Photo credit: Level Up/Elizabeth Dalziel
Pregnancy in Prison considered high-risk
Harriet Doveton
The number of pregnant women in prison has increased by 18% in just a year, new government data reveals.
There have been increasing concerns about the risks faced by incarcerated pregnant women following the deaths of two babies in women’s prisons in 2019 and 2020 and a recent third death revealed by the Prisons and Probation Ombudsman (still under investigation). In 2023, data revealed that jailed women were seven times more likely to suffer a stillbirth. These figures were collected through Freedom of Information requests sent to 11 NHS Trusts that serve women’s prisons in England. Figures from the HMPPS annual digest also reveal an increase in the number of pregnant women in prison. From April 2023 to March 2024 there were 229 pregnant women in prison, compared with 194 from the year before, with the number of mothers and babies received into MBUs (Mother and Baby Units) increasing for the third year running.
Figures from HMPPS annual digest 2022-2023/2023-2024
Feminist campaigning group Level Up have been aiming to end the imprisonment of pregnant women since 2021, this came after the Prison Ombudsman published its report on the death of baby Aisha Cleary at HMP Bronzefield. Level Up have organised petitions, launched video campaigns and appeared on major news networks to spread the message that all pregnancies in prison are ‘high-risk’. They also work alongside No Births Behind Bars – a solidarity movement of mums and babies who organised the biggest baby protest in history outside Parliament for Mother’s Day 2022.
Janey Starling, co-director of Level Up, recently won a Tenacious Campaigner Award for her work on ending the imprisonment of pregnant women. On the matter, she said ‘Prison will never be a safe place for anyone, and certainly not a safe place to be pregnant. It is urgent that the government ends the imprisonment of pregnant women and invests in community-based alternatives’.
In January 2024, the Court of Appeal quashed the sentence of a pregnant woman in what was considered a landmark ruling. The original sentence received from the Criminal Court for possession of a firearm was replaced with a two-year suspended sentence with a rehabilitation requirement. The court determined in this case that ‘exceptional circumstances exist’ due to the high health risks involved.
Following a consultation in March 2024, the Sentencing Council now recognise that all pregnancies in prison have been classified as high-risk by the NHS. New guidelines came into effect from 1 April 2024 that introduced a new ‘mitigating factor’ that sets out what the court may take into consideration when sentencing a pregnant person, this includes:
• the medical needs of the offender including her mental health needs
• any effect of the sentence on the physical and mental health of the offender
• any effect of the sentence on the child
These court rules could significantly reduce sentences for convicted pregnant women and new mothers. These changes align with UK public opinion, as a 2024 poll shared with The Observer revealed that 53% of respondents believed a mother with a baby shouldn’t be sent to prison ‘if a community-based alternative was available’.
On 5 September 2024, Level Up published their new legal toolkit: ‘Representing pregnant women and mothers in the criminal justice system’. A 22-page document designed to equip lawyers with the ‘core legal arguments, tools and resources’. This has just been made downloadable from their website.
Illustration by Akbar Ali
North West London IVF policy could see ‘same-sex’ couples spending up to £25k
Harriet Doveton
Under current IVF policies in England, Female ‘same-sex’ couples must navigate the ‘postcode lottery’ and face huge financial barriers to access fertility healthcare. In North West London, support from the NHS feels out of reach for many members of the LGBTQ+ community.
Investigations by BPAS (British Pregnancy Advisory Service) in 2021 illustrate a disproportionately negative impact on female same-sex couples and single women seeking IVF services and fertility healthcare from the NHS. The policies upheld by most local Clinical Commissioning Groups (now combined into Integrated Care Boards) require ‘same-sex’ couples to undertake 6-12 self-funded cycles of artificial insemination (6 in a private clinic) before being eligible for any IVF support. Under the ‘postcode lottery’ system, if your local CCG/ICB offers no funding for this you could be required to pay up to £25,000 to prove your fertility status. In contrast, the equivalent requirement for cisgendered heterosexual couples is to attempt pregnancy through two years of unprotected sex. This disparity shines a light on the financial burden felt by the LGBTQ+ community hoping to be parents.
In the BPAS fertility investigation, an FOI found that only 17 CCGs (16%) provide NHS funding for artificial insemination for female ‘same-sex’ couples proving fertility status. The North West London ICB is currently not included in those that help with AI funding. This is set out in their commissioning policy which says: ‘at least 12 cycles of self-funded AI must be undertaken’ and ‘NHS funding is not available for insemination facilities (IUI with donor sperm) where there is not an established clinical need.’
When asked for a comment on the policy, a spokesperson from the NW London ICB said: ‘NHS North West London are intending to commence a review of its IVF policy in its entirety within the next 12 months. This will include a review of the ICB's policy on the funding of same sex IUI.’
Currently, after proving up to 12 cycles of AI independently, and fulfilling several other criteria, the NHS offers a maximum of three cycles of funded IVF treatment for women under 40. This is where we encounter the ‘postcode lottery’ issue once again. It is your local Clinical Commissioning Group/Integrated Care Board that chooses how to delegate funding and eligibility. 2023 figures show that only 16 out of 106 CCGs in England currently offer the full three cycles of IVF:
The North West London CCG/ICB currently only offers funding for one cycle of IVF, compared to North East London who provide three.
Robin Gatt, 38, Uxbridge, is currently crowdfunding to cover private IVF treatment after facing multiple barriers on their journey to parenthood. Gatt is in a ‘same-sex’ couple but before even having the choice to self-fund 12 cycles of AI required by North West London ICB, they were immediately disqualified from any support due to Body Mass Index criteria set out in the policy:
“I felt immensely dehumanised. It’s the humiliation of feeling your body is being judged on whether it is capable of pregnancy by someone who doesn’t know anything about your health or wellbeing. That’s a very brutal thing to face. It’s based on inconclusive and junk science, it's another way of saving money. There’s no sympathy about fat people that want to have kids.”
Before even having to come to terms with these criteria, Robin and their partner had fears of navigating the fertility sector as a same-sex couple:
“It's discriminatory, they want to weed people out. It's very sad that a lot of the people they are weeding out have no other way of having a baby. It’s so much money to spend, most people will have given up on their dream of having kids. Even in the areas where there is more flexibility in funding, it’s still structured around the heterosexual normative ideal. It’s shaped around straight people, thin people and able-bodied people and that tells us we’re not welcome and have to go through more emotional labour as well as financial loss. If you’re in a same-sex couple you often can’t even get a scan, you’re even excluded from the diagnostic side of fertility treatment and be in the dark about it for the rest of your fertile years.”
The controversial blockade to treatment based on BMI criteria goes beyond NICE guidelines, which currently only states that: ‘Women who have a body mass index (BMI) of 30 or over should be informed that they are likely to take longer to conceive.’ Due to this, Gatt has had no choice but to seek IVF from a private clinic, where costs have already exceeded £8k for just one cycle.
Lesbian couple Megan and Whitney Bacon-Evans launched a judicial review in October 2021 against their local NHS board, Frimley IHB, accusing the fertility sector of discrimination. Although the legal case is ongoing, in 2022 the government announced the new Women’s Health Strategy, which aims to remove these barriers to fertility healthcare for same-sex couples. The goal is to remove the requirement to pay for artificial insemination and improve the transparency on IVF availability set out by each CCG/ICB. This strategy aims to implement these changes by a reform of the NICE guidelines, due to be reviewed in November 2024. Although this shows some progress in reproductive justice, these are just guidelines, not yet policy. As noted in the BPAS report, even currently: ‘The requirement that patients should self-fund all cycles of AI conflicts with NICE guidance which recommends that CCGs should fund at least 6 cycles of IUI.’ However, the launch of the Bacon-Evans legal case has triggered some change already. Bristol, North Somerset and South Gloucestershire (BNSSG) Integrated Care Board (ICB) approved a new fertility policy in response to the news of the judicial review.
Zoe Milburn (33) and Em Wilson-Black (31) of Uxbridge, welcomed the birth of their baby in 2021. Upon making their decision to become parents they had already given up hope of support from the NHS, on this Milburn said:
“We didn’t have any expectations of help from the NHS, as sad as this is, I had done my research at the time and basically found that you need to ‘prove’ you have been trying for X amount of time before they will refer you for IVF, obviously this wasn’t something we could do. I did go to my GP about 6 months before we contacted the private clinic and said I was hoping to try for a baby soon but was anxious about my fertility because of my irregular periods, she sent me for blood tests straight away, no questions asked. But equally, this lack of questioning could also be seen an assumption that I was in a straight relationship.”
On this journey Milburn noticed the lack of education and access to information about what same-sex couples were entitled to, she had to do all the research herself:
“There needs to be easier access to information for the LGBTQ+ community, also access to counselling to discuss options with an LGBTQ+ aware health professional to find out what we are entitled to across the country. Rather than us being dependent on having a nice GP or living in a certain postcode.”
Visualisation data set:
Fertility Treatment Funding Eligibility by CCG: https://fertilitynetworkuk.org/access-support/nhs-funding/england/
References:
https://www.bpas.org/media/3369/bpas-fertility-ivf-postcode-lottery-report.pdf
https://www.nwlondonicb.nhs.uk/application/files/5016/7664/3312/IVF_v7.pdf
https://www.gofundme.com/f/a-queer-couple-access-fertility-treatment
https://www.crowdjustice.com/case/lgbt-fertility-equality/