This week, Politico obtained and released a draft opinion revealing that the landmark Roe v. Wade Supreme Court decision may be overturned in coming months. For decades, advocates, politicians, judges, and policymakers have debated about abortion rights in the United States. However, access to abortion for incarcerated people has largely been missing from that conversation.
To ensure incarcerated people’s rights aren’t stripped further and to prevent reproductive health care disparities from widening, advocates, policymakers, and the general public can center incarcerated people in the national conversation. This is especially critical because nearly all incarcerated people reenter the community. The reproductive health care a person receives behind bars has far-reaching consequences beyond their time incarcerated.
Jails and prisons present unique barriers to abortion access
Incarcerated people face extensive challenges in accessing reproductive health care, including abortions, during incarceration. Although professional organizations including the American Congress of Obstetricians and Gynecologists and the American Public Health Association have established standards for practices and services that should be provided to incarcerated people, including access to abortion services and counseling, federal and state policies do not reflect these standards. Only 23 states have standards that address abortions during incarceration.
Further, incarcerated people may be unaware of abortion policies, and carceral staff have a history of using their own discretion to refuse requests for abortion services. A 2009 study found that only 68 percent of incarcerated people in women’s prisons believed their facility permitted women to obtain elective abortions, despite the absence of actual legal bans. (Note that in this post we are using the term “women” to align with the data sources referenced, however we recognize that many data sources conflate sex and gender and are not inclusive of everyone’s gender identity.)
Financial costs also pose a major barrier to accessing abortions during incarceration. A recent study of abortion policies in jails and prisons found two-thirds of prisons that allowed abortions required the incarcerated woman to pay for the procedure. A 2014 study found the average cost of an abortion varies by state, is typically more expensive in states with limited abortion access, and ranged from $508 at 10 weeks of gestation to $1,195 at 20 weeks of gestation.
Incarcerated people seeking abortions can be responsible not only for the cost of the medical procedure, but also for additional costs, including gas, tolls, other transportation fees, and officer time for transportation to the clinic. These costs are significant for incarcerated people who, on average, make a minimum daily wage of $0.86 and a maximum daily wage of $3.45.
Geography can present additional barriers. Prisons are often located in rural areas, but abortion services are concentrated in urban areas. In a study that georeferenced 643 abortion clinics with 95 state and federal prisons, researchers found that the average distance from a prison to a clinic offering abortion services varied from under a mile in Illinois and Pennsylvania to over 100 miles in West Virginia. This increases transportation costs, especially because many states require two visits before someone can receive an abortion.
Though abortion funds may be available to assist with costs, in many cases, incarcerated people are responsible for identifying an abortion provider themselves without assistance from prison staff. This creates additional challenges, such as not having access to stable Internet, personal identification documents, or sufficient money to afford stamps and mail paperwork.
Timing is another challenge, particularly for incarcerated people who have to navigate through the system, as abortion restrictions at certain points in pregnancy vary across the country.
Who does this affect most?
The very nature of being incarcerated undermines and violates bodily autonomy and reproductive freedom because it limits people from freely making decisions about their own well-being.
Mass incarceration in the United States disproportionately affects communities of color, particularly Black communities that have experienced centuries of disinvestment, overpolicing, and overincarceration that stem from the legacies of slavery and Jim Crow. Therefore, violations of incarcerated people’s reproductive rights especially affect Black people as they experience high rates of maternal mortality.
Further, the number of incarcerated women has increased 775 percent since 1980. Among women who enter prisons, the majority are of childbearing age, have been pregnant in the past, and are more likely to have risk factors for poor perinatal outcomes. And many incarcerated women have histories of physical or sexual violence, which contribute to high rates of serious medical conditions, including sexually transmitted infections that often go untreated.
It’s also critical to acknowledge that people of all gender identities can be pregnant and require access to an abortion. LGBTQ+ people have specific and significant reproductive health needs prior to and during incarceration. Transgender people in particular may face additional challenges in accessing reproductive health care while incarcerated.
And lastly, people with low incomes are overrepresented in the criminal legal system, experience unintended pregnancies, and terminate pregnancies at higher rates because of many underlying factors, particularly lack of reproductive health services.
It’s time to include incarcerated people in the conversation
Abortion services aren’t explicitly prohibited for incarcerated people, but they are already largely inaccessible. If abortion rights are left up to the states as anticipated, it will be especially critical to get this evidence into the hands of local providers and state policymakers so incarcerated people aren’t further forgotten.
The Urban Institute has the evidence to show what it will take to create a society where everyone has a fair shot at achieving their vision of success.