1. Combining the strengths of UMIST and The Victoria University of Manchester Perinatal Healthcare in Prisons Dawn Edge Mental Health Division School of Nursing, Midwifery & Social Work PHRN Conference Manchester October 2006

2. Combining the strengths of UMIST and The Victoria University of Manchester Background Prison Health Reform Prison health substantially inferior (HM Inspector of Prisons, 1996) Merger health & prison health agreed by Home Office & DH April 2006 NHS (PCTs) assumed responsibility for prison healthcare –To ensure equivalence of healthcare for prisoners

3. Combining the strengths of UMIST and The Victoria University of Manchester Women in Prison >139 prisons England & Wales –13 for women (male: female ratio 1:16) 75% increase in overall prison population (>300% women) Increasing numbers pregnant and recently- delivered women Rapid turnover –66% remanded never sentenced –61% sentences < 6 months –Implications for care and treatment

4. Combining the strengths of UMIST and The Victoria University of Manchester Aims of The Study 1.To generate a picture of perinatal healthcare in prisons 2.To identify gaps in the literature 3.To make recommendations for the prison healthcare research agenda

5. Combining the strengths of UMIST and The Victoria University of Manchester Methods Electric & hand searches (n = 420) Phase 1: (n = 142) Academic papers, grey literature, correspondence, opinion pieces Phase 2: (n = 23) (20 US, 3 UK) Peer reviewed papers only (1995 – 2005/6) Data extraction Verification by independent assessor

6. Combining the strengths of UMIST and The Victoria University of Manchester Findings Five Themes 1.Demographics & Risk Factors Young, poor, under-educated, BME predominate: >half women in prison MBU BME (Birmingham, 2004) Victimization & neglect in childhood - 76% experienced violence as children Strong association with substance misuse – 88% problems with drugs, alcohol or both (Eliason & Arndt, 2004) Social exclusion – 36% homeless, 25% IQ <70

7. Combining the strengths of UMIST and The Victoria University of Manchester Findings 2. Perinatal Health Needs & Service Provision 7 Prison MBUs. All in England. ‘…for benefit of children who are not prisoners’ (PSO4801) Number places: 114 women, 120 babies –1 st ¼ 2006 – 100 pregnant women, 19 births –82% pregnancies unplanned –60% women in MBU RDC depression – 3 receiving treatment (started pre-sentencing) –Little/no information re: mental health needs –Women’s experiences MBU generally positive

8. Combining the strengths of UMIST and The Victoria University of Manchester Findings 3. Pregnancy Outcomes Key indicators: birth weight, still birth, birth complications –Pregnant imprisoned women have better outcomes than disadvantaged women in community –38% ‘major complications’ 34% ‘inadequate care’ – linked to sentencing (Siefert & Pimlott, 2001; Kyei-Aboagye et al 2000)

9. Combining the strengths of UMIST and The Victoria University of Manchester Findings 4. Imprisoned Mothers & Their Children Mothers –55% have children 5 – 16 (n=32,000) –33% have children < 5 (2,888 <18 months) –20% are lone mothers Children –83% tearful, sad, calling for mothers –52% appeared confused –44% behavioural difficulties – anger –37% difficulty at school –32% difficulty sleeping & developmental regression (Black et al, 2004; Kay, 2004; Poehlmann, 2005; Caddle & Crisp, 1997)

10. Combining the strengths of UMIST and The Victoria University of Manchester Findings 5. Pregnant Adolescents in Prison No UK studies Little international research Pregnant adolescents <1% prison population Pregnant adolescents poorly served –UK - 2 MBU with facilities for YO –68% girls h/o sexual abuse – increased risk pregnancy complications/poor outcomes –38% no antenatal care - ??postnatal –29% did not know where babies placed

11. Combining the strengths of UMIST and The Victoria University of Manchester Conclusions Healthcare in prison – secondary function Imprisoned women have poorer health Imprisoned pregnant women at greater risk of perinatal mental illness e.g. PND –Poor social support –Adverse life events & difficulties –Increased risk poor pregnancy outcome –History mental health problems Reality of ‘equivalence’ for mothers in prison Children suffer the unintended consequences of their mothers’ incarceration

12. Combining the strengths of UMIST and The Victoria University of Manchester Future Research Little UK research, most US Establish Common Datasets  routine data collection Outcomes Research - longitudinal –Mothers and children Complex Intervention Studies Comparative Research – e.g. Prison & Community MBU Service Evaluation –Users and carers’ perspectives –Structural and process issues

13. Combining the strengths of UMIST and The Victoria University of Manchester Contact Details Dr Dawn Edge School of Nursing Midwifery & Social Work Coupland III The University of Manchester Oxford Road M13 9PL Tel: 0161 275 5553 dawn.edge@manchester.ac.uk