oldest prison nursery program, operating since 1901. Women who are pregnant when admitted to prison and who will give birth in custody are eligible for the program. Selection of participants is determined by a number of factors, including a consideration of who will have custody of the child, the length of the mother’s sentence, and the type of crime she committed. If the mother will be discharged from prison within 18 months following the birth of her child, the babies can stay with their mothers the entire time. Otherwise, the maximum stay is 12 months. Mothers receive weekly nurse visits, and the program includes specialized children’s activities, daycare, parenting education, family counseling, and assistance with child placement.

In 1994, Nebraska expanded an existing program for mothers and children into a prison nursery program modeled after the Bedford Hills New York program (Carlson 2001). Mothers in the women’s prison in Nebraska give birth at a local hospital. For program participants, both mother and baby return to the nursery facility after discharge from the hospital. To be eligible for the nursery program, women must have less than 18 months left on their sentence following the birth of their child, must have no prior convictions for child abuse, and must sign a parenting program agreement. As part of that agreement, prenatal classes are required, in addition to parenting classes, educational programs, and employment. In its early stages, participating mothers reported strong support for the program, feeling that they have a better relationship with their child and that they are better mothers as a result of their participation and involvement in parenting classes (Carlson 2001).

More recently, the Washington Correctional Center for Women opened the Residential Parenting Program in 1999 for minimum security women who had committed a nonviolent offense and would have no more than 3 years remaining on their sentence following the birth of their child (Women’s Prison Association 2009). In a separate unit within the facility, mothers in the program each have a private room with a bed for her child. The unit also includes indoor and outdoor children’s play areas. Monthly pediatrician visits are provided to monitor the health and wellbeing of the children. Because children may stay with their mothers up to 3 years, the facility partners with a local organization to provide an early head start program for the children, which incorporates activities for the children, nutrition counseling, information about child development, and maternal depression screenings.

Alternatives To Incarceration In The United States

There is also a growing effort in the USA to develop alternatives to incarceration for convicted women with young children. More than half of the states have some form of family-based treatment as an alternative to prison. Summit House in North Carolina was one example of a model residential alternative to incarceration program for women with young children who were convicted of a nonviolent offense (Women’s Prison Association 2009). Participation in the program for 12–24 months was a court-ordered condition of probation. With the goal of rehabilitating women while maintaining family bonds, the program included counseling, life and job skills training, substance abuse counseling, supportive housing, and parenting education. Like many alternative community-based programs, Summit House is a nonprofit organization with funding dependent on the current economic climate. Despite being recognized as a model program and evidence of substantial cost savings in terms of both reduced recidivism among the participants and reduced social service costs of dealing with the children, funding was cut substantially, and the program was forced to close in June 2011.

Another example is Drew House, described by Goshin and Byrne (2011), a newly designed program in New York that provides supportive housing to women charged with felony offenses and their children. The women in the program are typically charged with nonviolent offenses, although some women with violent felonies may be eligible if there was no serious injury and the victim agrees to the placement. The program uses a gender-responsive, relational model that promotes independence, and court-mandated conditions typically involve drug testing, educational and vocational training, efforts to find employment, as well as participation in parenting classes. Participation in the program typically lasts between 12 and 24 months. During program participation, the women and up to three children live in their own apartments, paying some or all of the rent. As with the Summit House program, availability of funding is also an issue with Drew House.

Results Of Prison-Based And Community-Based Programs

Research on the effectiveness of prison-based and community-based programs for parenting women and their children is very limited. While knowledge about the consequences of the separation of mothers and their children due to incarceration is also limited, research does suggest that both the mother and their children can be adversely affected. For example, children separated from their mothers may experience attachment disorders, mental health problems, and behavioral problems. Others report academic failure and increased levels of criminal involvement among children of incarcerated women (Byrne et al. 2012). Thus, it is important to consider the effectiveness of these types of programs in terms of their impact on the mothers who are participating but also in looking at the long-term impacts on the children.

When sufficient resources are dedicated to prison nursery programs designed for convicted women and their children, results are generally positive, providing an environment that facilitates appropriate child development and allows mothers and their children to develop strong relational bonds. For example, studies in the UK indicate that pregnant inmates are more likely to reduce their levels of smoking, drinking, and drug use when presented with information about healthy behaviors during pregnancy (Edge 2006). Longitudinal research also suggests that mothers are likely to retain custody of their children following participation, and the women also demonstrate reduced recidivism (Byrne et al. 2012). Community-based alternatives to incarceration also appear to produce positive results related to mother-child attachment and recidivism rates (Campbell and Carlson 2012). Additionally, the children who participate with their mothers avoid placement in the foster care system, maternal separation, and the related negative repercussions.

Future Directions

With the increasing attention being paid to pregnant and parenting women in prisons, it has become apparent that there is very little information maintained to track the number of pregnant women, the outcome of those pregnancies, and the numbers of children born or housed within prisons throughout the world. Poso et al. (2010) refer to the “institutional invisibility” of these children and the policies and practices related to children and their parents. In the USA, research has found that correctional administrators are generally unfamiliar with prison nursery programs (Campbell and Carlson 2012). While these administrators expressed some interest in learning more about this type of program, they expressed reservations that would ever be implemented in their state or facility. At a minimum, facilities should consider focusing on ways to facilitate relationships between incarcerated mothers and their children, including creating visitation areas for children that provide a more homelike setting or allowing mothers to create audio-recordings of bedtime stories that they could send to their children (Bastick and Townhead 2008). Other community-based programs face issues with maintaining sufficient resources to serve the women and children who need them.

Most of the parenting women in prison-based programs are low risk and could reasonably serve their sentences in the community. The Women’s Prison Association suggests increasing the use of community corrections and alternatives to imprisonment for parenting women. Whether in a prison-based or in a community-based program, these programs should address the needs of both the woman and her family and should offer educational and vocational services as well as education on parenting skills. More generally, there is a great need for additional research and evaluation to assess these programs, including the components that produce the greatest benefit to both the women and their children.

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