Incarcerated Women's Perceptions of a Reproductive Life Planning Class: A Qualitative Study

Background and Purpose: Unplanned pregnancies are common, but there is a large disparity in their frequency between women in the general population (50%) and women in the U.S. carceral system (84%). Mounting empirical evidence has correlated unplanned pregnancies with perinatal risks and adverse outcomes, such as the under-utilization of prenatal care, fetal exposure to cigarette smoke and alcohol, low birth weight, preterm birth, and forgoing breastfeeding. In an effort to mitigate the social and public health consequences of unplanned pregnancies, in 2006, the Centers for Disease Control and the U.S. Office of Population Affairs recommended that all women of reproductive age engage in reproductive life planning (RLP). RLP encourages women in healthcare settings to set personal goals about having or not having children. Despite its importance, however, RLP and its related reproductive health services are not widely available for incarcerated women. The current qualitative study used focus groups to explore women’s perceptions of a recently-implemented RLP class in the Century Regional Detention Facility (CRDF) located in Los Angeles, California.

Methods: Twelve focus groups were conducted with a total of 59 incarcerated women (M=5 per group). Women’s age ranged from 19 to 44 (median = 27) and 77% reported at least one previous unplanned pregnancy. Fifty-two percent identified as Hispanic/Latina, 30% identified as White and 19% as Black. Approximately 15% of participants were homeless prior to incarceration and 70% anticipated release from jail within 6 months of participation. Women were recruited via a list provided by the Education Based Incarceration (EBI) program nested in the CRDF. Interviews elicited participants’ opinions on the RLP class, including how participants felt about having the class while incarcerated. Interviews were transcribed verbatim and coded thematically using NVivo qualitative software, guided by the principles of thematic content analysis.

Results: Focus group analysis revealed four primary themes: (1) The RLP class was perceived as acceptable by incarcerated women. (2) Being in a jail setting allows women to reflect on their RLP preferences by removing stressors, such as homelessness. (3) Women want to learn about the range of contraceptive options by an instructor who is competent and empathic. (4) Receptivity to the RLP class was influenced by a fatalistic attitude toward pregnancy.

Conclusions and Implications: Taken together, participants’ testimonies indicate that most incarcerated women who participated in the focus group discussions consider an RLP class to be acceptable in a jail setting. In fact, many cited that jail is a prime location for an RLP class given that their basic needs are being met, adverse distractions are removed, and they can utilize jail time as an opportunity to reflect on previous and future life choices. To ensure the successful applicability of future RLP classes, however, key barriers will have to be addressed. One such barrier is the women’s fatalistic attitudes towards pregnancy. Future RLP classes should explicitly address fatalism and encourage a sense of agency with respect to planning or avoiding a pregnancy.