In contrast to the supportive environment that an unborn baby is required to reside, the prisons in which pregnant women sometimes find themselves offer no such sanctuary.

The Observer reports this month that women in prison are seven times more likely to suffer a stillbirth than those in the general population. For every 100 pregnancies in prison, three will result in stillbirth. For every 100 pregnancies in the wider population, there is a 50/50 chance that one of them will end in stillbirth.

Each of these stillbirths represents a failure of the state to protect vulnerable women, and arguably highlights the state’s culpability in the deaths of humans who have committed no crime but to be born of a prisoner.

The word culpability is important in these cases. Whilst there is no doubt that those pregnant and in prison are more likely to suffer socioeconomic deprivation, or engage in pregnancy damaging ‘behaviours’, from stressful life events through to drug use, many will argue strongly that these things are personal choices, and the state is absolved.

But once behind the cell door, it is hard to apportion blame in these cases to anyone but the state. It is their design, of prisons and prison regimes, which inflict these deaths.

The most pressing design flaw, is that in the world of prisons, non-medical staff are asked to make medical decisions. You need only look back to 2019, to the case of a stillbirth to Ms A, recorded in HMP Bronzefield, for the inherent wrongs with this.

Ms A, in labour, behind her cell door, called repeatedly for help via the buzzer. Officers, with no medical training, repeatedly assessed this woman, under their care, as not requiring treatment. Eventually, Ms A gave birth, alone, behind the cell door. It was reported she had to chew through the umbilical cord herself, as her baby lay motionless in a pool of blood.

While extreme, the example points to routine practice within prisons. The nonsense of locking up people who are pregnant, denying them the level of pregnancy care as they would be entitled to in the community, then acting shocked when things go badly wrong. Enquires and investigations follow, telling us what we already know. And nothing changes, so long as our societal attitude towards prisoners, pregnant or not, remains as it is.

When working in hospital, my old bosses, practising in the middle of the 20th century, would explain that patients used to just die overnight in hospitals. They weren’t observed, and doctors were seldom disturbed. This was accepted practice. It was the way things had always been. 

But in modern times, if we are admitted to hospital, we would find ourselves under a duty of care. A set of principles which are required in places where our autonomy is taken away. When others need to do our thinking or acting on behalf of us.

This means that when it’s 3am, you as the hospital patient, even if you can’t face disturbing the nurses on overnight about your stomach pain, because they look so busy. They will check on you anyway, as you are in a position of vulnerability. You get assessed, by a medical professional, and if necessary, you might be seen by other medical professionals.

Yet, when you enter prison, and are placed under a similar duty of care, it becomes unclear where your autonomy is redistributed.

Is the prisoner in their cell to be compared to a person in the community, sat at home, healthcare in their own hands? Well, no. You aren’t allowed to keep hold of certain medications in your domicile. You don’t have the ability to call 999. You can’t just walk out the cell door and march to A+E. 

So are prisoners instead then to be compared to a hospital patient, under constant observation and escalated appropriately. Again, no. You are left to your own devices, behind your door. The only observation a cursory glance to see if a body, alive or dead, is in the cell to make the roll check. 

In reality, in fitting modern healthcare standards to the Victorian prison regime, it seems often the model offering the least protection to the prisoner is preferred at any one moment, to suit the operational needs of the prison service. This is far from the healthcare equivalence espoused, and indeed leads you receiving the worst of both worlds.

In response to the HMP Bronzefield case; Ms A suffering stillbirth behind her cell door, the Prisons and Probation Ombudsman (PPO) report, helpfully stated that the standard of healthcare received was not equivalent to that she would have received in the community. Yet, these latest figures suggest little has changed since the publication of this report one year ago.

The healthcare deficits facing those pregnant in prison offer an informative parallel to the healthcare deficits facing all prisoners. Whilst many might say it is a prisoner’s own fault for ending up inside, and they should expect to suffer poorer healthcare accordingly, there are few who would argue that it is the fault of an unborn child that they are inside.

Measures enacted to protect these ‘innocent’ lives may therefore be more palatable to a certain portion of the electorate. I think any lessons learned, or changes in practice derived from these tragic cases, must also be extended to the benefit all prisoners.

Because as it stands, healthcare in prisons remains substandard to that in the community, for all prisoners. Inevitably, so long as this mish mash of care models persists, the duty of care will continue to fall on those not equipped to deal with it. And prisoners, and sometimes their unborn children, will continue to suffer preventable injury and death, at the hand of the state.