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Open Access Publications from the University of California

Scholarly Works (5 results)

  • Thesis
  • Peer Reviewed
UC San Francisco Electronic Theses and Dissertations (2014)

Institutions of incarceration are widely understood for their punitive, depriving, and at times even violent characteristics. Yet prisons and jails also provide medical care and other services that people marginalized by poverty, addiction, racism, and other forces of structural inequality might not otherwise have. This dissertation investigates the everyday contours of care in an urban women's jail in California. Based on six years of clinical work as an Ob/Gyn in the jail's clinic; ethnographic fieldwork throughout the jail and its surrounding community; and over 40 interviews with jail workers, medical staff and inmates, I describe how this jail was constituted by caregiving relationships which were inextricably linked to disciplinary structures, particularly for pregnant women. Deficiencies in the public safety net, market shifts, and trenchant problems in the criminal justice system meant that cycling between jail and the streets was a normative rhythm of everyday life for many of the urban poor. Recidivism was less a statistic and more an intimate relationship between inmates and jail workers. First, I describe how the medical triage system upon entry to jail diagnosed the deficiencies of people's lives on the streets. Next, I explore the quotidian rhythms of the jail medical clinic, and how health providers cultivated ambiguity as a form of caregiving to a patient who is also a prisoner. I then focus on reproduction as a key site where the deficiencies of public services and their substitution with incarceration were made visible. Custody and medical apparatuses in jail managed the figure of the pregnant inmate, with her gestating fetus, both as worthy of tender care and as a liability threat to the institution. Pregnant women similarly experienced jail with ambivalence, even desiring the relative safety of this punitive space. The ambiguity surrounding pregnant, incarcerated women, combined with their experiences of marginality outside, produced jail as a place--often the only place--where these women could enact a normative ideal of motherhood. Particularly for marginalized, reproducing women, jail has become an integral part of America's social and medical safety net.

    Cover page: Jailcare: The Safety Net of a U.S. Women's Jail
    • Article
    • Peer Reviewed
    UC San Francisco Previously Published Works (2023)

    Objective

    To describe patient approaches to navigating their probability of a vaginal birth after cesarean (VBAC) within the context of prediction scores generated from the original Maternal-Fetal Medicine Units' VBAC calculator, which incorporated race and ethnicity as one of six risk factors.

    Methods

    We invited a diverse group of participants with a history of prior cesarean delivery to participate in interviews and have their prenatal visits recorded. Using an open-ended iterative interview guide, we queried and observed these individuals' mode-of-birth decisions in the context of their VBAC calculator scores. We used a critical and feminist approach to analyze thematic data gleaned from interview and visit transcripts.

    Results

    Among the 31 participants who enrolled, their self-identified racial and ethnic categories included: Asian or South Asian (2); Black (4); Hispanic (12); Indigenous (1); White (8); and mixed-Black, -Hispanic, or -Asian background (4). Predicted VBAC success probabilities ranged from 12% to 95%. Participants completed 64 interviews, and 14 prenatal visits were recorded. We identified four themes that demonstrated a range of patient-led approaches to interpreting the probability generated by the VBAC calculator: 1) rejecting the role of race and ethnicity; 2) reframing failure, finding success; 3) factoring the physical experience of labor; and 4) modifying the probability for VBAC.

    Conclusion

    Our findings demonstrate that a numeric probability for VBAC may not be highly valued or important to all patients, especially those who have strong intentions for VBAC. Black and Hispanic participants challenged the VBAC calculator's incorporation of race and ethnicity as a risk factor and resisted the implication it produced, especially that their bodies were less capable of achieving a vaginal birth. Our findings suggest that patient-led approaches to assessing and interpreting VBAC probability may be an untapped resource for achieving a more person-centered, equitable approach to counseling.
      Cover page: Patient-Led Approaches to a Vaginal Birth After Cesarean Delivery CalculatorCreative Commons 'BY' version 4.0 license
      • Article
      • Peer Reviewed
      UC San Francisco Previously Published Works (2019)

      Study objective

      We applied a patient-centered care (PCC) framework to explore incarcerated girls' experiences of and preferences for family planning (FP) care.

      Design

      We conducted qualitative semistructured interviews with incarcerated girls to explore domains of PCC: access to care, patient preferences, information and education, emotional support, family and friends, physical comfort, coordination of care, and continuity and transition.

      Setting

      A juvenile detention center (JDC) in an urban California county.

      Participants

      Girls incarcerated during the study period.

      Interventions and main outcome measures

      Transcripts were analyzed using directed content analysis to identify themes related to PCC and additional overarching themes.

      Results

      Twenty-two participants completed interviews. Overarching themes of stigma and autonomy emerged as influential in girls' experiences and preferences for FP care. Participants described stigma related to incarceration, sexual activity, and lack of contraception use. Participants' desire for autonomy contributed to concerns around FP care. Despite this, most desired access to FP care while incarcerated. Many valued relationships they had with JDC providers, reporting more trust and familiarity with JDC providers than those in the community. Constraints of incarceration decreased availability of emotional supports and decreased involvement of family in health-related decision-making, which worsened girls' experiences with FP care and enhanced their sense of autonomy. Difficulties with care coordination and transitions between the JDC and community often resulted in fragmented care.

      Conclusion

      Providing patient-centered FP care in JDCs is desirable but complex, and requires prioritizing patient preferences while recognizing the strengths and limitations of providing FP care within JDCs.
        Cover page: Perspectives on Patient-Centered Family Planning Care from Incarcerated Girls: A Qualitative Study
        • Article
        • Peer Reviewed
        UC San Francisco Previously Published Works (2012)

        Introduction

        Obstetrics and gynecology residents benefit from providing care to diverse patient populations and increasing their awareness of the social determinants of health.

        Objectives

        To describe and evaluate an outpatient rotation for obstetrics and gynecology residents at a county jail.

        Methods

        A comprehensive curriculum incorporating Accreditation Council for Graduate Medical Education (ACGME) core competencies was designed for all first-year residents to rotate weekly at the local county jail during their 6-week ambulatory care block. Residents completed an anonymous online evaluation and wrote a reflective essay at the end of the rotation. Data for patient visits were tabulated.

        Results

        All 9 first-year residents completed the rotation and the evaluation. Seventy-eight percent of patient visits were for gynecologic services, predominantly family planning. Residents reported that the rotation overall was a positive experience, emphasizing the unique intersection between psychosocial issues and health care in the jail setting. Rotation objectives that satisfied the 6 ACGME competencies were met.

        Discussion

        Providing care to incarcerated women through a structured curriculum is a novel way to encourage obstetrics and gynecology residents to consider the social determinants of health and for residents to cultivate their counseling skills. The rotation also included a wide breadth and depth of clinical diagnoses and procedures. Obstetrics and gynecology residency programs should consider a curriculum in reproductive health for incarcerated women.
          Cover page: County Jail as a Novel Site for Obstetrics and Gynecology Resident Education
          • Article
          • Peer Reviewed
          UC San Francisco Previously Published Works (2020)

          Background and aims

          The established standard care in pregnancy is medication for opioid use disorder (MOUD); however, many institutions of incarceration do not have MOUD available. We aimed to describe the number of incarcerated pregnant women with opioid use disorder (OUD) in the United States and jails' and prisons' MOUD in pregnancy policies.

          Design

          Epidemiological surveillance study of 6 months of outcomes of pregnant, incarcerated women with OUD and cross-sectional survey of institutional policies.

          Setting

          United States.

          Participants

          Twenty-two state prison systems and six county jails.

          Measurements

          The number of pregnant women with OUD admitted and treated with methadone, buprenorphine or withdrawal; policies on provision of MOUD and withdrawal in pregnancy.

          Findings

          Twenty-six per cent of pregnant women admitted to prisons and 14% to jails had OUD. One-third were managed through withdrawal. The majority who were prescribed MOUD were on methadone (78%, prisons; 81%, jails), not buprenorphine. While most sites (n = 18 prisons, n = four jails) continued pre-incarceration MOUD in pregnancy, very few initiated in custody (n = four prisons; n = two jails). Two-thirds of prisons and three-quarters of jails providing MOUD in pregnancy discontinued it postpartum.

          Conclusions

          In this sample of US prisons and jails, one-third required pregnant women with opioid use disorder to go through withdrawal, contrary to medical guidelines. More women were prescribed methadone than buprenorphine, despite the fewer regulatory barriers on prescribing buprenorphine. Most sites stopped medication for opioid use disorder postpartum, signaling prioritization of the fetus, not the mother. Pregnant incarcerated women with opioid use disorder in the United States frequently appear to be denied essential medications and receive substandard medical care.
            Cover page: Opioid use disorder incidence and treatment among incarcerated pregnant women in the United States: results from a national surveillance study.
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