Women's prisons should routinely offer pregnancy tests on arrival, inspectorate recommends

The Department of Corrections' Office of the Inspectorate has released a report into how pregnant women and those with children under 24 months are managed in New Zealand's three women's prisons.

The report found that generally, pregnant women in prison receive the same standard of maternity care as they would in the community, and in some cases, are seen more often by their midwife.

But more needs to be done to ensure all women receive pregnancy tests on entry and then address the issues of mothers coping with alcohol and drug addictions.

Corrections' Pregnancy Healthcare Pathway requires that "Wāhine/woman aged 50 years or less are offered a pregnancy test on arrival into a custodial setting, or near after".

When prisoners are inducted on arrival they meet with a nurse and are asked "are you, or do you think you might be pregnant", the report said.

"We were advised that pregnancy tests are not offered in the Receiving Office because there is a lack of space and insufficient privacy. However, if a woman tells the nurse she is pregnant or might be, she will be prioritised with a triage score of one (immediate health need) or two (semi urgent health need) and will be scheduled to be reviewed by a nurse within 24 hours or one week with a more comprehensive Initial Health Assessment being completed."

"From our review it appeared that women were only offered pregnancy tests if they thought they may be pregnant or advised they were pregnant. They were not being proactively offered a pregnancy test as required by Corrections' Pregnancy Healthcare Pathway.

"While we understand that the Receiving Office may not be an appropriate place to undertake a pregnancy test, it is important that women are informed of the option of having a pregnancy test soon after their reception into prison. We have therefore included as an area for consideration that Corrections ensures this happens."

Chief Inspector and author of the report Janis Adair told Morning Report she thinks it is a real missed opportunity.

The earlier pregnancy is identified, the better plugged in to care someone will be, Adair said.

The report found more broadly that pregnancy was identified sufficiently early enough, she said.

Largely, the women that inspectors spoke to "were largely positive about their access to pregnancy tests", the report found. Though it found a number of the women had been unaware they were pregnant until after they were remanded in custody".

Since 2011, someone who has a baby in prison has been able to have their children with them in prison until 2 years old.

"What the investigation has found is that generally speaking, that opportunity for women to continue to be the primary care giver was under utilised and frankly not as well understood by Corrections staff as well as it should probably be so it's a real missed opportunity," Adair said.

There has been significant improvement to the facilities at each three sites in the past few years, she said.

This report is based on information gathered from a range of custodial and health records, and through observations and interviews during site visits in 2022.

The prisons were visited by inspectors between February and June 2022 and then again at the end of 2022.

There remained limited training for staff in the Mothers with Babies units, the report found.

Overarching recommendations

• Corrections must develop a Practice Centre setting out guidance for the management of women who reside in a Mothers with Babies unit, are pregnant or who have children in the community under 24 months, from when they arrive at prison through to when they are released.
• Corrections must ensure better collection of information about women who arrive at site with children under 24 months in the community, having regard to the privacy interests of the children.
• Corrections must better support women to maintain relationships with their children in the community, including both in-person visits and telephone and video calls.
• Corrections must better support, including through welfare checks, women who return to prison from hospital having miscarried, terminated a pregnancy or who have given birth where the child remains in the community.
• Corrections must develop criteria for selecting those staff most suitable for working in the Mothers with Babies unit, and appropriate training package for staff in the unit, and ensure that all staff who work in the unit have completed this and ongoing training.
• Corrections must develop and implement an assurance framework to ensure its policies for pregnant women and women with children under 24 months are being consistently applied across all three women's sites.
• Corrections must consider how comparable overseas jurisdictions manage visits for children, and consider the report of the Ministerial Committee of Inquiry into the Prison System, Te Ara Hou: the New Way, including the recommendation for visiting centres for children up to the age of five, and that assistance with transport and accommodation be provided across the entire prison network.

Department of Corrections deputy national commissioner Brigid Kean said it welcomed the report and it was "pleasing" it had noted its women's prisons provided a warm and comfortable environment for mothers.

"However, we acknowledge there is always more for us to do. The report makes seven recommendations, and Corrections has accepted six and partially accepted the seventh.

"The recommendations are consistent with many areas for improvement we have identified ourselves and align with work we already have underway."

Kean said it was "conscious" more needed to be done when collecting information from women arriving in prison who have children under 2 - and work was underway in this area.

"The recommendation to develop a Practice Centre was partially accepted because we believe this could be an overly prescriptive approach that does not account for the importance of tailoring our support and management to the individual needs of pregnant women and mothers.

"We have committed to developing guidance, which we feel is more appropriate to support the personal circumstances of each woman."