Updates! HB0235 – Correctional Services – Pregnant Incarcerated Individuals – Substance Abuse Assessment and Treatment – was not placed for a vote by the House Judiciary Committee during the 2021 Maryland General Assembly session. This usually indicates that more work and/or support is needed before the bill is considered ready for a committee voting session. We will convene the leadership of RJI and determine the next steps in improving pregnancy related healthcare for those inside the walls, as well as pregnant individuals returning to their communities.
We are eliminating barriers for incarcerated and detained individuals to receive quality and timely sexual and reproductive healthcare, instituting appropriate and clear written policies in all correctional and detention facilities, and helping more pregnant people learn about their rights to healthcare and services. In 2017, our affiliate has convened a coalition, Reproductive Justice Inside (RJI), which is collecting stories from current and previously incarcerated or detained individuals of being denied, delayed, or provided poor sexual or reproductive healthcare while in the care/custody/control of the state.
In the 2020 legislative session. and now during the current 2021 session, the RJI coalition is working to pass what we have been calling PICCA (The Pregnant Incarcerated Continuity of Care Act):
HB0235 – Correctional Services – Pregnant Incarcerated Individuals – Substance Abuse Assessment and Treatment
Lead Sponsor – Delegate Wanika Fisher – Hearing in House Judiciary Committee – Tuesday, January 26th at 1:30 p.m. Committee vote is pending
This legislation will ensure that pregnant incarcerated individuals will be able to access critical healthcare and be provided continuity of care upon release through coordinated and implemented reentry and referral plans. The bill calls for proper assessment for any factor contributing to a high-risk pregnancy, such as substance use, mental health, or HIV status. Receiving appropriate healthcare and assessment while inside, no matter the length of confinement, with coordination of continued care upon release will lead to improved pregnancy outcomes. This effort is good risk management for our correctional facilities and jurisdictions, and badly needed as our correctional systems continue to struggle with appropriate and timely responses to the COVID-19 pandemic.
More about this bill:
What is the issue?
Already a vulnerable population while incarcerated, pregnant inmates who are preparing to be released lack the support upon re-entry for their unique health needs. Pregnant inmates must be afforded continuity of reproductive health care upon release and there should be a relationship with community- based partners for care in the jurisdiction they will return to.
What this legislation does:
- It applies to all sentenced pregnant individuals who are being released
- It requires that they will be offered pre-natal testing and assessments to ensure the health of their pregnancy
- It requires that they will be offered screening for mental health and substance use disorder
- It requires that before their release, the institution will arrange health insurance coverage to become effective not later than 24 hours after her release
- It requires that before their release, the institution to make referrals to a qualified reproductive health care provider that offers specialized services for pregnant and postpartum care in the jurisdiction she will return to
- It requires they before their release, the institution to make referrals to a community based mental health and substance use professionals in the jurisdiction she will return to
- It requires that not later than 10 calendar days after her release, she will be provided with a complete set of her medical records, evaluations and test results.
Why is this legislation important?
Continuity of care would help to prevent adverse health outcomes for parent and child, as well as prevent unnecessary pregnancy complications. Additionally, pregnant inmates who present with a substance use disorder must also be afforded comprehensive assessment and offered medication assisted treatment as well as be offered mental health evaluations and care prior to release.
Currently, there is no care coordination provided between public safety institutions and community-based providers. This legislation will ensure that there is a clear referral to those providers and create a pathway that can lead to improved maternal health outcomes. The transition time between release and accessing reproductive health care represents a high-risk period for these individuals. It is also good risk management for the State and local jurisdictions.
The National Commission on Correctional Health (NCCHC) the American Congress of Obstetricians and Gynecologists (ACOG) and the American Public Health Association (APHA) all recommend that pregnant inmates receive timely and appropriate prenatal care, specialized obstetrical services when indicated, and postpartum care. They also stress the importance of providing assessments and treatments for substance abuse and mental health.
More about these pregnant individuals:
“According to a study published in the June 2017 Health Affairs, coauthored by Dr. Wang, about 80% of people released from prison have chronic medical, psychiatric, or substance abuse disorders, but care coordination is rare to nonexistent between prison and community health care settings. Many prisoners are never referred to a community physician or clinic or given their medical records upon release. Although the Affordable Care Act (ACA) allowed many former prisoners to become insured under Medicaid after 2014, insurance is only one among many barriers.”1
The National Commission on Correctional Health Care also weighed in on the need to view incarcerated women as a special population and to provide appropriate treatment. They recommended screening, health assessment, nutrition guidelines and medical diets, pregnancy counseling, and comprehensive services for incarcerated women’s unique health problems. They have health-care needs that are minimally met by prison systems. Many of these mothers have high-risk pregnancies due to the economic and social problems that led them to be incarcerated: poverty, lack of education, inadequate health care, and substance abuse.
With the growing number of incarcerated women who are pregnant, it is important to recognize that failing to provide preventive and curative health care for these women may cost more to society than funding programs that might improve attachment and parenting behaviors, facilitate drug rehabilitation, and reduce recidivism among this population.
1 Colwell, J. (2017). Caring for ex-prisoners presents management challenges Retrieved from https://acpinternist.org/archives/2017/09/caring-for-ex-prisoners-presents-management-challenges.htm