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Ethical care of pregnant adolescents in correctional settings.

As nurses, our ability to provide healthcare to pregnant adolescents within correctional systems is limited not only by access to appropriate knowledge and resources, but also, more importantly, is compromised by ethical and legal dilemmas that often restrict access to quality care. Adolescents who enter custodial facilities (e.g., juvenile detention centers, correctional facilities) are an infinitely underserved at-risk population who require unique services to meet their needs related to growth and development, education, and special healthcare concerns including pregnancy. When compared to their nonincarcerated counterparts, female adolescents who are incarcerated generally present with: (1) higher rates of sexually transmitted diseases (STDs) and immunodeficiency virus (HIV); (2) histories of significant substance use and abuse; (3) extensive physical, psychological, and sexual abuse histories; (4) family issues regarding pregnancy and parenting; and (5) preexisting mental health disorders, such as schizophrenia, anxiety disorders, depression, and behavioral disorders (Bonham, 2006; Cahsin, 2006; Hufft, 2004; Shelton, 2005). 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