Restraint of pregnant women in prison: our response to the Ombudsman's interim data review

We welcome the Ombudsman’s focus on protecting the dignity of pregnant women in prison, and on getting to the truth of what has been happening. He is right to emphasise the importance of looking at the culture of these prisons, and the impact of culture on whether policy is followed in practice.

What the data shows so far

• Huge gaps in the records. Large numbers of escort records and supporting information are missing, including for 56% of prison escorts for birth. As the Ombudsman says, accurate record keeping is key to accountability and transparency.
• Women restrained while giving birth. Of the 99 birth escort records the PPO has received so far, 13 show restraints were used in hospital and 26 show restraints were used during transport. A further 8 are unclear. At a minimum, then, it seems around 13% of women were restrained in hospital while giving birth, and more than one in four were restrained during transport to hospital to give birth, or afterwards. It’s notable that the rate of restraint during birth escorts seems to have stayed broadly the same, even after policy was strengthened.
• Women missing from official data. Seven women whose birth escort records were received by the PPO did not appear in prison pregnancy data as they should have. This raises wider concerns about the accuracy of the data held and published by HM Prison and Probation Service (HMPPS).
• Practice lagging behind policy. When policy was updated to clarify the position on restraining pregnant women, restraints remained in use at some prisons for a significant time afterwards.
• Healthcare objections overruled. Prison healthcare staff objected to the use of restraints in 20% of escorts. In 91 of these cases, restraints were used anyway. Data hasn’t yet been captured on objections to restraints raised by healthcare staff in hospitals.
• Risk assessments not made by the right people and not followed. In many cases escort risk assessments appear to have been signed off by middle managers rather than at the level policy requires. Where escort staff acted differently to the authorised assessment, in most cases they used more restraint than had been authorised. This includes restraint after birth or miscarriage.
• Wide variation between prisons. Use of restraint was particularly high at HMP Bronzefield, low at HMP Foston Hall, and fluctuated significantly elsewhere.
• Possible racial disparity. The data suggests Black women may have been restrained at a higher rate than white women. This must be explored fully in the next phase.

Our view

Behind all these figures are pregnant women, mothers and their babies. The trauma and the risk to physical and mental health created by being restrained at any point of pregnancy cannot be overstated. The scandal of women being restrained during labour was what led to the creation of Birth Companions 30 years ago, and the fact that it’s still an issue today is truly shocking. Our thoughts are with every single woman who has experienced such treatment at the hands of the prison system, and our energies are focused on supporting them, while ensuring this practice stops now, forever.

While this stage of the investigation provides only an initial read of the available data, it’s important that we be clear: any restraint of a pregnant woman in hospital is highly likely to have been against established government policy, and therefore unlawful.

The problems here are systemic; there is evidence of restraint without appropriate risk assessment and therefore justification across the estate. But the numbers are particularly high in some prisons, and they fluctuate significantly over time. We need to understand what drives these rises and falls in the use of restraints, which means looking beyond the policies themselves to culture and individual practice. And we need to know how this practice, against policy, was allowed to continue for so long.

What must happen next

The next phase of the investigation must put the experiences of the women affected at its centre, and uncover the full picture of what happened and why. In particular, it must establish:

• Why HMPPS, HM Inspectorate of Prisons, the Care Quality Commission and the PPO itself did not identify these practices through routine monitoring and inspection
• If failures to follow policy were identified, what action was taken as a result
• What women knew about their rights, and what happened when they, or the staff around them, including hospital staff, objected to the use of restraints
• What happened where escort records are missing or are unclear
• What took place during these hospital appointments, including how women were restrained during intimate examinations or other procedures, how long restraints were applied for, and the gender of escorting officers
• How healthcare advice is sought and weighed in risk assessments, so that risks to health are considered, as well as security risks
• How many women were restrained during the postpartum period, which itself carries huge physical and mental health risks

The aim must be to establish the scale, impact and causes of this practice, and to make sure no woman is ever unlawfully restrained again. Funded legal representation is an important factor in supporting women’s full and fair participation in the investigation.

Why this matters beyond restraint

Policy changes, legal action and public pressure have reduced the use of restraints on pregnant women, but that doesn’t mean it can’t happen again. The evidence in this review shows how policies can be ignored or overridden in practice. And the use of restraints is only one of many concerns about pregnancy, birth and the postnatal period in an environment that is inherently unsafe and inappropriate for women and babies, and where there is such limited scrutiny and accountability.

That is why we continue to call for an end to the imprisonment of pregnant women and mothers of infants in all but the most exceptional circumstances.

Read the PPO’s interim data review. Women who want to share their experience with the investigation can find information on contributing here.

If you would like to discuss any of these issues further, please contact Kirsty Kitchen: kirsty@birthcompanions.org.uk

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