An estimated 5% of women in jails are pregnant, and human rights groups and researchers have collected evidence that these women often receive poor care and are neglected.1

One solution is to provide contraceptive care to incarcerated women who would like to avoid pregnancy. Contraceptive Technology Update interviewed two researchers who have studied a program that provides contraceptive access to women with substance use disorders in county jails: Clea McNeely, DrPH, research professor at the University of Tennessee College of Nursing, and Tara L. Sturdivant, MD, regional medical director at the Tennessee Department of Health.

McNeely and Sturdivant answered a few questions via email about their research.

CTU: How would you describe your study’s comprehensive family planning education sessions and the impetus behind these?

Sturdivant: The original objective of our comprehensive family planning education sessions was to educate female inmates in the jail system on the value of reproductive life planning and the potential risks that occur when an infant has in utero exposure to addictive drugs. We also discussed the availability of family planning services, various contraceptive methods, and other preventive health services available at the local health departments.

The impetus behind these sessions was the very high number of babies born drug-dependent in Tennessee, particularly in rural east Tennessee. According to the Tennessee Department of Health Office of Health Statistics, Hospital Discharge Data and Birth Statistical Data, Tennessee had seen almost a seventeenfold increase in the NAS [neonatal abstinence syndrome] hospitalization rate between 1999 and 2012. A total of 921 NAS cases were identified in 2013, the year the program was conceived. The rural, 15-county region where the program began accounted for 268 of those reported cases.2

CTU: What did your data show?

McNeely: We conducted a pilot study, which means that our findings are not necessarily generalizable to people who didn’t participate in the study. We asked two questions: Was the information delivered to women accurate? Did the participants in the education sessions feel pressured to get a long-acting reversible contraceptive (LARC) method?2

The answer to the first question was yes. We found that the information delivered in the comprehensive family planning education sessions was accurate. The answer to the question of whether participants felt pressured to get a LARC was no. The women reported that their participation in the education session was voluntary, as was the choice to receive a LARC. A few women thought that the nurse educators were actively promoting the benefits of birth control, but none of the women we spoke to perceived any pressure to receive a contraceptive method.2

Several of the women expressed appreciation for the opportunity to get a LARC at no cost, which was made available after the education session. There are some quotes in the paper that are representative of women’s experiences.

CTU: How might this type of education session help reduce disparities and fill gaps in contraceptive care?

Sturdivant: The education enables individuals to make informed decisions and better understand the options that are available to them. The participants interviewed reported increased knowledge, participation in, and comfort with decision-making regarding contraceptive use.

The key to the success of the education sessions was the direct linkage between education and access to family planning services. No-cost family planning services were offered at the education sessions, along with information about how to access low-cost preventive health services.

The Tennessee Department of Health is focused on improving rural maternal health outcomes through the implementation of innovative partnerships with national, state, and local organizations. A priority is to reduce the maternal mortality rate for rural women.

CTU: Since your paper was published in 2019, have other departments of health inquired and/or implemented similar education programs? Has the partnership between the East Region of the Tennessee Department of Health and county correctional facilities continued for the purpose of these educational sessions?

Sturdivant: We have had other states reach out for study information and teaching tools. We have shared this outreach initiative with state family planning administrators through our collaboration with the National Family Planning and Reproductive Health Association. We discontinued group in-person educational sessions in March, once COVID-19 became a safety concern in jails, courthouses, and health departments.

CTU: What do you think is the take-home message from your study and intervention?

McNeely: The take-home message of our study is that it is possible to provide comprehensive reproductive health education in rural jails and to increase voluntary access to contraception in a way that women feel respected and valued, and in a way that protects their autonomy.

REFERENCES

  1. Wagner P, Widra E. No need to wait for pandemics: The public health case for criminal justice reform. Prison Policy Initiative. March 6, 2020. https://www.prisonpolicy.org/blog/2020/03/06/pandemic/
  2. McNeely CA, Hutson S, Sturdivant TL, et al. Expanding contraceptive access for women with substance use disorders: Partnerships between public health departments and county jails. J Public Health Manag Pract 2019;25:229-237.