Ill-equipped prisons and lack of health care access leave pregnant prisoners and their children at significant risk

A new Nuffield Trust report explores the health care experiences of women in prison.

Press release

Published: 19/07/2022

A lack of appropriate maternity facilities and staffing is putting women in prison at significant risk of pre-term labour, missed midwifery appointments, and without appropriate support for mothers and young children dealing with the severe impact of separation.

Findings from the Nuffield Trust , reported by The Guardian, reveal that over one in ten (11%) of women in prison who gave birth between 2016 and 2019 went into preterm labour, while more than a fifth of midwifery appointments are being missed by pregnant prisoners due to problems accessing hospital and care services.

It comes at a time when government continues with plans to build 500 more prison places for women despite opposition from charities and advocacy groups and following the published reports into the tragic deaths of newborns at HMP Bronzefield and HMP Styal.

Inequality on the inside: Using hospital data to understand the key health care issues for women in prison calls for urgent action to better understand and tackle issues with accessing healthcare for women in prison compared with their counterparts in the general population. It finds:

  • Women in prison are almost twice as likely to go into preterm labour or delivery (11%) proportionately compared to the general population (6.5%).
  • In 2019/20, 109 women had given birth in hospital within the last two years before prison. To date, there has been no routine data collected on prisoners with young children, so it is very unclear that mothers in prison are receiving adequate support.
  • The capacity of mother and baby units is not large enough for the number of women in prison who have very young children born within the last 18 months (75) and would be entitled to make use of them. The national capacity of mother and baby units in prison is 64 mothers and 70 babies according to the Ministry of Justice (1).
  • In 2019/20, Women in prison are almost twice as likely to miss obstetric appointments as the wider population, with 31.5% of appointments missed compared to 16.8% in the wider population.
  • In 2019/20, Midwifery appointments were also missed by a slightly greater proportion of the prison population (21.5% compared to 16%).
  • Just under 45% of all outpatient appointments for women were missed in 2019/20. Missed appointments are a long-standing issue with access to health care services in prison and show little signs of improvement. Challenges remain likely to be a symptom of wider problems the prison estate faces, particularly staff availability.  

Labour continues to be an especially high risk point. Previous findings from the Nuffield Trust revealed in 2017/18, show that just over 1 in 10 births by women in prison took place outside a hospital setting, meaning they gave birth either in a prison cell or on the way to the hospital.

The report, funded by the Health Foundation, calls on the government and health care bodies to prioritise better data collection about the maternity health needs of women in prison and those with children before entering prison, and to tackle the long-standing issues with access to appointments across the prison estate.

Report author and Nuffield Trust Senior Research Fellow Dr Miranda Davies said:

“Women in prison face many of the same difficulties accessing vital health and care services that we have seen across the prison estate in England. The tragic circumstances leading to the deaths of newborns at HMP Bronzefield, and HMP Styal have led to steps that acknowledge and plan for the health care needs of pregnant and postnatal women in prison and their children, but more needs to be done.

“While the number of pregnant women in prison are small, the risks to these women and their babies are very real. Prisons and their staff are not equipped to support women or newborn babies who require specialist care, so the risks to the one in ten women in prisons going into pre-term labour or giving birth in their cell or on the way to the hospital are extremely worrying. Appointments that could help to prevent and mitigate these risks are also being routinely missed.

“If the government remains so set on building new prison places for female prisoners, it urgently needs to get a handle on these specific health care issues for women and how to address them or we continue to put these mothers and children at risk.”

Notes to editors

  1. There are six mother and baby units in prisons in England where women can apply to stay if they have a child under 18 months old when they enter prison or give birth in prison.

About the report:

  • This project was funded by The Health Foundation, an independent charity committed to bringing about better health and health care for people in the UK.
  • For this report, we used Hospital Episode Statistics (HES) data to look at female prisoners' use of hospital services including admitted patient care and outpatient services in England. The focus of this report is on data from 2019/20, but we also refer to historical data from 2016/17 onwards for certain aspects of the analysis, where appropriate, such as when we look at hospital activity associated with pregnant women in prison. We used postcode as a proxy for prison location and therefore associated hospital activity linked to prisoners.
  • The Prisons & Probation Ombudsman published reports following the tragic deaths of newborn babies at HMP Bronzefield in 2019 and HMP Styal in 2020. [LINKS]

About Nuffield Trust

  1. The Nuffield Trust is an independent health think tank. We aim to improve the quality of health care in the UK by providing evidence-based research and policy analysis and informing and generating debate www.nuffieldtrust.org.uk.

  2. For all queries or to arrange an interview, contact: Simon Keen: 07780 475571 / simon.keen@nuffieldtrust.org.uk; or Eleanor Martin: 07920 043676 / eleanor.martin@nuffieldtrust.org.uk

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