PURPOSE:
To identify the legal and institutional issues preventing incarcerated women from making autonomous choices about reproductive health. To discuss the process of changing policies to meet those needs.

DISCUSSION:
The carceral system is well hidden from public scrutiny. While legal obligations and standards exist to offer services and meet needs of incarcerated people, a wide variation exists in what actually takes place . Incarcerated women have little utilization of health care when not incarcerated. Reproductive health issues take a low priority in correctional health systems. Incarceration can impede the rights of women to access reproductive health. Institutional policy rather than laws may dictate whether someone has the right to make decisions that affect her life long after incarceration. For example, while abortion is a protected constitutional right, factors such as payment, scheduling difficulties and transportation problems may make it difficult or impossible. Women with low income have been susceptible to the possibility of forced or coerced sterilization since mid-20th century. Trading fertility for reduced sentencing, making sterilization or long-acting birth control required for release, or involuntary sterilization after childbirth, have been documented as recently as 2018. In an effort to avoid any possible appearance of coercion, in recent years it has been a general recommendation that "pregnant women may not sign permission for sterilization while incarcerated." But this has not been an ideal solution either. We evaluated the precedents, legal issues, use of terminology around capacity, custody and guardianship to develop a more humane policy that was acceptable for all systems-carceral facility, hospital and gynecologic providers and the women who strongly requested this procedure.

EVIDENCE WHERE RELEVANT:
n/a

KEY MESSAGE:
MIdwives have always been strong advocates for the needs and rights of our clients and families. Advocating for the right to make choices in a rigid system can be laborious and difficult but worthwhile when successful. Spanish - other (including three-minute presentation competition)