Advertisement
JOGC

The Unmet Contraceptive Need of Incarcerated Women in Ontario

      Abstract

      Objective

      Studies from the United States have shown that women in correctional facilities have higher rates of unintended pregnancy and unmet need for contraception compared with the general population, and that the provision of family planning services in correctional facilities may improve access to contraception. No study has examined these issues in women in correctional facilities in Canada. We aimed to describe the rates of unintended pregnancy and contraceptive use for incarcerated women in Ontario.

      Methods

      Women in a provincial correctional facility in Ontario completed a written survey in 2014. We calculated the prevalence of prior unintended pregnancy, prior therapeutic abortion, and contraception use. We calculated the unmet need for contraception, defined as the proportion of women who were not using reliable contraception among women who were sexually active and were not trying to conceive.

      Results

      Of 85 participants, 82% had been pregnant, and of these women, 77% had experienced an unintended pregnancy and 57% reported having undergone a therapeutic abortion. Regarding the most recent pregnancy, 72% of women scored their pregnancy intention as unplanned or ambivalent. Of women who were at risk for unintended pregnancy prior to incarceration, 80% were not using a reliable form of contraception.

      Conclusion

      Incarcerated women in Ontario have higher rates of unintended pregnancy and unmet need for contraception than does the general population. The provision of family planning services during and after incarceration may improve the health of individuals and reduce costs for society overall.

      Résumé

      Objectif

      Des études réalisées aux États-Unis ont démontré que les femmes en établissement correctionnel ont un plus haut taux de grossesses non désirées, que leurs besoins non satisfaits en contraception sont plus élevés que ceux de la population en général et que la prestation de services de planification familiale dans les établissements correctionnels pourrait améliorer leur accès à la contraception. Aucune étude ne s'était encore penchée sur ces questions au Canada. Notre objectif était de déterminer quels sont les taux de grossesses non désirées et d'utilisation de contraceptifs chez les femmes incarcérées en Ontario.

      Méthodes

      Les détenues d'un établissement correctionnel provincial de l'Ontario ont répondu à un sondage par écrit en 2014. Nous avons calculé la prévalence des grossesses antérieures non désirées, des avortements thérapeutiques antérieurs et de l'utilisation de contraceptifs. Nous avons également calculé les besoins non satisfaits en matière de contraception, que nous avons définis comme la proportion de femmes n'utilisant pas de méthode de contraception fiable parmi les femmes sexuellement actives qui ne cherchent pas à tomber enceintes.

      Résultats

      Quatre-vingt-deux pour cent des 85 participantes (soit 70 répondantes) avaient déjà été enceintes. De ces 70 femmes, 77 pour cent avaient eu une grossesse non désirée et 57 pour cent avaient subi un avortement thérapeutique. Concernant leur plus récente grossesse, 72 pour cent de ces femmes l'ont qualifiée de non planifiée ou se sont déclarées indécises quant au fait d'avoir un enfant. En outre, 80 pour cent des femmes qui étaient à risque d'une grossesse non désirée avant leur incarcération n'utilisaient pas de méthode de contraception fiable.

      Conclusion

      Les femmes incarcérées en Ontario ont un plus haut taux de grossesses non désirées et leurs besoins non satisfaits en contraception sont plus élevés que ceux de la population en général. La prestation de services de planification familiale à ces femmes pendant et après leur incarcération contribuerait à améliorer leur santé et à réduire les coûts pour la société dans son ensemble.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Obstetrics and Gynaecology Canada
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Sedgh G.
        • Singh S.
        • Hussain R.
        Intended and unintended pregnancies worldwide in 2012 and recent trends.
        Stud Fam Plann. 2014; 45: 301-314
        • Jones R.
        • Singh S.
        • Finer L.B.
        • Frohwirth L.F.
        Repeat abortion in the United States.
        Guttmacher Institute, New York2006: 29
        • Finer L.B.
        • Zolna M.R.
        Unintended pregnancy in the United States: incidence and disparities, 2006.
        Contraception. 2011; 84: 478-485
        • Canadian Federation for Sexual Health
        Sexual health in Canada: baseline 2007.
        Canadian Federation for Sexual Health, Ottawa, ON2007
        • Jones E.F.
        • Forrest J.D.
        • Henshaw S.K.
        • Siverman J.
        • Torres A.
        Unintended pregnancy, contraceptive practice and family planning services in developed countries.
        Fam Plann Perspect. 1988; 20: 53-67
        • Cheng D.
        • Schwarz E.B.
        • Douglas E.
        • Horon I.
        Unintended pregnancy and associated maternal preconception, prenatal and postpartum behaviors.
        Contraception. 2009; 79: 194-198
        • Maxson P.
        • Miranda M.L.
        Pregnancy intention, demographic differences, and psychosocial health.
        J Womens Health (Larchmt). 2011; 20: 1215-1223
        • Shah P.S.
        • Balkhair T.
        • Ohlsson A.
        • Beyene J.
        • Scott F.
        • Frick C.
        Intention to become pregnant and low birth weight and preterm birth: a systematic review.
        Matern Child Health J. 2011; 15: 205-216
        • Monea E.
        • Thomas A.
        Unintended pregnancy and taxpayer spending.
        Perspect Sex Reprod Health. 2011; 43: 88-93
        • Gold R.B.
        • Sonfield A.
        • Richards C.L.
        • Frost J.J.
        Next steps for America's Family Planning Program: leveraging the potential of Medicaid and Title X in an evolving health care system.
        Guttmacher Institute, 2009 (Available at:) (Accessed on August 24, 2015)
        • Norman W.V.
        Induced abortion in Canada 1974-2005: trends over the first generation with legal access.
        Contraception. 2012; 85: 185-191
        • Clarke J.G.
        • Hebert M.R.
        • Rosengard C.
        • Rose J.S.
        • DaSilva K.M.
        • Stein M.D.
        Reproductive health care and family planning needs among incarcerated women.
        Am J Public Health. 2006; 96: 834-839
        • Clarke J.G.
        • Rosengard C.
        • Rose J.
        • Hebert M.R.
        • Phipps M.G.
        • Stein M.D.
        Pregnancy attitudes and contraceptive plans among women entering jail.
        Women Health. 2006; 43: 111-130
        • Clarke J.G.
        • Rosengard C.
        • Rose J.S.
        • Hebert M.R.
        • Peipert J.
        • Stein M.D.
        Improving birth control service utilization by offering services prerelease vs postincarceration.
        Am J Public Health. 2006; 96: 840-845
        • Clarke J.G.
        • Phipps M.
        • Tong I.
        • Rose J.
        • Gold M.
        Timing of conception for pregnant women returning to jail.
        J Correct Health Care. 2010; 16: 133-138
        • Larochelle F.
        • Castro C.
        • Goldenson J.
        • Tulsky J.P.
        • Cohan D.L.
        • Blumenthal P.D.
        • et al.
        Contraceptive use and barriers to access among newly arrested women.
        J Correct Health Care. 2012; 18: 111-119
        • Sufrin C.B.
        • Creinin M.D.
        • Chang J.C.
        Contraception services for incarcerated women: a national survey of correctional health providers.
        Contraception. 2009; 80: 561-565
        • Committee on Health Care for Underserved Women
        Committee opinion No. 535: reproductive health care for incarcerated women and adolescent females.
        Obstet Gynecol. 2012; 120: 425-429
        • Statistics Canada
        Admissions to adult correctional services by jurisdiction and type of supervision, 2011/2012.
        Statistics Canada, 2014 (Available at:) (Accessed on September 15, 2015)
        • Correctional Service Canada
        Frequently asked questions.
        Correctional Service Canada, 2015 (Available at:) (Accessed on September 20, 2015)
        • Statistics Canada
        Correctional Services Program. Adult correctional statistics in Canada, 2013/2014.
        Statistics Canada, 2015 (Available at:) (Accessed on October 1, 2015)
        • Barrett G.
        • Smith S.C.
        • Wellings K.
        Conceptualisation, development, and evaluation of a measure of unplanned pregnancy.
        J Epidemiol Community Health. 2004; 58: 426-433
        • Morof D.
        • Steinauer J.
        • Haider S.
        • Liu S.
        • Darney P.
        • Barrett G.
        Evaluation of the London Measure of Unplanned Pregnancy in a United States population of women.
        PLoS One. 2012; 7: e35381
        • World Health Organization
        Unmet need for family planning.
        World Health Organization, 2013 (Available at:) (Accessed on September 15, 2015)
        • Black A.
        • Yang Q.
        • Wu Wen S.
        • Lalonde A.B.
        • Guilbert E.
        • Fisher W.
        Contraceptive use among Canadian women of reproductive age: results of a national survey.
        J Obstet Gynaecol Can. 2009; 31: 627-640
        • Raosoft
        Sample size calculator.
        Raosoft, 2004 (Available at:) (Accessed on September 12, 2013)
        • Statistics Canada
        Maternity Experiences Survey (MES).
        Statistics Canada, 2006 (Available at:) (Accessed on September 12, 2013)
        • Centers for Disease Control and Prevention
        National Survey of Family Growth: questionnaires, data sets, and related documentation.
        Centers for Disease Control and Prevention, 2011 (Available at:) (Accessed on September 14, 2013)
        • World Health Organization
        Health statistics and information systems: health survey instruments and related documents.
        World Health Organization, 2013 (Available at:) (Accessed on September 14, 2013)
        • USAID
        Questionnaires: household, woman's, and man's: demographic and health surveys methodology.
        USAID, 2011 (Available at:) (Accessed on September 14, 2013)
        • Bureau of Justice Statistics
        National Inmate Survey: year 3. Bureau of Justice Statistics.
        2012 (Available at:) (Accessed on September 16, 2013)
        • Zakaria D.
        • Thompson J.M.
        • Borgatta F.
        2007 National Inmate Infectious Diseases and Risk Behaviours Survey.
        Correctional Service Canada, 2007 (Available at:) (Accessed on September 12, 2013)
        • Bureau of Justice Statistics
        Survey of inmates in local jails.
        Bureau of Justice Statistics, 2002 (Available at:) (Accessed on September 12, 2013)
      1. The Elizabeth Fry Society, Hamilton Branch. Available at: http://www.efryhamilton.org/. Accessed on July 30, 2013.

        • Public Health Agency of Canada
        What mothers say: The Canadian Maternity Experiences Survey.
        Public Health Agency of Canada, 2009 (Available at:) (Accessed on September 12, 2013)
        • Santelli J.
        • Rochat R.
        • Hatfield-Timajchy K.
        • Gilbert B.C.
        • Curtis K.
        • Cabral R.
        • et al.
        • Unintended Pregnancy Working Group
        The measurement and meaning of unintended pregnancy.
        Perspect Sex Reprod Health. 2003; 35: 94-101
        • Kavanaugh M.L.
        • Schwarz E.B.
        Prospective assessment of pregnancy intentions using a single- versus a multi-item measure.
        Perspect Sex Reprod Health. 2009; 41: 238-243
        • Green S.
        • Foran J.
        • Kouyoumdjian F.G.
        Access to primary care in adults in a provincial correctional facility in Ontario.
        BMC Res Notes. 2016; 9: 131
        • Hauck B.
        • Costescu D.
        Barriers and misperceptions limiting widespread use of intrauterine contraception among Canadian women.
        J Obstet Gynaecol Can. 2015; 37: 606-616
        • Davis A.
        Are prisons obsolete?.
        Seven Stories Press, New York2003
        • Hulme J.
        • Dunn S.
        • Guilbert E.
        • Soon J.
        • Norman W.
        Barriers and facilitators to family planning access in Canada.
        Healthc Policy. 2015; 10: 48-63
        • Norman W.V.
        • Dunn S.
        • Guilbert E.
        • Soon J.
        • Hutchison P.
        Developing a national family planning primary healthcare research program: opportunities and priorities identified through stakeholder and Expert consultations.
        CART-GRAC, 2012 (Available at:) (Accessed on August 25, 2015)
        • Simmons K.B.
        • Rodriguez M.I.
        Reducing unintended pregnancy through provider training.
        Lancet. 2015; 386: 514-516
        • Sufrin C.
        • Oxnard T.
        • Goldenson J.
        • Simonson K.
        • Jackson A.
        Long-acting reversible contraceptives for incarcerated women: feasibility and safety of on-site provision.
        Perspect Sex Reprod Health. 2015; 47: 203-211