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Reproductive Health Issues in Newly Incarcerated Women at Cook County Jail. Elizabeth Feldman, MD Kathleen Talamayan, MD, MPH Cermak Health Services of Cook County Linda Forst, MD, MPH University of Illinois at Chicago. Acknowledgments.

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Reproductive health issues in newly incarcerated women at cook county jail

Reproductive Health Issues in Newly Incarcerated Women at Cook County Jail

Elizabeth Feldman, MD

Kathleen Talamayan, MD, MPH

Cermak Health Services of Cook County

Linda Forst, MD, MPH

University of Illinois at Chicago


  • Adina Goldberger, MS2, Miranda Hart, MD, and Rose Kiken, BSN served as research assistants

  • Carolyn Sufrin, MD for her 2010 NCCHC presentation and willingness to permit us to adapt her survey instrument


  • 37 yo G4P2002 c/o opioid withdrawal

  • Multiple arrests for retail theft, PCS, prostitution

  • Unprotected vaginal intercourse in previous 5 days

  • Never used hormonal contraception

  • +GC dx last incarceration

  • + regular tobacco use, + 3-4 bags intranasal heroin/d

  • Urine HCG negative


  • Women represent the fastest growing prison population (Greenfield and Snell,1999, Staton et al, 2003)

  • Incarcerated women are underserved and socioeconomically disadvantaged (Covington,2007)

  • This population has reduced access to and utilization of family planning services (US DHHS)


  • In the US, 39m women are at risk for unplanned pregnancy (Clark et al, 2006a)

  • Of those women at risk for unplanned pregnancy, 67% report inconsistent use of birth control (Clark et al, 2006a)

  • Despite OTC availability, emergency contraception (EC) is underutilized (Devine,2012)

  • Only 4% of women ages 15-44 who have ever had sexual intercourse have used EC (CDC, 2005)

Public health opportunity
Public Health Opportunity

  • Jail setting is a unique access point for high risk women

  • Opportunity to provide reproductive health education and services including contraception

  • Provision of EC at entry may impact unintended pregnancies in incarcerated women

  • Offering birth control services pre-release improves likelihood of initiating contraceptive use after release (Clarke, 2006b)


Explore reproductive health needs among newly incarcerated urban women

Describe the knowledge, attitudes and practices related to long term and emergency contraception

Discuss barriers to utilization of contraception

Advocate for policy change within Cook County Jail to provide EC at entry and contraception prior to release


  • Design: Cross-sectional

  • Participants: newly incarcerated women, 18-50 yo

  • Recruitment: convenient nights, 33 occasions over 14 month period

  • Survey: 41 items, face to face interview

  • Data: frequency analysis

  • Human Subjects: CCBHCS IRB protocol for research on incarcerated subjects

Barriers to use of ec
Barriers to Use of EC Regarding EC

Discussion ec at intake
Discussion: EC at Intake Regarding EC

  • 66% of those who had had recent sex reported it was unprotected

  • 21% of our sample had unprotected sex within previous 5 days

  • 70% of our sample would take EC if offered

  • As many as 1982 women annually may be eligible for EC at entry to Cook County jail

  • As many as 1387 doses may be dispensed

Discussion birth control services
Discussion: Birth Control Services Regarding EC

  • Majority of women did not wish to become pregnant

  • Majority wanted to use birth control

  • Only about 1/3 had used any birth control in the past year, and a much smaller number were currently using hormonal contraception

  • Most women would accept free birth control prior to release from jail

Discussion Regarding EC

Newly incarcerated women are at high risk for unintended pregnancy

Knowledge about EC and ability to access birth control services are both significantly limited

Other studies show that interventions during incarceration work (Clarke, et al)

During incarceration there is an opportunity to provide sex education - “teachable moment”

Recommendations intake
Recommendations: Intake Regarding EC

Intake screening to identify women at risk for unintended pregnancy during previous three to five days

Intake providers educated about use and provision of emergency contraception

Emergency contraception immediately available during Intake to jail for those women who desire it

Recommendations birth control
Recommendations: Birth Control Regarding EC

  • Implement reproductive health education for incarcerated women

  • Provide opportunity to meet with health care provider to discuss contraceptive choices for those who desire

  • Offer birth control services prior to release

Limitations of the study
Limitations of the Study Regarding EC

  • Study based on convenience sample may not be representative of all incarcerated women

  • Small sample size

  • Self report data introduces some bias

  • Utilized frequency analysis

Case continued
Case, continued Regarding EC

  • Pt urine + chlamydia

  • PAP showed ASCUS, cannot r/o HGSIL

  • colpo with LGSIL, cryo performed

  • Educated about contraceptive choices by PCP, chose to start depo-Provera

  • Provider ordered first depo shot to be administered day before next court date (expected release date)

  • Pt received depo, but was not released until 6 weeks later, with info about Family Planning Clinic walk-in options at Stroger Outpatient

References Regarding EC

Baldwin, K., & Jones, J. (2000). Health issues specific to incarcerated women: Information for state maternal and child health programs. Retrieved from for Disease Control and Prevention. (2005). Fertility, family planning, and reproductive health of US. women: Data from the 2002 national survey of family growth. Vital and Health Statistics, 23(25), 1-180.Clarke, J. G., Hebert, M. R., Rosengard, C., Rose, J. S., DaSilva, K. M., & Stein, M. D. (2006a). Reproductive health care and family planning needs among incarcerated women. American Journal of Public Health, 96(5), 834-839.Clarke, J. G., Phillips. M., Tong, I., Rose, J., & Gold, Melanie, G. (2010). Timing of conception for pregnant women returning to jail. Journal of Correctional Health Care, 16(2), 133-138. Clarke, J. G., Rosengard, C., Rose, J. S., Hebert, M. R., Peipert, J., & Stein, M. D. (2006b). Improving birth control service utilization by offering services prerelease vspostincarceration. American Journal of Public Health, 96(5), 840-845. Clarke, J. G., Rosengard, C., Rose, J., Hebert, M. R., Phipps, M. G., & Stein, M. D. (2008). Pregnancy attitudes and contraceptive plans among women entering jail. Women & Health, 43(2), 111-130. Covington, S. (2007). Women and the criminal justice system. Women's Health Issues, 17(4), 180-82.Crandall, L. A., Metsch, L. R., McCoy, C. B., Chitwood, D. D., & Tobias, H. (2003). Chronic drug use and reproductive health care among low-income women in Miami, Florida: A comparative study of access, need, and utilization. Journal of Behavioral Health Sciences Research, 30(3), 312-331.

References Regarding EC

Devine, K. S. (2012). The underutilization of emergency contraception. American Journal of Nursing,112(4), 44-50. Department of Health and Human Services. (2012, Sept. 6). Family Planning. Retreived from, L.A., & Snell, T. L. (1999). Women Offenders. Washington, D.C.: Bureau of Justice Statistics.Hale, G. J., Oswalt, K. L., Cropsey, K. L., Villalobos, G. C., Ivey, S. E., & Matthews, C. A. (2009). The contraceptive needs of incarcerated women. Journal of Women's Health, 18(8), 1221-226. LaRochelle, F., Castro, C., Goldenson, J., Tulsky, J. P., Cohan, D. L., Blumenthal, P. D., & Sufrin, C.B. (2012). Contraceptive use and barriers to access among newly arrested women. Journal of Corrective Health Care, 18(2), 111-119.Oswalt, K., Hale, G. J., Cropsey, K. L., Villalobos, G. C., Ivey, S. E., & Matthews, C. A. (2010). The contraceptive needs for STD protection among women in jail. Health Education & Behavior, 37(4), 568-579.Prine, L. (2007) Emergency contraception, myths and facts. Obstetrics and Gynecology Clinics of North America, 37(1), 127-36.

References Regarding EC

Staton, M., Leukefeld, C., & Webster, J. M. (2003). Substance use, health, and mental health: problems and service utilization among incarcerated women. International Journal of Offender Therapy and Comparative Criminology, 47(2), 224-239.Sufrin, C. B., Creinin, M. D., & Chang, J. C. (2009). Contraception services for incarcerated women: A national survey of correctional health providers. Contraception, 80, 561-565.Sufrin, C. B., Tulsky, J. P., Goldenson, J., Winter, K. S., & Cohan, D.L. (2010). Emergency contraception for newly arrested women: Evidence for an unrecognized public health opportunity. Journal of Urban Health, 87(2), 244-53.

Thank you
THANK YOU Regarding EC