Babies deserve the very best start in life, regardless of what their mothers have or haven’t done. About 600 women receive antenatal care within the prison service in England and Wales each year. But when some prisons have food budgets as low as £1.87 per person per day, there is a potential threat to the health of mothers and the long-term development of their babies. A very poor start in life, indeed.
The low budgets for prison catering services contrast with the average NHS hospital food budget of about £10.75 per person per day. Prisoners may be able to buy food to supplement their diets, but these foods are likely to be of poor nutritional value. Indeed, many young offenders complain of being constantly hungry, and there can be long periods of time between meals.
It seems unlikely that £1.87 a day can provide the nutritious and varied diet needed to keep a pregnant woman and her baby healthy. If the development of the baby is less than optimal, there can be lifelong consequences with subsequent demands on the budgets of health, social and educational services.
The government provides detailed information on dietary requirements for the UK population, including for pregnant and lactating women. During the third trimester of pregnancy, for example, extra energy – about 200 kcal per day (equivalent to about two and half slices of bread) above a non-pregnant requirement of about 2,175 kcal per day – is recommended. The energy requirements during breastfeeding increase to 2,505 kcal per day – equivalent to about an extra four slices of bread above the needs of a woman who isn’t pregnant.
Women also need more of certain vitamins and minerals during breastfeeding. For example, zinc requirements (essential for wound healing and maintaining a healthy immune system) increase from seven to 11mg per day, while calcium requirements (essential for bone formation and blood clotting) almost double from 700 to 1,250mg per day. Pregnant women are advised to take supplements of folic acid in the first trimester and vitamin D throughout their pregnancy.
The prison service is required to provide three meals a day that are “wholesome, nutritious, well prepared and served, reasonably varied and sufficient in quantity”, with at least one of these being a hot meal. But there are no minimum nutrition standards.
Poor nutrition overall can contribute to disease, causing an increased demand on health services, as well as being implicated in poor behaviour. Guidance on diet for women prisoners, and particularly for those that are pregnant or breastfeeding, is vague and sometimes inaccurate. For example, Prison Service Order no. 4800 (April 2008) states that: “Most women prefer and need a lower carbohydrate diet than men and … this should be reflected in the menus”, although there is no scientific basis for this (UK recommendations state that 50% of energy should come from carbohydrate for both men and women).
Similarly, the Prison Service Order states: “Certain groups of women will need to eat enough of or avoid certain foods – such as pregnant or lactating women”, without including any detail on specific foods. The recent Inspectorate of Prisons report hints that prisoners in some mother and baby units receive extra milk but does not give specific detail.
The UK prison service guidance on food and diet for all prisoners, and especially for those who are pregnant or breastfeeding, needs to be based on government guidelines and should include specific and accurate information. Above all, the prison catering service needs to be adequately funded. Without these things, we are doing a terrible disservice to pregnant women in prison and their babies.