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Excerpt
On any given day, approximately 100,000 juvenile offenders are held in custodial facilities in the United States, often representing multiple failures in the care of young people with complex social and healthcare needs (Trulson, 2007). Although there are clear statistical data regarding the number of adult pregnant women entering prison, accurate corresponding data are not readily available for adolescents. At best it is estimated that approximately 24,000 pregnant adolescents are arrested annually, and roughly 670 are in custodial facilities at any given time (Myanard & Garry, 1997; Sickmund, 2002). Conventional wisdom would dictate that for most young women, an unplanned pregnancy would be difficult to cope with; thus, being pregnant, alone, and incarcerated, is perceived as a challenge of particular significance. Unfortunately, many correctional facilities housing adolescent girls are ill equipped to provide healthcare in general, let alone prenatal services, postpartum care, or parenting classes.
The assumption that all nurses provide nonjudgmental, unbiased nursing care is a comforting thought, but a false one. When a pregnant adolescent presents in a correctional setting, nurses' affective responses may be intensified and influenced by their attitudes and beliefs about teen pregnancy (including abortion); the client's social, cultural, and mental health background; substance abuse history; and criminal behaviors. More often than not, the clients' behavioral problems associated with their criminal charges draw attention away from their overall healthcare needs. And although nurses are ethically obligated to keep their biases in check, they often find themselves at odds with the values and behaviors of the adolescents in their care, particularly when a pregnant adolescent voluntarily engages in activities that may be harmful to her unborn child. Moreover, the lack of definitive clinical research regarding the care of pregnant adolescents confined to correctional settings further exposes them to stereotypical care based on nonincarcerated pregnant youth and/or incarcerated adults, neither of which may be appropriate. Clearly, additional evidence is required to make informed decisions regarding nursing interventions with this high-risk group.
Access to healthcare equivalent to the community standard is further complicated by the imposition of legal considerations regarding custody and rights among incarcerated pregnant adolescents. In a discussion of health services for juveniles involved in justice programs, Cohen, Burd and Beyer (2006) state that “pregnant youth must have access to counseling regarding options to terminate consistent with state law or to continue the pregnancy, with the choice to keep or place the child for adoption” (p. 134). When considering the right to provide consent for treatment, the issue of who has the right to provide that consent comes in to question.
