89.Relatively little research has been done about women’s experiences of pregnancy and maternity in prison. One of the few studies undertaken was that conducted by Dr Laura Abbott from the University of Hertfordshire, who told us:
“There was overwhelmingly a sense of incredible stress, distress and frustration from the women who I spoke to. They did not understand or know what they were entitled to and what their rights were.”
90.The evidence on the quality of care given to pregnant women in prisons makes us concerned about whether their dignity and right to respect for private life (Article 8 ECHR) is being adequately protected. For example, Polly, who was four months pregnant when she entered prison, and who had been sentenced to 6 months for interfering with her electricity meter, told researchers:
“When I lost my baby, I was bleeding on my own in my cell for hours. I was terrified, and the prison said they would get me to the doctors in the morning. I was in so much pain they called an ambulance eventually. I lost my baby on the way to the hospital, in handcuffs. I will never forgive them for that. There was no need for cuffs. I wasn’t exactly running away, was I?”
91.Concerns were also raised about access to basic necessities. Dr Laura Abbott gave us the example of breastfeeding women or those who have been recently separated from a new-born baby, not having access to breast pads which they found “frustrating, incredibly embarrassing and really upsetting.” Other women were reported to be hungry and their nutritional needs not met.
92.The Women’s Policy Framework (WPF) and supporting guidance were issued in December 2018 and require that the needs of pregnant women and women who have given birth are assessed and addressed, and that pre-natal and post-natal care is available in all women’s prisons. This is a welcome commitment and we look forward to it being fully implemented across the women’s custodial estate.
93.It has been reported that some women have given birth in prison. Without accurate data collection, collation and publication it is impossible to know how widespread this issue is (see recommendations in Chapter 3) but in October 2017 Birth Companions wrote to the HMPPS Women’s Team about a number of incidents where women in custody gave birth in inappropriate settings, including in prison cells. As the Royal College of Midwives highlights this can pose serious risks to human rights:
“We would also like to alert the Committee to dangerous practices in prisons where women are denied access to qualified maternity practitioners when in labour. This risks the health of mother and newborn, and risks a breach of Article 2 [ … ] If a woman is denied access to maternity care which results in harm, we argue this could be a breach of Article 3.”
94.Edward Argar MP, Parliamentary Under Secretary of State for Justice sought to reassure us that the introduction of the Women’s Policy Framework will ensure that women are able to access the care they need when the need it:
“All pregnant women in prison will have an individual care and management plan that is communicated to staff, and they will be seen by a midwife at least fortnightly or as required. Should any concerns be raised by a pregnant prisoner and there are no midwives in the prison, telephone access will be provided to enable the woman to phone the labour ward for advice and reassurance or prison staff will alert healthcare staff, who will contact the local hospital maternity unit. Medical emergencies are dealt with by 999 calls and prisoners have access to an emergency bell to alert staff at night.”
95.The evidence we have received about the experiences of these women serve to demonstrate to us that their imprisonment poses a threat to their human rights. The Government’s commitments to improving the care of pregnant women and those who give birth in prison are welcome and must be implemented swiftly.
96.It is nearly always in their best interests for babies and very young children to be with their mothers during the crucial stages of early development. Mother and Baby Units (MBUs) enable women to stay with their babies and young children up until the age of 18 months and provide parenting support. There are six MBUs in England and Wales with a total capacity of 64 babies. Figures provided to the Committee by the Ministry of Justice show that these places are underutilised.
97.There is no automatic transition of new mothers from the usual prison setting to MBUs after birth; women must make an application and only approximately 50% of women will gain a place with their baby with the remaining 50% separated from their babies shortly after birth.
98.Prison Service Instruction 49/2014 sets out the application process for MBU places. It states that women who are eligible should be encouraged to make an application for a place in an MBU at the earliest opportunity. In practice though, women are not able to apply for places before they get to prison meaning that the ‘earliest opportunity’ is on arrival. As a result, women are routinely separated from their babies while their applications are being processed. Dr Laura Abbott cited this example from her research:
“I spoke to one woman who had a three-week-old baby when she was sentenced to a prison where she was not able to take her baby with her. She was a breastfeeding mother. She was reunited with her baby about two months later, so it is not automatic that mothers will go with their baby to the mother-and-baby unit.”
99.We also heard evidence that women can face very long delays in finding out whether they have a place at an MBU, with some women giving birth without knowing if they have a place. There is very little support for women who are separated from their babies despite the risk this situation holds for suicide and self-harm.
100.The Female Offender Strategy notes that the MoJ intends to review the operation of mother and baby units “[t]o ensure that the existing provision responds to need and offers the best support to women and their children [ …]” We welcome the Ministry of Justice review of mother and baby units. It should ensure that mothers are not separated from their babies simply because they have been imprisoned. The process for applying for and allocating places in Mother and Baby Units (MBUs) must be reformed. If a baby is born during the mother’s sentence, they should both be discharged from hospital directly to an MBU, other than in exceptional circumstances When a baby is born shortly before the mother’s sentence begins, the sentence should only in exceptional circumstances start before a place is secured in an MBU.
118 [Dr Laura Abbott]
119 Lucy Baldwin and Rona Epstein, , July 2017, p. 29
120 [Dr Laura Abbott]
121 [Dr Laura Abbott]
122 The Royal College of Midwives ()
123 The Royal College of Midwives ()
124 Ministry of Justice ()
125 Bronzefield, Eastwood Park, Styal, New Hall, Peterborough and Askham Grange.
126 The Royal College of Midwives ()
127 Ministry of Justice ()
128 The Royal College of Midwives ()
129 National Offender Management Service, , December 2014
130 [Dr Laura Abbott]
131 [Naomi Dalep]
132 [Naomi Dalep]
133 Ministry of Justice, , Cm 9642, July 2018
Published: 9 September 2019