"My story is good… It's not like that for all": Uneven access to contraception among incarcerated women in New South Wales, Australia.

Evidence indicates high levels of unmet contraceptive need among justice-involved women, linked to intersecting vulnerabilities such as housing instability, substance use, violence and poor mental health. In Australia, limited research has explored how women in prison navigate access to family planning services. This study aimed to examine the experiences of incarcerated women in New South Wales (NSW) in accessing contraception and making fertility-related decisions. The study formed part of the Second Sexual Health and Attitudes of Australian Prisoners (SHAAP-2) study. Seventeen women aged 19–45 were recruited from two NSW correctional centres. Semi-structured qualitative interviews were conducted face-to-face or via video call, recorded, transcribed, and analysed thematically in NVivo14. Coding drew on the Behavioural Model for Vulnerable Populations, supplemented by inductive thematic analysis to capture cross-cutting themes. Content analysis was also applied to describe contraceptive needs. Three overarching findings were identified. First, women’s access to contraception was less shaped by mistrust of providers than by system unreliability. While some reported supportive care, many described unanswered requests, long delays, and unsafe practices such as attempting implant removals. Second, incarceration prompted reflection and deliberate fertility planning. Women re-evaluated what it meant to be “ready” for motherhood, some seeking to delay pregnancy until achieving stability, others eager to conceive quickly after release, due to a sense of lost time. Third, women’s choices were constrained by side-effects and limited method options. Repeated failures with pills, injections, or devices sometimes led women to sterilisation as the “only certain” option, though some later regretted this decision. Prisons represent a critical but underutilised setting for meeting reproductive health needs. Despite policy commitments to equivalence of care, contraceptive services in custody remain neglected. Findings highlight the need for stronger structural supports including timely service pathways and effective pre-release planning, to ensure women can access safe, flexible, and non-coercive contraception. Addressing these gaps is essential to upholding reproductive rights and reducing health inequities for incarcerated women. This study looked at how women in prison in New South Wales, Australia, access contraception and make decisions about their reproductive health. With many incarcerated women of childbearing age, research indicates that they often experience challenges such as unstable housing, substance use, violence, which can limit access to contraception in the community. Consequently, many women may enter prison with unmet family planning needs. Researchers interviewed 17 women aged 19–45 years. Most did not want to become pregnant after release, and many wanted advice on contraception, help with side-effects, or removal of implants or Intrauterine Devices (IUDs). The study highlighted three main findings. First, women’s ability to access contraception was shaped less by mistrust of providers and more by an unreliable system. Some women received supportive care, but many described delays, unanswered requests, and unsafe practices such as trying to remove expired implants themselves. Second, prison provided time for reflection and intentional fertility planning. Women described rethinking what it meant to be “ready” for motherhood. Some wanted to delay pregnancy until life felt more stable, while others wished to conceive quickly after release, seeing incarceration as lost time. Third, women’s choices were strongly influenced by contraception side-effects and limited options. Repeated failures had led some women to view sterilisation as the only certain choice, though some later reconsidered. Overall, the study shows that prisons are a critical setting for reproductive health, including contraceptive care. However, this is often neglected suggesting that stronger structures, including timely services, choice, and clear pathways, are needed to ensure women receive appropriate care.