Following her residency in obstetrics and gynecology, Andrea Knittel, MD, sought fellowship opportunities that would allow her to serve women who needed her most. In UNC’s Division of General Obstetrics and Gynecology, she found a place where she could build her expertise in offering comprehensive, patient-centered treatment to women who are incarcerated.
“I came to UNC because there was a program for treating women at the prison. My interests in residency had focused on health care and needs for incarcerated people, and I found that practice setting to be challenging and rewarding.”
Knittel worked with Cris Muñoz, MD, longtime faculty in the division, in the department’s clinics at N.C. Correctional Institute for Women in Raleigh, and after her fellowship, she joined the faculty at UNC OB-GYN to lead the program. As an assisted professor of obstetrics and gynecology and Director for Incarcerated Women’s Health, she coordinates obstetric and gynecologic services offered to incarcerated women through the North Carolina Department of Public Safety.
“The prison allows us to practice to full extent of what it means to be a generalist,” says Knittel. “We see a lot of women who have not had access to care, or who have had sporadic care. They may have gynecologic problems that haven’t been addressed in a long time or problems for which they’ve had short fixes.”
Incarcerated women face specific challenges when it comes to their healthcare, says Knittel, and it is important to provide respectful care. Some pregnant women may have substance use disorders. Their pregnancies may be high risk, or they may have had a lack of prenatal care before incarceration.
“We can promote the public health of these women by practicing harm reduction. We’re not here to change the system, but we can decrease the harm that is done to these women and their families while they are incarcerated.”
Part of optimizing their care has been to offer medication assisted treatment for substance use disorders and reshape postpartum care, taking seriously the difficulty of being separated from their babies after delivery, and investigating a program to allow women to pump, freeze and ship breastmilk to their infants. Knittel is also increasing the amount of clinic time they have for gynecologic care, and she has been able to decrease the time to colposcopy – a special procedure to closely examine the cervix after an abnormal Pap test – from a few months to within a few weeks.
“It is fulfilling to treat a patient with the most respect, whether I’m seeing patients in my UNC clinic or at the prison. When the patients express feeling listened to, understood and educated, I know we’re moving in the right direction.”