Factors that impede women's contraceptive care needs during and immediately after incarceration in New South Wales, Australian. Qualitative perspectives of professional staff working with incarcerated women.

Abstract

Women with a history of incarceration report higher rates of pregnancy and abortion, lower contraception use and poorer birth outcomes compared to other women in the community. This suggests family-planning and reproductive-health needs that are not well served by current models of care. Despite this, little is known about how contraception is provided within Australian carceral settings, or the structural barriers experienced by professional staff working in these environments. We report findings from a qualitative study conducted in New South Wales (NSW), Australia, describing professional staff's views of factors that support or impede women's contraceptive care needs both during and immediately after incarceration. We conducted semi-structured interviews with n = 12 professionals working in NSW, who either provide healthcare services or individual case management to women during incarceration or in the immediate post-release period. Data was analysed thematically, initially guided by the Vulnerable Populations Behaviour Model and adjusted iteratively as analysis developed. Participants described contraceptive needs and preferences as shaped by 1) a state of interrupted fertility caused by incarceration, and 2) post-release instability and intersecting demands, which impeded access to community family planning. Areas of high need were characterised by 1) accessible, reversible and non-invasive contraception options, and 2) thoughtful counselling. Structural factors impeding contraception service access during incarceration included: 1) service priorities 2) poor overall health service integration, and 3) inequitable funding models. Structural constraints during incarceration, staff attitudes and women's complex post-release circumstances, limit equitable contraception care, underscoring the need to address barriers at system, clinician and patient levels.