While the US prison industrial complex affects us all in ways that are both obvious and subtle, the majority of attention has been on the very real experiences of incarcerated cis-gendered men. Men make up the majority of incarcerated individuals, and it’s important to highlight the fact that incarcerated men (especially Black and Brown men) make up a forgotten part of our society. This article, however, is going to focus on the experiences of incarcerated women and birthing people. As a result, this article will contain gendered language that may seem to and actually exclude others. It’s important to the author to note that the experiences of non-birthing people (men and non-men alike), trans folks, and other minorities are worthy of attention that may not be provided by the purposes of this article.
It’s also important to me to mention that this blog is written from a scholarly stance, with research cited and referenced throughout, and that while viewing the issues through this lens gives viability to the data, the issues discussed are being experienced by real humans. Behind each piece of data and every citation you will read, there are hundreds and thousands of actual human beings whose lives, for better or worse, are being impacted. I want to bring attention to those people and their unique stories while also highlighting the fact that this is a systemic issue for which we all hold some responsibility.
“I didn’t know I was pregnant when I got arrested, and I was shocked when I found out. My first thought was, what is going to happen to my baby? You are a prisoner, a number, not a human, not a pregnant woman. What I was going through wasn’t important to them. Being separated from my daughter like that sent me into a deep depression. I know I committed a crime and had to serve my time, but I did the wrong, not my child.”Angelica Rangel, (Simons & Craig, 2022)
The United States incarcerates more people than any other country in the world, and women are the fastest-growing prison population today, with the number of incarcerated women increasing by 525% between 1980 and 2021 (Monazzam & Budd, 2023). While the data is limited, it is frequently reported that upwards of 80% of incarcerated women are mothers, the vast majority of whom are the primary (and often solo) parents of their minor children. Many women report that the period of their incarceration was the first time that they had been separated from their children; additionally, it is far less likely that the children of incarcerated mothers are cared for by their fathers. Grandparents (especially grandmothers) and the foster care system are the primary means of care for children of incarcerated women (Friedman et al., 2020).
Beyond the data surrounding the numbers of incarcerated women already mothering, most women entering the justice system are of childbearing age. There is no mandate, federal or otherwise, that correctional facilities track or report on pregnancy-related data. Most correctional systems lack the ability to collect such data, and even more importantly, they often lack the ability to provide necessary specialized care related to pregnancy and birth. What this means in practice is that we are woefully unaware of the actual impact of incarceration on pregnancy, childbirth, postpartum, and mothering practices. In the available data, estimates range between 3-10% of women entering the prison system who are pregnant at the time of their admission (Friedman et al, 2020). We also know that women who enter the justice system are less likely to have been engaging in positive health-related behaviors prior to their incarceration; for example, incarcerated pregnant women are less likely to have attended prenatal doctor’s visits or to have taken prenatal vitamins. Additionally, pregnant incarcerated women are significantly more likely to have been in intimate partnerships wherein they were exposed to abuse and to report having relied on WIC and/or Medicaid. Incarcerated women also report higher rates of substance dependence, sexually transmitted infections, and other health conditions potentially affecting pregnancy outcomes. In fact, even when other confounding variables (e.g., homelessness, unemployment) are controlled for, we see these differences persist (Dumont et al., 2015).
Prenatal Care in Jails and Prisons
The penal system is one that was designed for male bodies, and even while women make up the fastest-growing population, roughly 90% of incarcerated people are men. This focus on men and the needs of men extends to the structure and workforce of the justice system. Medical treatment within the system is focused on the needs of men, so pregnancy care is typically limited at best and completely unavailable at worst. This is all despite the Eighth Amendment providing that all incarcerated people are entitled to medical care for “serious medical needs.”
Pregnancy testing is an important first step in the care of incarcerated birthing people. The American College of Obstetrics and Gynecology (ACOG) recommends the regular pregnancy testing of every childbearing woman upon booking into the jail and/or prison system and additional testing in the two weeks post-booking for those incarcerated people who are at risk of becoming pregnant. Early detection provides the opportunity for appropriate counseling of pregnancy options (i.e., abortion and adoption) and the detection of those birthing people who are at high risk for complications (e.g., bleeding, ectopic pregnancy, etc.). Available research indicates that correctional staff often rely on self-report for pregnancy detection and that regular testing is relatively rare, with one study showing regular testing among 38% of facilities holding incarcerated women (Kelsey et al., 2017).
Prenatal care is usually a responsibility shared between system and community medical staff, which is dependent on the availability of transportation, the availability of supervisory correctional staff, and the availability of appointments within a usually overstretched and under-resourced community obstetric provider. Incarcerated pregnant people experience a distinct lack of control in the correctional environment, from the timing and frequency of doctor’s appointments to diet, sleep, medication, and exercise needs being unmet and the risk of violence (Dumont et al., 2015).
ACOG provides standards for pregnancy care in the correctional environment, which include:
- access to pregnancy testing
- access to and counseling for abortion
- access to and counseling for contraception (before and after pregnancy)
- assessment and treatment for reproductive health concerns (e.g., HIV, depression, substance use/abuse, etc.)
- appropriate diet and vitamin supplementation
- delivery in hospital settings with access to high-risk care for mothers and babies
Other invested organizations have set similar minimum standards for the care of birthing people in correctional facilities, and yet care varies widely between facilities. Even when standards are legal requirements as opposed to standards, there is very little oversight into whether those laws are being followed. For example, many states have laws against the use of shackles during pregnancy and the postpartum period (due to the risk of potential harm to the birthing person and/or the fetus); however, among nurses in hospitals caring for pregnant/birthing incarcerated people, over 80% reported that incarcerated birthing people we regularly shackled, some of them for the entirety of the time they were in the hospital (Glenn, 2018).
Incarceration does not preclude someone’s right to an abortion, though incarcerated pregnant people often face barriers above and beyond what is faced by pregnant people in the free world, with many formerly incarcerated birthing people reporting they were either not supported in their request for access to outright being denied access to termination (Sufrin et al., 2009). Recent legislation has only served to increase these barriers.
Labor and Delivery
The prospect of labor and delivery can be overwhelming under the most supportive of conditions; however, for incarcerated birthing people, the process is even more daunting. Incarcerated birthing folks experience a lack of control over the birthing experience as a whole, limited health education, the lack of a freely chosen birth support person, the looming separation of baby and mother, and concerns about the placement of the baby once the mother returns to the correctional facility. These stressors have clear links to increased risk of perinatal mental health conditions, preterm delivery, and low birth weight (Kotlar et al., 2015).
It is not uncommon for newly postpartum incarcerated women to be returned to the correctional facility without any support for their physical and/or psychological needs, with many women reporting that their fellow incarcerated women were left to do the work of what should be trained medical and mental health professionals. The option to pump and provide human milk to their babies is rarely an option. It is also rare that mothers are allowed to return to the facility with any way to feel connected with or to mourn the loss of their babies, whether that means bringing a photo from the hospital or being provided grief counseling.
To mitigate postpartum risks, there have been a number of programs developed, ranging from peer support to the creation of regular programming led by midwives and other birthing professionals (for one example, explore the work by the Ostara Initiative, a multi-state collective focused on the goal of eliminating prison birth).
In 2007 the United Nations Children’s Fund (UNICEF) stated that it would be against the rights of children and their best interests to remove infants from their mothers due to incarceration and that if a mother is being held in a correctional facility, it is in the best interest of mother and baby for the baby to also be present in prison when possible (UNICEF, 2007). Many countries have normalized the use of mother-baby units in carceral settings, though the United States has lagged behind, being one of only 4 nations that regularly separate mother and baby (Warner, 2015).
Conclusions and Call to Action
“The mission of Postpartum Support International is to promote awareness, prevention and treatment of mental health issues related to childbearing in every country worldwide.”
As if there were not enough tragedies in this blog, one of the greatest tragedies is that the birthing people and children in our communities, represented by the statistics and citations within this blog, are often the people we as a culture value the least. The stigma against incarcerated women in our culture is pervasive and most intensely focused on incarcerated mothers. It is unreasonable for us, as a country and as a movement, to claim care for birthing people and babies without acknowledging the harm we are allowing and causing to the most marginalized and forgotten among us.
Consider the following as some options for specific routes to becoming involved:
- Donate to the Ostara Initiative as they continue their work to end prison birth across the U.S.
- Doulas can apply now to attend the second Prison Doula Certification Program, led by the Ostara Initiative, and happening February 2-4 in Milwaukee, WI, OR with one of Birth Behind Bars’ trainings for birth professionals
- Explore the Read and Watch section of the Ostara Initiative’s website for continued learning
- Contact your congressional representatives and encourage them to support H.R. 982, the Pregnant Women in Custody Act, which would ban restraint use on pregnant women, require pre- and post-natal education and care, increase accountability for the care of pregnant and postpartum incarcerated women, and end restrictive housing policies to encourage family preservation (note: this bill would only affect Federal facilities controlled by the Bureau of Prisons).
- Don’t forget the folks held in your local jails – reach out to those facilities and inquire about the possibility to provide educational classes, support groups, supplies, and other support for the incarcerated people.
This is not an easy battle – thankfully, those of us who have professional and personal interests in the realm of maternal and infant wellbeing are familiar with hard battles. We are also aware of the intense reward of joining in those battles and becoming agents for change. Let this blog be an invitation to you to join me in this worthy fight. Incarcerated women and their children deserve better. We deserve better. It’s up to all of us to make better happen.
Dumont, D. M., Wildeman, C., Lee, H., Gjelsvik, A., Valera, P. A., & Clarke, J. G. (2015). Incarceration, maternal hardship, and perinatal health behaviors. Maternal and Child Health Journal, 18, 2179-2187. doi: 10.1007/s/10995-014-1466-3
Friedman, S. H., Kaempf, A., & Kauffman, S. (2020). The realities of pregnancy and mothering while incarcerated. Journal of the American Academy of Psychiatry and the Law, 48, 1-11. doi: 10.29158/JAAPL.003924-20
Glenn, A. (2018). Shackling women during labor: A closer look at the inhumane practice still occurring in our prisons. Hastings Women’s Law Journal, 29. https://repository.uchastings.edu/hwlj/vol29/iss2/4
Kelsey, C., Medel, N., Mullins, C., Dallaire, D., & Forestell, C. (2017). An examination of care practices of pregnant women incarcerated in jail facilities in the United States. Maternal and Child Health Journal, 21. doi: 10.1007/s10995-016-2224-5
Kotlar, B., Kornrich, R., Deneen, M., Kenner, C., Theis, L., von Esenwein, S., & Webb-Girard, A. (2015). Meeting incarcerated women’s needs for pregnancy-related and postpartum services. Perspectives on Sexual and Reproductive Health, 47, 221-225. https://www.jstor.org/stable/10.2307/48576281
Monazzam, N., & Budd, K. M. (2023). Fact sheet: Incarcerated women and girls.The Sentencing Project. https://www.sentencingproject.org/fact-sheet/incarcerated-women-and-girls/
Sufrin, C. B., Creinin, M. D., Chang, J. C. (2009). Incarcerated women and abortion provisions: A survey of correctional health providers. Perspectives on Sexual and Reproductive Health, 41. https://www.jstor.org/stable/20462705
United Nations Children’s Fund. (2007). Implementation Handbook for the Convention on the
Rights of the Child.
Warner, J. (2015). Infants in orange: An international model-based approach to prison nurseries. Hastings Women’s Law Journal, 26. https://repository.uchastings.edu/hwlj/vol26/iss1/5