Research roundup: The positive impacts of family contact for incarcerated people and their families

The research is clear: visitation, mail, phone, and other forms of contact between incarcerated people and their families have positive impacts for everyone — including better health, reduced recidivism, and improvement in school. Here’s a roundup of over 50 years of empirical study, and a reminder that prisons and jails often pay little more than lip service to the benefits of family contact.

by Leah Wang, December 21, 2021

To incarcerated people and their families, it’s glaringly obvious that staying in touch by any means necessary — primarily through visits, phone calls, and mail — is tremendously important and beneficial to everyone involved. Yet prisons and jails are notorious for making communication difficult or impossible. People are incarcerated far from home and visitation access is limited, phone calls are expensive and sometimes taken away as punishment, mail is censored and delayed, and video calls and emerging technologies are all too often used as an expensive (and inferior) replacement for in-person visits.

Prison- and jail-imposed barriers to family contact fly in the face of decades of social science research showing associations between family contact and outcomes including in-prison behavior, measures of health, and reconviction after release. Advocates and families fighting for better, easier communication behind bars can turn to this research, which demonstrates that encouraging family contact is not only humane, but contributes to public safety.

In-person visitation is incredibly beneficial, reducing recidivism and improving health and behavior

The positive effects of visitation have been well-known for decades — particularly when it comes to reducing recidivism. A 1972 study on visitation that followed 843 people on parole from California prisons found that those who had no visitors during their incarceration were six times more likely to be reincarcerated than people with three or more visitors. A few years later, researchers found similar results in a study of people paroled from Hawaii State Prison.

Since the 1970s, the body of evidence in favor of prison visitation has only grown. In 2008, researchers found that among 7,000 people released from state prisons in Florida, each additional visit received during incarceration lowered the odds of two-year recidivism by 3.8 percent (in this study, recidivism was defined as reconviction). Findings out of Minnesota a few years later were similar: Receiving one visit per month was associated with a 0.9 percent decrease in someone’s risk of reincarceration; better yet, each unique visitor to an incarcerated person reduced the risk of re-conviction by a notable 3 percent.¹ Among people who received visits during their incarceration, felony re-convictions were 13 percent lower and revocations for technical violations of parole were 25 percent lower compared to people who did not receive visits.

Visitation is also correlated with adherence to prison rules. In 2019, an Iowa researcher found that in-prison misconduct (as measured by official citations) was reduced in people who received visits at Iowa state prisons. Based on these results, one additional visit per month would reduce misconduct by a further 14 percent. “Probably as a direct result of the reduced misconducts,” the study’s author notes, “a similar increase in visitation would also reduce time served by 11 percent.”

These findings add to other recent studies linking visitation and reduced prison misconduct. The timing of visits may matter, as visiting “privileges” can swiftly be taken away as a cruel punishment: According to one study, misconduct tended to decrease in the three weeks before a visit. This may explain why more frequent visits lead to more consistent good behavior, better overall outcomes and post-release success. Families who visit, concluded Holt and Miller in the California study, are a “prime treatment agent” for incarcerated people.²

Research has also found that visitation is linked to better mental health, including reduced depressive symptoms — an important intervention for the isolated, stressful experience of incarceration. Yet even before the pandemic halted visitation, and despite these known benefits, correctional facilities have made visitation hard due to remote locations, harsh policies, and the financial incentives to replace visits with inferior video calls.

Consistent phone calls to family improve relationships

Phone calls tend to be more common than in-person visitation, as they involve fewer logistical barriers. In fact, the key studies we found reveal that 80 percent or more respondents used phone calls to contact family, far more than the number receiving visits, and sometimes more than those using mail to keep in contact.³ As with visitation, family phone calls are shown to reduce the likelihood of recidivism; more consistent and/or frequent phone calls were linked to the lowest odds of returning to prison.

A 2014 study of incarcerated women found that those who had any phone contact with a family member were less likely to be reincarcerated within the five years after their release. In fact, phone contact had a stronger effect on recidivism compared to visitation, which the study also examined.

Of course, reduced recidivism is not the only benefit. A 2020 survey of incarcerated parents showed that parent-child relationships improved when they had frequent (weekly) phone calls.

These positive findings have not gone unnoticed by senior policy makers: “Meaningful communication beyond prison walls helps to promote rehabilitation and reduce recidivism,” explained Mignon Clyburn of the Federal Communications Commission (FCC) in a 2015 statement on the high cost of phone calls. “In a nation as great as ours, there is no legitimate reason why anyone else should ever again be forced to make these levels of sacrifices, to stay connected.”⁴

Given the frequency and importance of phone calls from prisons and jails, their prohibitive cost in many jurisdictions and the loss of phone “privileges” as a punishment are both inhumane and counterproductive.

Mail correspondence is a lifeline, and taking it away only hurts families

Mail is widely understood as a major lifeline for incarcerated people, with some literature finding that it’s the most common form of family contact.The fulfilling feeling of receiving personal mail, the ability to write and read (and reread) mail at one’s own pace, and the relatively low cost of a letter mean that it’s a highly practical and cherished mode of communication, universal to people both inside and outside of prison. And while prison mail hasn’t taken center stage in academic literature, some of the studies mentioned earlier did examine mail contact as part of their methods, finding that it contributes to parent-child attachment and relationship quality.

Yet mail is another example of a service whose benefits become obvious once it’s under attack. In 2007, notoriously cruel Maricopa County, Arizona, sheriff Joe Arpaio instituted a postcard-only policy in the county jail, with sheriffs in at least 14 states following suit. These postcard-only policies severely limit parents’ and children’s ability to stay in touch. A study of incarcerated parents in Arizona cited mail as the most common mode of communication with their children, and those who used mail contact reported improved relationships with their children as compared to the year before their incarceration. Postcards also change the economic argument for mail correspondence: With their tiny physical space available for writing, we found that relaying information on a postcard is about 34 times as expensive as in a letter.

In recent years, other correctional systems have embraced another mail-restriction policy that advocates know is harmful: The telecom company Smart Communications has created “MailGuard,” a mail digitization service marketed as a response to (exaggerated) claims of contraband entering prisons through the mail. MailGuard’s scans of letters and photographs tend to be low-quality, and privacy is clearly violated as one’s mail is opened and scanned. We’ve criticized this practice and maintain that mail scanning is a poor substitute for true mail correspondence.⁵

Video calling and emerging technologies could enhance carceral contact if they weren’t prohibitively expensive

Sometimes billed as “video visitation,” video calling from prisons and jails allows families to connect virtually. Used effectively as a supplement, video calls could help eliminate many of the barriers that in-person visitation presents. However, we’ve argued time and time again that these calls fail to replicate the psychological experience — and therefore benefits — of in-person visitation, and should never be used as a replacement. A 2014 survey found incarcerated people in Washington State were pleased when video calling allowed family to see them, but extremely frustrated by the cost and significant technical challenges of the software. Video calling is a “double-edged sword” providing a mediocre service while lining the pockets of private corporations.

Most advocates and groups (including the American Correctional Association) agree that video calling should only supplement in-person visitation, not replace it entirely. But anecdotally, some corrections officials offer video calling only, and promote it as a safer and more efficient option to visitation. (In terms of safety, the argument that most contraband is introduced into prisons through visitation is a myth we’ve busted.)

In fact, taking away visitation can make prisons and jails less safe. For example, when in-person visits were banned at the jail in Knox County, Tennessee, in favor of video-only visitation, incarcerated people lost the opportunity to maintain healthy social connections. As a result, assaults between incarcerated people and assaults on staff increased in the months after the ban on visits was implemented. Data also show that, similar to the Iowa study mentioned earlier, disciplinary infractions in the jail increased after the ban.

Though the Knox County, Tennessee Sheriff’s Office claimed video-only visitation would be safer, the data suggest the opposite: The replacement of family visits with video calls at the Knox County Detention Facility resulted in more assaults between incarcerated people and on staff. There was also no drop in the rate of reported contraband, and there were higher levels of disciplinary infractions at the jail. See more of the devastating findings compiled by the grassroots coalition Face to Face Knox.

The Knox County research wasn’t an isolated finding: In Travis County, Texas, there was an escalation of violence and contraband after that jail switched from offering both video calls and visitation for a few years, to banning in-person visitation altogether. The change also reduced overall family contact: The number of video calls dropped dramatically compared to the average number of in-person visits that had happened at the jail before the policy change. As it turns out, the availability of both in-person visitation and video calling actually increased the average number of in-person monthly visits. And unsurprisingly, visitors who were surveyed overwhelmingly preferred in-person visitation to video calling. In 2015, the Travis County Sheriff’s Office reinstated in-person visits.

Technologies like video calling (and electronic messaging) have the potential to improve quality of life for incarcerated people and help correctional administrators run safer and more humane facilities. New research suggests that video calls may even help reduce recidivism (but only when they supplement in-person visits). Sadly, the promise of these new services is often tempered by a relentless focus on turning incarcerated people and their families into revenue streams.

Families endure tremendous hardship due to incarceration, but staying in touch can mitigate negative impacts

Many of the studies discussed here focused on the benefits of family contact for incarcerated people. But what about their families — do they gain from the time spent visiting, writing, or calling? Research says yes, family contact also provides relief to the family of an incarcerated person. This is important, because simply having an incarcerated loved one indicates poorer health and a shorter lifespan. In particular, children — the “hidden victims” of incarceration — are at increased risk for mental health problems and substance use disorders, and face worse intellectual outcomes compared to children without an incarcerated family member. (Youth can themselves be confined in detention facilities, turning parents into visitors; similar to the research explored earlier, visitation of confined youth was remarkably beneficial.⁶)

Research suggests that families who visited during a loved one’s incarceration show improved mental health measures and have a higher probability of remaining together after release. And a 1977 study, explained in a larger review of family contact research, found that children who had displayed concerning behavior upon their fathers’ incarceration showed improved behavior after visiting with their fathers.

The R Street Institute sums it up nicely: Supportive family relationships can promote psychological and physiological health for incarcerated people and their loved ones, at a time when everyone’s health is otherwise deteriorating. When done well, visitation can ease anxiety in children and mitigate some of the impacts on strained interpersonal relationships. Serving families at this most critical period simply makes communities healthier.

Making family contact readily available should be a no-brainer for prisons and jails

Of course, staying in touch with an incarcerated person is almost never easy. There can be great distress and tension as a family navigates its role, and the inconsistent timing and frequency of contact can be unsettling to someone whose incarceration is overly predictable and tedious, while life outside can be anything but.

Still, academic research is unified in its message that family contact during incarceration provides immense benefits, both during incarceration and the reentry period. Prisons and jails should make all types of family contact safely and equitably available, and end the practice of taking contact away as a punishment for rule violations. And with no certain access to visitation as the pandemic wears on, families and incarcerated people should receive more phone and video time, fewer fees, and better mail options in order to preserve family ties and the critical benefits that result from family contact.

Below, we’ve compiled all of the research discussed and linked above as a bibliography for our readers. And for further reading on the harmful restrictions on communication between incarcerated people and their loved ones, see our resources on visitation and our campaigns fighting for phone, mail, and visitation justice.

Calling on the FCC to regulate video-calling technology in prisons and jails

The FCC has regulated video calling since the 1960s, and there is no reason why it should not use its authority to crack down on high prices and unfair practices in the correctional video-calling market.

by Stephen Raher, December 20, 2021

On Friday December 17, Prison Policy Initiative presented our latest arguments to the Federal Communications Commission regarding steps that the agency should take to combat financial exploitation of incarcerated people and their family members.

A decade ago, the battle for prison and jail phone justice was in its formative years. At that time the movement was focused on phone justice because telephone calling was the only technology available to most incarcerated people for real-time communication. But a lot has changed in the intervening time — new technologies are proliferating in prisons and jails, most prominently video calling.

While activists have won several notable victories in terms of bringing down outrageous phone rates, correctional video calling is completely unregulated. In the face of legal requirements to reduce phone rates, many companies are simply steering people to use more expensive video calling. Our recent filing provides the FCC with a blueprint for addressing this growing problem.

AT&T’s Picturephone provided video calling service in the 1960s. Although the product was a commercial disappointment, the Commission regulated Picturephone as a communication service without any serious objection. Source: Jon Gertner, The Idea Factory: Bell Labs and the Great Age of American Innovation (2012) (reprint courtesy of AT&T Archives and History Center).

The dominant prison telecom companies have waged a years-long misinformation campaign claiming that the FCC lacks the power to regulate video calling. But the legal arguments upon which the companies base their clams are gravely flawed. The FCC has regulated video calling since the 1960s, and there is no reason why it should not use its authority to crack down on high prices and unfair practices in the correctional video-calling market.

Our filing provides an extensive analysis that the FCC can use to reject industry arguments and assert its power to protect consumers. We remain hopeful that the FCC will rise to this challenge.
Other topics that we address in our filing include:

• The need for the FCC to act as quickly as possible to further reduce limits on voice-calling rates and ancillary fees.
• The thorny issue of jail security costs: we review the evidence gathered by the FCC and encourage the agency to not cave to the National Sheriffs’ Association demands that jails be able to charge families for a wide range of security services.
• Industry seizure of customer prepaid funds from “inactive” accounts, and the need to prevent this practice.
• The dominant company’s improper use of patents to stifle competition in the industry and the need for an investigation.

11 of our most important reports of 2021

Some highlights from the six major reports and 40+ short reports we've published this year.

by Wanda Bertram, December 20, 2021

Our work in 2021 has exposed little-known forms of exploitation behind bars, heartless COVID-19 policies, and overlooked reasons that mass incarceration persists. With 2021 coming to a close, we thought we’d share the most important reports we published this year:

States of emergency: The failure of prison system responses to COVID-19

We gathered data from all 50 states and the federal government to compare how prison systems responded to the coronavirus in the pandemic’s first year and a half. We graded each state’s pandemic response along almost 30 data points, finding that virtually every state allowed prisons to remain crowded and unsanitary, abandoning incarcerated people to die. Our report includes graphics showing how states compare on key issues — like getting the vaccine to incarcerated people — and appendix tables breaking down all of the data we collected.

Parole boards approved fewer releases in 2020 than in 2019, despite the raging pandemic

Our analysis of parole releases in 13 states shows that in 2020 — amid a global pandemic that infected one in three people in U.S. prisons — parole boards actually held fewer parole hearings and granted fewer releases than in previous years. Parole grant rates are low in ordinary years, but the number of hearings and releases fell even lower during COVID-19, even in “progressive” states like New York.

States of Incarceration: The Global Context 2021

In this report, we compare the incarceration rates of every U.S. state to those of almost every independent country. We find that many states — if they were independent countries — would have the highest incarceration rate in the world. Moreover, every U.S. state incarcerates at least twice as many people (per capita) as do countries like the U.K., Canada, France, and Belgium, even though many of these countries have comparable or higher rates of violent crime.

Smoke and mirrors: A cautionary tale for counties considering a big, costly new jail

One of the many reasons mass incarceration persists is that county governments, dealing with crowded jails, believe the only solution is to build a new, bigger jail — even though their constituents often know better. This year, a resident of Otsego County, Michigan sent us his county’s proposal for a bigger jail, a report that the county had commissioned from a private jail architecture company. Our analysis of the firm’s arguments found that the county, contrary to needing a larger jail, was locking up many people for no good reason and should instead be working to reduce incarceration. Shortly after we released this piece, residents of Otsego County once again voted down the proposed jail expansion.

Building exits off the highway to mass incarceration: Diversion programs, explained

What should counties with crowded jails do, instead of building bigger jails? Policymakers often say the solution is a “diversion program” to keep people out of jail. But what exactly is a diversion program? This report explains the wide variety of programs that can be called “diversion,” and the benefits and drawbacks of each. We envision the criminal legal system as a highway, with diversion programs offering five major “exits” off the road to incarceration. We compare and contrast the different programs, showing how the best programs get people off the highway to incarceration as early as possible, long before arrest or jail time.

Slamming the courthouse door: 25 years of evidence for repealing the Prison Litigation Reform Act

The Prison Litigation Reform Act (PLRA) — one of many damaging Clinton-era crime bills — has made it harder for incarcerated people to file federal lawsuits and seek relief when their civil and human rights are violated. For the 25th anniversary of the PLRA being signed into law, we worked with Professor Margo Schlanger, the nation’s leading expert on the issue, to expose the harm done by this law and explain how it limits access to meaningful justice and makes court orders less effective.

Rigging the Jury: How each state reduces jury diversity by excluding people with criminal records

Our first-of-its-kind report surfaces an important but under-discussed issue: the policies in all 50 states that reduce jury diversity by excluding some people with criminal records from serving. Our report includes an easy-to-read map and detailed table describing each state’s policies, and explains how these policies make criminal trials even less fair.

Native people in the criminal justice system: the data, visualized

For Indigenous People’s Day, we gathered and reported the key facts showing how Native people are overrepresented in the criminal justice system. Most importantly, we explain how the number of Native people locked up in prisons and jails has skyrocketed since 2000, coinciding with a jail-building boom on tribal lands. Our briefing also explains how persistent flaws in data collection obscure the scale and scope of Native people in the criminal justice system.

For the poorest people in prison, it’s a struggle to access even basic necessities

All too often, prisons force people to buy certain basic necessities (such as soap) from the commissary, rather than providing them at no cost. Prisons claim that people who are extremely poor can get certain items for free. But who qualifies as “poor” in prison? We conducted a 50-state survey to find out how prisons determine who “really needs” financial assistance, and discovered requirements so strict that even the poorest people often don’t qualify.

Show me the money: Tracking the companies that have a lock on sending funds to incarcerated people

Our 50-state report breaks down how much it costs to send funds to an incarcerated loved one. As people in prison are increasingly expected to pay for everyday costs like food and hygiene items, a whole industry has arisen to provide faster — but vastly more expensive — electronic money transfers to incarcerated people. Our report shows which companies (if any) hold the contracts to provide money-transfer services in each state prison system, and explains what the fees are to use these services, which harmful clauses are hidden in the “fine print,” and what a better money-transfer system might look like.

New data: state prisons and local jails are increasingly deadly places

Data released this year by the Bureau of Justice Statistics shows that prison and jail deaths steadily increased in the several years leading up to 2018, even as correctional populations stayed relatively flat. In a short report, we dive into the new BJS data to explore what has caused in-custody deaths to rise over the past several years — a disturbing trend that anecdotal reports suggest is getting even worse during the COVID-19 pandemic. We identify several key factors at play, including abusive correctional healthcare systems, officials unwilling to give effective care to people with substance use disorders, and cruel policies that hurt incarcerated people’s mental health, driving many to suicide.

This list only scratches the surface of the work we’ve done in 2021. In total, we’ve published six major reports and over 40 shorter research briefings this year. To see more of our work, check out our Reports page and our Briefings page. Or, to see research we’ve conducted about your state, visit our state profile pages. And if you’d like to get more frequent updates on our work in 2022, you can sign up for our approximately-weekly email newsletter.

As we head into a new year, we’ll continue producing cutting-edge research that exposes the ways mass incarceration harms the people behind bars and our society as a whole.

Since you asked: What information is available about COVID-19 and vaccinations in prison now?

Despite the new variants of COVID-19, prison systems are failing to publish up-to-date and necessary data and we don’t know much about booster shot access.

by Emily Widra, December 16, 2021

Early in the COVID-19 pandemic, prison systems throughout the country began publishing COVID-19 data, lifting a tiny corner of the veil of secrecy that usually shields prisons from public scrutiny. These “COVID data dashboards” — which varied from state to state, but generally at least tracked the number of active cases, testing efforts, and COVID-19 deaths — marked a departure from the outdated, obscure data we usually see coming out of prison systems and state and federal agencies. However, the quality and comprehensiveness of the published data varied from state to state, and dashboards were often riddled with inadequacies and confusion. To make matters worse, even as the Delta variant surged through the country in the summer of 2021, the UCLA Law COVID-19 Behind Bars Data Project reported that a number of states — including those with some of the highest case rates, like Florida and Georgia — had rolled back their publicly available prison data.

Now that we’re facing yet another COVID-19 threat with the Omicron variant, many of these states have reinitiated data reporting on the number of COVID-19 cases and tests behind bars. And yet, data on COVID-19 vaccinations and booster doses — our strongest protection in the face of COVID-19 — are scarce and incomplete across the nation’s prison systems. Publicly available and regularly updated COVID-19 prison data — including vaccination and booster data — are crucial for holding public officials, politicians, and legislatures accountable, as well as for helping families and the general public obtain even the simplest information about COVID-19 in their loved ones’ facilities and local communities.

Most state prison systems provide patchy COVID-19 data, at best

In July 2021, the UCLA Law COVID-19 Behind Bars Data Project reported a startling trend: Many state correctional agencies were failing to regularly update their COVID-19 data, including lags of 58 days in Florida, 40 days in New Jersey, and more than two weeks in Wyoming, New Hampshire, Utah, Mississippi, Alaska, and Montana. Massachusetts and Rhode Island announced that they would no longer be updating their COVID-19 prison data dashboards. A month later, in August 2021, UCLA found that Florida and Georgia had completely removed their COVID-19 data dashboards, while Louisiana drastically reduced its published data to only include active case counts.¹

In fact, patchy and delayed prison COVID-19 data has become the norm, not the exception. As of December 14, 2021, 8 state correctional agencies have COVID-19 data dashboards that have not been updated in the last week. The DOC COVID-19 dashboard in Montana has not been updated for 88 days so far, and it’s been 25 days in Mississippi, 14 days in Tennessee, 12 days in North Carolina, 11 days in Alabama and New York, 9 days in Alaska, and 8 days in Oregon. An additional four states’ DOC COVID-19 dashboards — Maryland, Missouri, New Jersey, and Oklahoma — appear to be updated frequently but have no consistent information about when they last updated the data, leaving us unsure of how accurate and relevant the data are. West Virginia updates most of their COVID-19 data regularly, but their vaccination data are from November 5th, 2021, 39 days ago.

Even when they do update their dashboards, most states fail to report crucial information.

There are five major metrics that states should be tracking and publishing:

• cumulative case counts,
• active or current cases,
• cumulative deaths,
• vaccination progress, and
• testing counts.

Yet only three states provide sufficient data on all five of these metrics, for both incarcerated people and correctional staff: Washington, West Virginia, and Maryland. All other states with COVID-19 data dashboards are only publishing some of this data.

In particular, data on vaccine administration — and booster doses — are rare. Only 22 states and the federal system provide vaccination data for incarcerated people and only 15 states and federal prisons provide vaccination data for staff. Only two states — Maryland and South Carolina — are publishing the number of incarcerated people who have refused the vaccine, while no prison systems are publishing the number of staff who have refused a vaccine.²

Only a few state prison systems are publishing data on booster shots

The CDC has made clear to the public that booster shots are crucial to maintaining protection from COVID-19 — particularly from newer variants like Delta and Omicron. But are prison systems following the booster dose recommendations of the federal government and the CDC? It’s hard to know, given the absolute scarcity of information about booster doses of COVID-19 vaccines administered in prisons across the country. Our survey of websites operated by state departments of corrections and the Bureau of Prisons found that only four states — Delaware, Missouri, Michigan, and Minnesota — are publishing data on booster dose administration for incarcerated people, while only one prison system — Maryland — is making data available about correctional staff booster doses.

Given the scarcity of COVID-19 vaccination data, it is concerning but perhaps not surprising that we struggled to find data on booster doses administered. Even more troubling, we were only able to find four state prison systems — North Dakota, Pennsylvania, South Dakota, and Utah — that published explicit start dates for the administration of booster doses on their websites.³ An additional six prison systems — Arkansas, Pennsylvania, Idaho, Utah, Wisconsin, and the BOP — have put out policies or public statements that at least mentioned COVID-19 booster doses. This leaves us with no evidence that more than 40 other states are providing boosters at all. And when it comes to staff, we found no explicit plans for administering booster doses to prison staff in any prison system.

The COVID-19 pandemic is not over, either inside or outside prison walls. COVID-19 cases have spiked nationwide this fall (and are expected to again this winter), and many of the people most vulnerable to the virus are currently locked up. What’s more, we know that COVID-19 outbreaks in prisons can quickly spread to surrounding communities, with grave public health consequences. But alarmingly, it appears that state prison systems are not offering the booster shot to incarcerated people to protect them — as well as the general public — from COVID-19.

Finally, by retiring their COVID-19 data dashboards, prison systems are leaving the public in the dark about a critical public health measure. Rather than waiting until the pandemic is over to hold these prison systems accountable for their healthcare policy failures, we should demand transparency — and booster shots for incarcerated people — now.

If you know of notable policies or data about booster doses that should be included here, please let us know at virusresponse@prisonpolicy.org.

Recent studies shed light on what reproductive “choice” looks like in prisons and jails

States that are otherwise hostile to abortion rights are especially likely to make it difficult for incarcerated people.

by Katie Rose Quandt and Leah Wang, December 8, 2021

In the nearly 50 years since Roe v Wade established the right to an abortion without excessive governmental restriction, the courts have repeatedly confirmed that incarcerated people retain this constitutional right. Yet abortion rights throughout the country are under attack: The Supreme Court is currently deciding on a 2018 Mississippi law that bans abortions after 15 weeks, and a new Texas law empowers private citizens to sue anyone who provides an abortion after six weeks — long before many people know they are pregnant. In the first half of 2021, state legislatures enacted 90 abortion restrictions, the most of any year to date.

Life behind bars does not occur in a bubble, and these state policies have implications for the estimated 58,000 pregnant people who enter jail or prison each year. Two articles recently published in medical journals analyzed incarcerated people’s access to abortion and to permanent and reversible contraception across 22 state prison systems¹ and six (mostly large) county jail systems.^{2 3} The studies reveal that abortion and contraception access varies greatly between states — and that abortion access for incarcerated people is related to broader state policies. Even in states that officially allow abortion, many people may be effectively blocked from obtaining the care they need, thanks to insurmountable barriers like self-payment requirements and physical distance from abortion caregivers.⁴ The studies make clear that people behind bars often have very few — if any — choices and autonomy when it comes to their reproductive health and decisions.

The two articles are based on data from the Pregnancy in Prison Statistics (PIPS) project, a series of studies aiming to fill in significant gaps in data, spearheaded by Dr. Carolyn Sufrin of the Johns Hopkins University School of Medicine and School of Public Health. Earlier studies from this project found a lack of supportive policies for pregnant, incarcerated women, as well as adverse outcomes for expectant mothers and their babies. Taken all together, these studies explain the stakes for incarcerated people during pregnancy — intended or unintended — and the postpartum period: They are likely to receive inadequate prenatal care, give birth without companion support and possibly in shackles, and have their babies taken away immediately after birth.

Main findings

• Most state prison systems (19 of the 22 studied, or 86%) allowed abortion, whether it was written policy or not. Of these, eight allowed it during the first trimester only.
• Seven state prison systems (32%) did not have an official written policy regarding abortion. While four of these states did allow abortions in practice, the lack of policy is concerning and may leave individuals’ access to the discretion of prison staff.
• Three prison systems did not allow abortions at all. None of these three had an official written policy on abortion access, but in practice they did not allow any access, and did not indicate exceptions for rape or incest, in violation of the Constitution.
• Most jails (4 of the 6 studied) allowed abortion. The two that banned abortion were both in Texas: Harris County (Houston) and Dallas County. The four other jails allowed abortion during both the first and second trimesters.
• Abortions are relatively uncommon behind bars: Over the one-year course of the study, there were 33 abortions reported in the study jails and 11 in the study prisons — out of 1,040 total pregnancies that ended in custody during that period.
• Access to contraception varied greatly throughout the study prison systems and jails: Some provided both reversible and permanent contraception,⁵ but more often than not, women had few choices. Concerningly, some states provided access to permanent contraception (i.e. sterilization), but not reversible contraception.
• More than one-fourth of study prisons offered no contraception access at all.

State hostility to abortion rights affects access behind bars

The authors find that there are correlations between statewide abortion policies and abortion access behind bars. Just three of the study’s 22 state prison systems banned abortion entirely. All three were in states with policies considered “hostile” to abortion rights, a distinction coined by the Guttmacher Institute.⁶ In all, 77% of state prison systems in hostile states allowed abortion for incarcerated people, compared to 100% of prison systems in nonhostile states. Second trimester abortions were allowed for incarcerated people in 38% of hostile states and 67% of nonhostile states.

The study’s jails revealed a similar pattern: Both of the jails in a hostile state (Texas) banned abortions for incarcerated people, while all four jails in nonhostile states allowed them in both the first and second trimesters.

Abortions can be prohibitively expensive and impossible to obtain, even in states that allow them

The study identified additional barriers to access, even in facilities that officially allow abortion, chief among them payment. Among the study’s 19 state prison systems that allowed abortion, 13 (68%) required individuals to pay for their own abortion care.⁷ This lack of financial support stems in part from the fact that incarcerated people have been excluded from Medicaid coverage since Medicaid was introduced in 1965.⁸ And in federal facilities, the Hyde Amendment forbids the use of federal funds on abortions, except to save the life of the pregnant person or in cases of rape or incest.

Although Medicaid funds may not be used on incarcerated people, the paper does reveal a correlation between states that allow Medicaid to cover abortions in the non-incarcerated population, and states that assisted with payment for abortions behind bars. Within states included in the study that have opted to allow Medicaid to cover abortion, 57% of prison systems and 75% of jails paid for an incarcerated people to obtain an abortion over the course of the study (or arranged for an outside source, like Planned Parenthood, to pay). In comparison, in states where Medicaid does not cover abortion in the non-incarcerated population, just 17% of prison systems and 0% of jails paid for (or arranged payment for) an abortion.

Other barriers include a lack of written policies on abortion in some states, and the physical distance to abortion caregivers from many rural prisons. And while pregnancy tests should be given at every intake in every women’s facility, pregnancy testing was not part of official policy in eight (36%) of the study’s prison systems and in one of the study’s six jails (17%). Especially in facilities where abortions are only allowed during the first trimester, this may leave people unaware they are pregnant until it is too late to access abortion.

There are significantly fewer abortions in prison than in the general population

Barriers to abortion access in the greater community are amplified among incarcerated populations. Abortions are already more difficult to obtain for people of color, those living in rural areas, and low-income individuals — many of the same people who are more likely to be incarcerated.

Over the course of the study, 33 abortions were reported in the study jails and just 11 in the prisons — out of 1,040 total pregnancies that ended in custody during that period.

This led to an overall “abortion ratio” of just 1.4% in the study’s prisons (the share of non-miscarriage pregnancies that ended in abortion), which is 13 times lower than the overall U.S. ratio of 18.4% in 2017. In other words, excluding miscarriages, just under one in five pregnancies ended in abortion in the general U.S. population in 2017, compared to one in about 72 pregnancies in prisons. Interestingly, the abortion ratio in study jails was 18%, similar to that of the general population. And looking only at the four jail systems that allowed abortions, that rate was even higher: 33% of non-miscarriage pregnancies that ended in those jails ended with an abortion, suggesting to the authors that “pregnant incarcerated individuals…may actually have an increased need for abortion access.”

The discrepancy between abortion rates in prisons and jails might be partially explained by timing: People typically go to jail before prison, so pregnancies may be more likely to be discovered in jail than prison. Pregnant people entering prisons may also tend to be farther along in their pregnancies, and by then it may be too late to request an abortion, although the study was not able to compare gestational age at admission. In addition, five of the six study jails were in large urban areas in close proximity to abortion caregivers (and four of the six were in nonhostile states) — meaning that access may have been better in the study’s jails than its prisons.

Incarcerated people have few — if any — choices regarding contraception

Prior studies have shown that three-quarters of incarcerated women are of reproductive age and many want to use contraception in advance of their release. The second recently-released PIPS study surveyed prison and jail policies regarding both permanent and reversible contraception (“permanent contraception” here refers to tubal ligation or getting one’s “tubes tied”; reversible contraception methods include methods like IUDs and hormonal implants). As with abortion, many facilities did not have a written policy regarding contraception, meaning actual access in those states might fall to the discretion of staff members.

Among the 22 state prison systems studied, five (23%) allowed both permanent and reversible contraception, five (23%) only allowed reversible contraception, and six (27%) only allowed permanent contraception. The remaining six states (27%) did not offer contraception at all. All six studied jails provided access to reversible contraception, with five also offering permanent contraception.

It is particularly alarming that six prison systems allowed access to permanent contraception, but not reversible contraception. This means that incarcerated people who want contraception may be forced to choose between permanent sterilization or nothing at all. In the context of prisons and jails, permanent contraception is a complex issue that blurs the line between choice and coercion, especially where no other options are provided. An audit of California prisons, for example, found that more than 100 women — particularly women of color — were subjected to illegal sterilization procedures between 2006 to 2010, many of whom did not know their surgeries would prevent them from ever getting pregnant. And in 2020, a whistleblower alleged that an immigration detention center was conducting mass hysterectomies; one detained woman compared it to an “experimental concentration camp.” Historically, forced sterilization has disproportionately devastated the lives of Black, Indigenous and other women of color.

Among the 11 state prison systems and five jails in the study that allowed permanent contraception, this procedure was only available after childbirth as a postpartum procedure in all but one prison system and one jail. This raises two concerns: Outside of prisons and jails, this procedure occurs equally frequently outside the postpartum setting, so only allowing it as a postpartum option limits choice. Secondly, incarcerated people are often in a particularly vulnerable position after giving birth in prison: They generally have no choice in their healthcare provider or birth location, and have little privacy. This vulnerability could further contribute to coerced decisions regarding postpartum permanent contraception.

In fact, as the study notes, the American College of Obstetricians and Gynecologists advises that incarcerated women should rarely undergo permanent sterilization — and only then if long-acting reversible contraception is also available, and if there is documentation of a pre-incarceration request for the procedure.

Prisons and jails must expand access to reproductive healthcare, both in policy and practice

Pregnancy overlaps with incarceration often enough that prisons and jails should have clear policies and procedures to screen for pregnancy, provide quality prenatal and postnatal care, and ensure that incarcerated people have access to safe abortions, deliveries, and contraception, as they are entitled to by law. People do not lose their constitutional right to reproductive autonomy when they are incarcerated. Yet these two recent studies reveal abortion and contraception policies that are sometimes unwritten, sometimes unconstitutional, and frequently undermine individuals’ autonomy. They also make evident that more ongoing data collection is needed. Significant data remains uncollected,⁹ including demographic data (broken down by race, ethnicity, gender identity, etc.), which would allow us to see any disparities in pregnancy outcomes and access to contraception.

In many states where abortion is currently allowed behind bars, the narrow existing window of abortion eligibility may be shut if Roe v Wade is overturned by the Supreme Court. The Guttmacher Institute expects that 26 states are certain or likely to ban abortion if the right is not protected by the Constitution.¹⁰ In Texas, for example, the new law bans abortions after six weeks. The jails in Harris County (Houston) and Dallas County do not allow abortions at all, meaning that an incarcerated person in early pregnancy could easily miss this tiny window of eligibility while jailed, and not be able to obtain an abortion upon release. And while people on the outside can — if they have the means — travel to a nonhostile state for abortion care, those in jails and prisons are held captive to the policies of their states.

The study’s findings suggest clear policy recommendations:

• Prioritize the diversion and/or early release of pregnant people from jail and prison, in recognition of the existing, serious risks to parental and infant health and well-being in carceral settings.
• Standardize correctional health care and require oversight to ensure all incarcerated people are provided standard reproductive health services.
• Establish clear, written policies regarding access to abortion care and contraception.
• At intake, screen for pregnancy and provide clear information about how to access available services.
• Provide non-coercive access to begin or end reversible contraception.
• Ensure that abortion access in all facilities is in line with state and federal law.
• Remove financial barriers to needed services for incarcerated people: State and local authorities should cover the cost of abortions and contraception for incarcerated people, or arrange for costs to be covered by service provider partners.
• Connect pregnant people with needed services upon release from jail or prison.
• Collect more data, disaggregated by race, ethnicity, gender identity, and other individual characteristics, on pregnancy prevalence, outcomes, policies, practices, and individual experiences — including requests for both reversible and permanent contraception.