Teaching Residents about Family Planning and Disparities by Taking Care of Incarcerated Women

Carolyn Sufrin, MD, PhD.

Jail might seem a strange place for a resident to be. But that’s where we at UCSF have been taking our Ob/Gyn interns for the last five years every Monday—and not because they have committed a crime. As part of their ambulatory care rotation, interns spend six clinic sessions at the county jail, caring for one of the most marginalized groups of patients in our country. The millions of women who pass through our nation’s jails and prisons every year have lives that are often characterized by poverty, addiction, histories of physical and sexual abuse, unemployment, mental illness, racial inequalities, health disparities, and poor access to health care. Two-thirds of these women are mothers to children younger than 18 years old. The so-called “war on drugs” has led to a 757% increase in the number of women, especially women of color, behind bars—now over 200,000 on any given day– since 1980, most of whom are there for non-violent crimes.

So why send Ob/Gyn residents to jail? What can they learn from providing care in a constrained, punitive environment? A lot, it turns out. With a median age of 32, these are women of reproductive age; they have significant reproductive health needs which have been neglected by prisons and jails. Studies have shown that these women report a high rate of prior unintended pregnancies (83%), abortion (55%), STIs (50%), and low rates of consistent contraception use prior to incarceration (28%). There are as many as 15,000 pregnant incarcerated women at any given time, and many of them first learn they are pregnant when they enter prison or jail. For an Ob/Gyn resident, then, caring for incarcerated women presents tremendous opportunities to provide reproductive health care for a uniquely underserved population. From contraception to preconception counseling, from prenatal care to arranging abortion services, residents see how these core reproductive health issues fit into a bigger picture of social justice.

In addition to supervised clinical care, the rotation also includes a “Caring for Challenging Patients” exercise, weekly readings in the social sciences, and an end-of-rotation essay. This coordinated curriculum encourages residents to think more broadly about reproductive justice, a framework which puts women’s abilities to determine their reproductive destinies into the context of race and class disparities. Residents read about coerced, eugenics sterilization of institutionalized women, about racial disparities in mass incarceration, about women’s experiences of homelessness and drug addiction, incarceration of pregnant women who use drugs, and other topics which highlight the key issues in reproductive health care politics that are magnified for women in prison. The curriculum also challenges residents to understand their own biases and judgments in caring for patients from different backgrounds.

Residents have responded enthusiastically to this rotation as an enriching part of their professional development. One resident wrote, “I felt, as a physician, I was helping women who had very constrained choices create more choices for themselves.” Another resident stated that “this experience reminded me of the passion I felt for my career as my desired platform to silently speak up for the rights of other women.” The patients benefit, as well, by having expanded services they might not otherwise have access to.

 Dr. Sufrin is an Obstetrician-Gynecologist and a medical anthropologist who has worked on reproductive health issues for incarcerated women for the last seven years. She is currently  working on a book, Jailcare: The Safety Net of a U.S. Women’s Jail.