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Acknowledgements

Thank you to all of the prison administrators and officials whose cooperation was vital to the research presented here.  Thank you also to the staff at the Cambodian Defenders Project, Cambodian Health and Human Rights Alliance, Cambodian National Council for Children, CRC-Children’s House, Legal Aid of Cambodia, United Nations Cambodia Office of the High Commissioner for Human Rights and United Nations Children’s Fund Cambodia for sharing information and insights. 

This report would not have been possible without the aid of the staff at LICADHO’s Phnom Penh office, especially the Children’s Rights, Medical, Monitoring, and Prisons Offices, and the staff at LICADHO’s offices in Banteay Meanchey, Battambang, Kompong Som, Pursat and Siem Reap. 

Special thanks to Cheng Phal, Ham Sunrith, Khiev Chan, Man Sotheara, Ngeng Teng, Nhean Sarin, Nuon Sokchea, Samreth Chantha, and Ty Virak for their assistance in facilitating interviews and translation; to Jason Barber for his editorial insights; to Alex Lemon for his skills in layout and design; and to Steve Gourley for ongoing guidance. 

Finally, a very special thank you to the women and children who shared their stories and allowed me into their lives for a short while. The children’s constant smiles and good humor never failed to astound me. This report has been written for them, in hopes that it may help them to enjoy a brighter future.

By Hillary Margolis

Published by the Cambodian League for the Promotion and Defense of Human Rights (LICADHO)

June 2002

Contact:

Dr. Kek Galabru, President

Mailing Address: PO Box 499, Central Post Office

Office Address: #103 Street 97, Phnom Penh, Cambodia

Tel: 855 (23) 360965/364901

licadho@camnet.com.kh

Table of Contents

I. Introduction

There are those who must live in prisons despite never having committed—or even been accused of—a crime.  A shocking statement perhaps, yet this is precisely the case for children living with convicted or detained parents.   What happens to children raised in a prison environment?  While the number of Cambodian children living with incarcerated parents is not extraordinarily high, neither is it uncommon for children to accompany their mothers to jail or for women to give birth during their time in prison.  The issue has been considered serious enough to warrant both a national directive and specific mention in the Standard Prison Procedures issued by Cambodia’s Ministry of Interior.  

Despite this, little attention has been paid to the issue and no research has been conducted with specific reference to this topic.  Aside from regular reports from LICADHO’s Medical and Prison Project Offices, no local or international organizations have compiled data regarding children living with pre-trial detainees or inmates or pregnant pre-trial detainees or inmates, nor have any other organizations developed programs to address the unique problems they face.  To the researcher’s knowledge, LICADHO is the only organization currently providing regular services that target women and children living in prisons.  LICADHO provides assistance in the form of medical care for inmates as well as supplementary food for mothers, children, and pregnant women. LICADHO’s Children’s Rights Office distributes food once a month to mothers with children and pregnant inmates, including canned fish, rice, cooking oil and sometimes canned or powdered milk.  Distribution of food generally continues for three to six months following the birth of a baby, though the timeframe varies according to circumstance.  At CC2 prison, for example, the researcher witnessed all mothers with children—including those well beyond infancy—receiving extra food from LICADHO.  In prisons further from Phnom Penh, food distribution is conducted by local LICADHO staff who receive supplies on regular visits to LICADHO’s Phnom Penh headquarters. 

LICADHO’s Medical Office also provides food for pregnant prisoners and prisoners with children.  During monthly visits to monitor the health of inmates, the medical team gives them sugar, bananas and sometimes other foodstuffs.  Distribution of food continues for as long as the medical team deems necessary and the amount of food provided varies based on circumstance.  Medical Office staff said that they spend approximately US$100 to US$150 per month on extra food for all prisons. 

The medical team also provides regular health care for inmates.  In 2001, LICADHO medical staff made monthly visits to twelve prisons, conducting a total of 5,083 consultations with inmates and pre-trial detainees.   Additionally, investigators from LICADHO’s Monitoring and Prison Project Offices visited 19 civilian prisons and one military prison at least three times a month in 2001.  During these visits, staff conducted 2,324 interviews with pre-trial detainees and inmates to monitor human rights conditions in Cambodian prisons.  Consistent interaction with prison populations brought the plight of mothers, children and pregnant women to the attention of LICADHO staff.  

Fortunately, the relatively small number of children born and raised in prisons at present gives cause to hope that the situation can be addressed before it escalates further.  This is among the reasons that LICADHO opted to undertake research on the issue at this time.  In writing the following report, LICADHO hopes to provide a voice for the affected women and children who, up to this point, have had little if any opportunity to be heard.

The objectives of this study are as follows:

• To determine the scope of the problem and ascertain the general demographics of the affected population;
• To increase understanding of the primary needs and concerns of mothers and their children and pregnant women living in prisons, as well as the ways in which living in prison affects children’s rights, through documentation and analysis of the circumstances they face;
• To compile information on Cambodian and international laws and policies related to the issue and determine the degree to which such laws/policies are being implemented;
• To ascertain how current conditions support and/or violate children’s rights with reference to the four “baskets” of rights (Survival, Protection, Development, and Participation rights) as contained in the CRC;
• To create recommendations for addressing said needs and concerns so as to prevent this matter from becoming a larger social problem.

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II. Executive Summary

The word “prisoner” usually calls to mind images of hardened criminals—thieves, rapists, murderers and those who pose a threat to society.  Prisons in Cambodia do house such violent offenders, but they are also home to a population that is often overlooked: innocent children.  These children live in prisons not because of their own actions, but because their mothers have been charged with a crime.  As their mothers serve their sentences or await their trials, so too do their children, living the life of the accused without ever having disobeyed the law.

Such children reside in prisons because Cambodian law permits it and because, for myriad reasons, no other options are available.  Some accompany their mothers to correctional centers because they have no extended family to raise them or because their mothers do not trust the care available in outside facilities.  Others are deemed too young to separate from their mothers, often because they are still breast feeding at the time of her arrest.  Still others are born while their mothers are serving time or awaiting sentencing; at times they are even born in the prison facility itself.  Regardless of the circumstances, the mothers of these children tend to have one thing in common: the feeling that keeping their children in prison with them is their best available option.

Through its medical and human rights monitoring work in 20 prisons in Cambodia, LICADHO staff became aware that numerous children are growing up in jail.  Yet no organization had collected information on the situation or compiled data to analyze its effects on children.  Few organizations even provide assistance to mothers with children or pregnant women in prisons.  Moreover, despite specific national legislation pertaining to the topic, awareness of the issue is minimal.

LICADHO undertook research between October 2001 and April 2002 in order to assess the conditions in which these children live and determine whether such conditions endanger children’s rights.  Evaluation of the situation included a review of pertinent policy and literature, as well as personal interviews with incarcerated or detained mothers and pregnant women, children living in prisons, prison staff and individuals at relevant outside agencies.  Interviews were conducted at prisons in Banteay Meanchey, Battambang, Kompong Som (Sihanoukville), Phnom Penh (Prey Sar Correctional Center 2), Pursat, Siem Reap and Takhmau (Kandal province).  Thirteen mothers with children living in prison and seven pregnant inmates were interviewed.  Only one child, aged seven, was old enough to be interviewed.  In addition, interviews were conducted with eight prison directors, six prison staff members, and five prison health workers. 

In completing this research, LICADHO discovered numerous issues that severely compromise the rights of children living in prisons.  Despite international and national law—including Cambodian legislation and procedures specifically aimed at protecting imprisoned pregnant women, mothers and children who accompany parents to prison—the needs of this population are continually ignored.   These women and children are routinely denied access to suitable health care, adequate nutrition, education and basic human rights. 

The majority of children living in prisons at present are under the age of five, which means that they are at a crucial formative stage both physically and socially.  Five of the 15 children included in the study are below six months of age.  Meanwhile, seven out of ten women interviewed reported an inability to produce adequate breast milk due to an insufficient diet.  This is merely one indicator of the nutritional deficiencies facing children in prisons.  Though children often share the allotted prison food with their mothers, extra food is not distributed to prisoners with dependents.  The food provided typically lacks ample nutrients for adults, let alone for growing children.  When split among two or three or even more people, the nutritional value is depleted even further.  Yet few measures have been taken to supplement the food supply of pregnant and breastfeeding women, and none have been taken to supply children who are no longer breast feeding with food apart from that distributed to their mothers. 

Moreover, mothers and pregnant women described an ongoing inability to obtain health care while in prison, whether for themselves or their children.  At times this is because women’s own lack of funds prevents them from seeking treatment outside the prison or paying for transportation to a medical facility.  In other cases it is because women are not permitted to leave the prison in order to visit a health professional.  In still other situations, it is because the prison health service is unresponsive to women’s requests for care.  Though some NGOs and government health workers provide medical care in prisons, they are unable to do so on a daily basis or to focus specifically on mothers with children and pregnant women.  When prison health services provide care, it is often inadequate due to a lack of resources.  Available medicines are usually intended for adults rather than children, for example, and prison health service providers are overworked, understaffed and often not appropriately trained.

Living in prisons also presents a threat to children’s safety.  The potential for maltreatment at the hands of other prisoners or prison staff is ever-present, particularly in facilities where sex offenders or child abusers may be held.  

The effects on children’s development are social and psychological as well as physical.  Without access to standard education, children are at a disadvantage in terms of intellectual development.  Furthermore, they must forgo opportunities to interact with peers and the outside world in general.  These children rarely, if ever, venture beyond the prison walls and thus have little chance to adapt to so-called normal society.  Their world is limited in scope and largely influenced by what they observe in the prison.  Positive role models may be rare in such an environment, potentially impeding children’s moral development as well. 

Instead, these children are often surrounded by a culture of fear and helplessness.  A common theme among the inmates and detainees interviewed was that of vulnerability.  The women found themselves powerless for numerous reasons.  First, they all face poverty on a daily basis.  Though this might appear irrelevant in the life of a prisoner, in fact it is a crucial factor in their quality of life and that of their children.  Lack of funds impedes their ability to procure supplementary food or quality health care.  For some women, it even leads to an extended prison sentence; in cases where sentences include monetary compensation, those unable to pay the fine remain in prison instead.  This can result in an even lengthier stay in prison for a young child living with his or her mother. 

The women interviewed also expressed a sense of powerlessness within the prison system.  Though Cambodian procedures explicitly call for a means to address prisoners’ grievances, currently there is no adequate structure for doing so.  Women stated repeatedly that their complaints were ignored.  Perhaps more crucially, many women did not even bother to voice their concerns because they felt certain they would not be heard.  Some women were even afraid to express discontent because of possible ramifications for themselves or their children.  This pervasive sense of helplessness cannot be permitted to continue, both because it undermines prisoners’ rights and, more critical to the matter at hand, it thus undermines children’s rights as well.

Current legislation and procedures place responsibility for ensuring adequate care of children in prison squarely on the shoulders of prison staff and the Prisons Department under the Ministry of Interior.  Neither sector is fulfilling this responsibility at present.  While they have been charged with the duty of maintaining a high standard of care to children, their mothers, and pregnant women in prisons, they have in fact provided little if any of the treatment called for by existing policies.  Prison staff have not monitored the situation of children or pregnant women in prisons, as is required, nor have they facilitated collaboration with outside agencies able to assist in providing quality care.  Moreover, they have not evaluated children’s circumstances to ensure that each child’s best interests are served.   Policies and procedures to address many of the above issues are already in place; they are simply not upheld.  In failing to meet the standards outlined in existing laws and procedures, the Prisons Department and the Royal Government of Cambodia have allowed children’s rights to be compromised.  Without enforcement of the current procedures and a demand for accountability, this will continue to happen again and again. 

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III. Methodology

The following report is based on several methods of study including:

• Interviews with mothers, children and pregnant women living in prisons;
• Interviews with prison staff including prison directors, guards, and administrative and medical staff;
• Direct observation of mothers, pregnant women and children living in prisons, as well as direct observation of the prisons themselves, including living conditions and medical facilities where possible;
• Interviews and discussions with representatives from relevant local and international NGOs;
• Assessment of pertinent national and international legislation, policies and procedures;
• Review of literature pertaining to the effects of prison life on children and families, as well as review of literature on programs in other countries that offer alternatives to prison for mothers and pregnant women.

Research and interviews were conducted in seven prisons between October 2001 and April 2002.  The author attempted to interview all mothers whose children were living with them in Cambodian prisons, as well as their children when age-appropriate. The author interviewed 13 incarcerated or detained mothers with children living in prisons. Due to the fact that the majority of children living in prisons at the time were under the age of four, only one child (aged seven) living with her convicted mother was interviewed comprehensively.   Much of the information was therefore gleaned from the mothers, future mothers and prison staff.  Seven pregnant inmates and pre-trial detainees were interviewed to determine pre- and post-natal care conditions in prisons and to gain insight into women’s decisions about keeping newborns in prison with them.  In addition, eight prison directors, six prison staff members (four males and two females) and five prison health workers (one male and four females) were interviewed in an attempt to attain a more complete understanding of the living conditions and treatment of mothers, their children and pregnant women who are detained or incarcerated.  Emphasis should be placed on the Case Studies described in Section III of this report, as the research findings’ significance is largely qualitative rather than quantitative.  Despite the relatively small sample size, those interviewed represent virtually the entire population of mothers living with children and pregnant women in prisons at the time the interviews were conducted.  The author therefore feels the results are conclusive and representative of the complex situation these women and children face.

The author conducted interviews at prisons in seven areas: Banteay Meanchey, Battambang, Kompong Som (Sihanoukville), Phnom Penh (Prey Sar Correctional Center II), Pursat, Siem Reap and Takhmau (Kandal province).  These prisons were selected based on data attained by the Prison Project Office of LICADHO and LICADHO staff’s confirmation of the presence of mothers with children and pregnant women living in these facilities.

LICADHO’s pre-existing relationships with many of these prisons were beneficial in obtaining permission to conduct interviews on the premises.  As a human rights organization with offices in 14 Cambodian provinces, LICADHO has established working relationships with local prison staff in order to monitor prison conditions and provide assistance to inmates when necessary and possible.  Several of the author’s interview trips were concurrent with prison visits by LICADHO’s medical staff.  This helped the author gain acceptance and trust among prison staff and ensure legitimacy of the study in the eyes of prison administrators. 

Interview questions were developed by the author in collaboration with the LICADHO Children’s Rights Office and were aimed at determining how living in prison impacts children’s rights.\  Questions also addressed the health and well-being of the mothers themselves, as well as that of pregnant pre-trial detainees and inmates, because this affects the physical and emotional health of children both directly and indirectly. 

A standard set of questions was posed to each group of interviewees: mothers with children living in prison, pregnant women, prison administrators, prison staff and children of pre-trial detainees/prisoners or prison staff’s children living on prison grounds.  However, time constraints and other factors occasionally forced the author to limit or alter the questions posed.  The presence of prison guards and officials, for example, at times prevented the author from discussing sensitive issues with pre-trial detainees/inmates.  Likewise, the lack of privacy clearly deterred some women from answering particular questions.  It can be logically deduced that this may have also impacted the truthfulness of some interviewees’ responses, but to what degree this affected the researcher’s ability to gather accurate and complete information cannot be determined. 

The researcher’s gender worked in her favor when interviewing pre-trial detainees and inmates as she was able to relate to the women in ways that might have otherwise been impossible, and thus to create a sense of ease and identification.  Due to language limitations, however, the researcher conducted interviews with the aid of an interpreter.  The researcher remains confident, however, that the quality of the information within this report remains high and that interviewees’ responses are both revealing and significant.
 

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IV. Within the Walls: A Summary of Research Findings

Several clear patterns emerged during the course of the author’s interviews.  Mothers’ decisions to keep their children with them in prison often reflected the women’s common dilemmas, such as a lack of childcare alternatives. Mothers and pregnant women also shared many of the same concerns with regards to the effects of prison life on their children and/or future children.  The major issues that were raised through discussions with these women, as well as with prison staff and administrators, will be highlighted and explored more thoroughly in the following paragraphs. Case Studies excerpted from the interviews exemplify the women’s experiences and support the main points in the following sections of this report.

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A. Who Are They?  Demographics of Interviewees

The majority of children living in prisons (14 out of 15, or 93%) are aged five or under.  This is particularly significant in light of the fact that the first five years of a child’s life tend to be the most critical to his or her development.  The average length of a mother’s sentence is six years, while the average length of time served so far is just over one and a half years.  This indicates that infants currently living in prisons may spend a considerable portion of their formative years there.  (See charts below.)

Chart 1: Ages of Children Living with Mothers in Prisons

Chart 2: Ages of Mothers with Children and Pregnant Women in Prisons 

 Chart 3: Length of Mothers’ Sentences in Years 

Chart 4: Time Served by Mothers and Pregnant Women

It is also interesting to note that slightly more than half of the children (eight out of 15) accompanied their mothers to prison immediately upon the mothers’ incarceration.  Slightly less than half of the children (six out of 15) were born in the prison.  Only one child had come to live with his mother after she had been imprisoned for a period of time.  This demonstrates that the entrance of inmates’ children into the prison directly correlates to their mothers’ imprisonment or detainment.  Children do not tend to live in prisons following failed attempts at other living arrangements.  This could result from a lack of availability, desirability, or feasibility of alternative childcare at the time of the mothers’ arrest or detainment. 

Chart 5: Timing of Children’s Entrance into Prisons

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B. Asking Why: Reasons Children Live in Prisons

Interviews revealed that women faced similar circumstances and had parallel thought processes when it came to making the choice—that is, if they indeed felt they had a choice—to keep their children in prison with them.  The following comprise the primary reasons that women’s children reside in prisons:

• No other relatives to care for the child.  This could be due to a lack of living relatives, the fact that relatives live far from where the mother is imprisoned (such as is the case for one woman of Vietnamese origin whose relatives live in Vietnam) or a lack of financial or other resources on the part of the family. 

• The child is still breastfeeding.  Mothers and prison staff interviewed agreed that a child should remain with its mother during the time that it continues to breastfeed.

• The mother does not want to be separated from her child.  Many women commented simply that they love their child and do not want anyone else to care for him or her.  Others stated that they would feel lonely and sad were the child to be removed from the prison.  Some women also expressed concern over whether other available options, such as placement with an NGO or orphanage, would provide adequate childcare. 

• Lack of choices.  Numerous interviewees used identical terminology when discussing why their children live in prison with them: variations on the phrases “I have no other choice” or “there are no options.”   The number of times that these terms were used during the course of the interviews was striking.  Most often these words came from women who believed living in prison was not in the child’s best interests but felt they had no alternative solution.

 Chart 6: Reasons Why Mothers Keep their Children in Prison

C. Speaking Out: Primary Concerns of Imprisoned Mothers and Pregnant Women

While the women interviewed articulated various feelings about their children living in prison, many of their concerns overlapped.  The majority of the thoughts they expressed fall within the following six categories:

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1.      Food, nutrition and water

By far the most recurring concern in talking to the incarcerated women was that of lack of food and improper nutrition.  Fourteen of 20 women (70%) said that they and their children do not receive enough food or nutrients.  Eight of 13 mothers (62%) reported that their children complain of hunger on a regular basis.  

The majority of prisoners receive food twice a day; the meals usually include rice and one other dish, often only soup or vegetables.  Both prisoners and prison staff made frequent mention of the fact that the food available is insufficient in terms of quality and quantity.  In theory, prisons are allotted 1,000 riel per prisoner per day for food, but this money is used to cover expenses other than food as well (electricity, maintenance, etc.). This amount remains constant regardless of whether dependents live with a prisoner, despite the fact that many mothers share the prison food with their children.  While the meals are meager to begin with, they become more so when split between a mother and child, or perhaps even among a mother and more than one child.  For example, Sothy’s three children live with her in the prison and all share the food she is given by prison staff.  Sothy said that her children do not get enough to eat, especially her son who complains of hunger daily. 

Prisoners’ relatives can provide extra food, but this was rare among the women interviewed.  Only two of the imprisoned interviewees named their families as a consistent source of food.  A LICADHO report on the human rights situation in prisons notes: “Women receive to a lesser extent than men extra food from their families.  The food situation is even more troublesome for prisoners accompanied by children, as no extra food rations are provided for children.”  Many families of inmates and pre-trial detainees live too far away and/or are too poor to travel to the prison for visits.  Some inmates and pre-trial detainees simply have no relatives at all.
 

Only two prisons appear to provide extra food for mothers and pregnant women on a regular basis.  At Takhmau prison, the sole inmate whose child lives with her reported receiving more food than other female inmates; this was confirmed by both the prison health worker and prison director.  Likewise, at CC2 the prison director said he had asked the cook specifically to give more food to women who had recently given birth  At the time of the interviews, the prison was providing two mothers of newborns with extra food (fish) to cook themselves.  However, one woman noted that she did not have other ingredients necessary for cooking and the other said that she would only receive the supplementary food for one month following the birth of her child.  A third mother who had given birth in the past ten days reported receiving milk powder from the prison doctor.  He had given her 1 kg. of powder, but she did not know whether more would be provided in the future.  The supplementary food at CC2 appears to be made available only to mothers who have recently given birth; only one mother of a five-year-old child reported receiving more food than other prisoners and the remaining five mothers said they shared the standard allotment of food with their children. 

Staff at two other prison facilities claimed to provide extra food for children of prisoners, saying that they sometimes used personal funds to purchase “cake with vitamins” or “cake with milk” for children or coconut milk for a breastfeeding mother.  However, this was not corroborated in interviews with the inmates themselves.  In fact, mothers at both prisons remarked that getting supplementary food requires payment either in kind or out of pocket.  One mother said she sometimes washes clothes for the police (guards) in order to receive more food.  A woman at another prison said she only receives extra food when her husband comes to visit and brings her money, which she then uses to purchase goods from outside the prison via the prison staff. 

The failure to provide a nutritious, well-balanced diet for children and pregnant women in prisons is cause for significant concern.  A lack of adequate sustenance has been shown to have harmful effects on children, both directly and indirectly.  Malnutrition is a serious condition that can lead to stunted growth and development as well as various diseases.  Moreover, malnourishment during pregnancy can affect fetal development and maternal and infant mortality.  The State of the World’s Mothers 2001, a report published by Save the Children, recognizes that “newborn health…is dependent to a large degree upon the mother’s nutritional status…. Eliminating malnutrition during pregnancy reduces an infant’s risk of death and disease by almost one-third.”

Following birth, insufficient nutrition can prevent a woman from producing breast milk, as appears to be the case among many of the interviewees.  Seven out of ten women with infants reported an inability to breastfeed and/or an inability to produce adequate amounts of milk for their babies.  These women sometimes supplemented their infants’ diets with water or food from the prison.  One woman reported feeding her infant rice porridge because she was unable to provide him with enough breast milk; the porridge had to be made from rice given to her by other prisoners as the prison did not provide it. 

The importance of breastfeeding has long been stressed as a key to infant health in developing nations.  Based on research conducted by the World Health Organization and others, Save the Children’s State of the World’s Newborns report states: “A recent review has demonstrated the substantial benefits of exclusive breastfeeding over substitute feeding or partial breastfeeding, showing, among other things, that early and exclusive breastfeeding reduces neonatal mortality from infections.”  Women bearing infants in prison, however, are often unable to provide for their children’s nutritional needs exclusively through breastfeeding.

Finally, women at Battambang, Pursat, and CC2 prisons were all concerned about the lack of clean drinking water.  Out of the eighteen women asked, three named a nearby lake as their source of drinking water.  An additional woman said the drinking water comes from a local river and a further six women said it comes from an unknown source.  Of these women, only six boil the water before drinking it; two women mentioned specifically that they were unable to boil it because they did not have the necessary equipment.  As exemplified in the Case Study below, two women even pay for water in order to ensure that they and their children have an adequate supply.

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2.      Health and Access to Medical Care

Lack of adequate health care is another matter that was raised frequently during the interview sessions.  Eleven out of thirteen women (85%) reported that their children had experienced health problems while living in prison.  Most problems are considered minor—coughs, colds, fever, upset stomachs and the like.  However, many of the women expressed the fear that should their child have a serious illness, proper medical treatment would not be available.

LICADHO’s Medical Office does provide treatment to women and children during its monthly visits to 12 prisons.  During 2001, women accounted for 7.7% of prisoners treated, including several pregnant women.  (No statistics are available for the number of children treated.)  However, not all of the prisons referred to in this study are visited by LICADHO medical staff.  Moreover, LICADHO is unable to provide daily or continuous care; aside from monthly consultations with inmates, LICADHO only has the resources to provide assistance in emergency situations or under certain circumstances.  Mothers, children and pregnant women are therefore forced to rely on prison medical staff and assistance the majority of the time.  

The above Case Study raises two other important points with regards to the situation of children living in prisons: the lack of care available in the specific field of maternal and child health and the need for funds to pay for treatment outside of the prison.  Two of the seven mothers who had given birth while living in prison had done so in the prison itself—despite the fact that Cambodia’s own Proclamation No. 217 on the Administration of Prisons, as well as the Prison Procedures and the UN Standard Minimum Rules for the Treatment of Prisoners, state that women should be brought to a hospital in order to give birth.  Two of the seven pregnant women said they will deliver their babies in the prison, while four others said they did not know where they would give birth, indicating that no definitive plans have been made for them to deliver at a medical facility.

The health care available in prisons is often limited due to lack of equipment and supplies.  Three of five health staff interviewed said that they are unable to provide sufficient care to all of the prisoners, either because they do not have the time to attend to all of them or because they do not have the necessary tools at their disposal.  Moreover, none of the medical staff interviewed has received an M.D; one prison health worker said she had no medical training whatsoever. Two nurses said they did receive certificates in “maternity,” while the three other health staff interviewed had no specific training in maternal and child health. 

Even if they were qualified pediatricians or obstetrician-gynecologists, many of the prison health workers would face an uphill battle.  The health centers viewed by the researcher were sparse, furnished with only basic equipment and facilities.  None of them were properly equipped to care for children.  In fact, the health workers often said they did not have adequate medicine for treating the adult inmates, let alone the children.

Prison health staff also face difficulties as a result of issues extending beyond the prison walls, as is shown in the following case described by a prison health worker. In this instance, the health staff’s ability to provide proper care for the newborns was hampered by a lack of response from the Ministry of Health. 

If women do want expert medical care for themselves and their children, it often comes at a price they cannot afford.  This fact reflects the mutual dilemmas of insufficient medical treatment and poverty that affect many incarcerated women.  Several prison directors said that local hospitals charge prisoners minimal fees because they recognize the plight of inmates and pre-trial detainees.  Still, one of the main obstacles to health care that these women face is the need to pay for medication from and transportation to medical centers outside of the prison.

Even within the prison, women reported that they often have difficulty getting treatment from medical staff.  Several women noted that their requests for medical assistance for themselves and/or their children had been disregarded.

An additional cause for concern is the failure to vaccinate all of the newborns.  Cambodia’s 2000 Demographic and Health Survey, released by the Ministries of Planning and Health, notes the importance of vaccinations for all infants in reducing child mortality from preventable diseases including tuberculosis, diphtheria, whooping cough, tetanus, polio, and measles.  Save the Children’s report on the status of newborns also emphasizes the need for vaccinations as a means of preventing potentially fatal infections in infants.  However, vaccinations are often unavailable to children born in prisons.  For example, one prison medical assistant said that she is not permitted to give vaccinations at the prison and must therefore take the children to the hospital in order to be vaccinated.  Given the frequent inability for mothers and children to reach hospitals, as outlined above, infants may simply go without the necessary vaccinations.  The following Case Study illustrates this problem:

Sanitation presents yet another health issue confronting mothers and children.  Cells are sometimes crowded—one woman reported that she shares her cell with 26 others—and sanitation facilities are frequently sub-standard.  Of the diagnoses made by LICADHO’s medical team in 2001, twenty percent were conditions caused by or related to poor sanitation, such as diarrheal or parasitic diseases, typhoid fever, and skin infections. LICADHO’s 2001 report on health concerns in prisons states that “given the serious overcrowding and poor sanitation present in Cambodian prisons it is no surprise that infectious disease accounts for a large percentage of prison disease.”

One particular problem mentioned by women in several prisons is a lack of water during the dry season, which prevents prisoners and their children from maintaining good hygiene.  In one case described below, a woman even purchases water in which to bathe her child because she does not trust the cleanliness of the water available at the prison.

Another critical issue the LICADHO Medical Office raises in its 2001 report is that of pregnancy resulting from sexual assault of inmates.  Details in part one of the following Case Study have been taken from the Medical Office’s report.
 

The above incident reflects not only the aforementioned concerns about nutrition and health care, but also the threat women face as potential victims of sexual abuse at the hands of others within the prison.  This in turn may affect both them as mothers and any children they might bear.  In the above case, the inmate’s usual struggles are compounded by her role as the sole caretaker and provider for an infant she conceived through sexual abuse.

The LICADHO medical report concisely summarizes the health issues reflected in the situation of Nia Ry and other female prisoners: “[I]t is clear that [women’s] health needs differ from those of their male counterparts.  They need better access to gynecological and obstetric services.  Additionally, sexual abuse remains a serious health concern.” As shown above, each of these issues can seriously impact both mother and child.

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3.        Financial Constraints

Monetary concerns often arose in conjunction with discussions about food and medical care.  A dearth of funds was considered a major factor in preventing female pre-trial detainees and inmates from procuring more or better quality food and health care, or even water.  Moreover, several women mentioned giving money to prison guards and asking the guards to bring them items from outside the prison. 

Some of the women suffer a double dilemma financially as a result of their sentences.  In addition to the inability to purchase supplies from outside the prison or pay for transport to a medical center, these women may face extended jail time due to their incapacity to fulfill payments included in the terms of their sentences.  Such sentences require monetary compensation as well as jail time.  The Case Study below describes what happens if an inmate is unable to make the necessary payments.

This Case Study provides a clear example of how such financial constraints can continue to impact mothers and children even after the mother’s official prison term ends.

 
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4.        Access to Education

Even for mothers of infants and young children, the lack of educational opportunities weighs heavily on their minds.  Many women said that living in the prison will prevent their children from attending school.  This could be for a variety of reasons, such as a woman’s inability to pay for a child’s transportation to and from school, an inability to fund school uniforms and other materials, or non-existent educational facilities nearby. The women interviewed were obviously aware of how a lack of education could negatively impact their children.