This essay was first published in the 2019 edition of Voices and uses MLA documentation.

IN AN INFAMOUS EIGHTH CIRCUIT CASE, Pool v. Sebastian County, a woman entering a county jail informed the staff that she was pregnant and hemorrhaging. The prison nurse did not believe her, and she was ordered to stay in bed. Later, she was transferred to an observation room where she screamed and cried and still never had the opportunity to see a doctor. Five days after entering the jail, she miscarried alone (Luhlik 524). A deputy who was involved in the incident said, “[H]er supervisors had refused to respond to Pool’s medical needs, even though it was obvious that she was bleeding heavily” (Luhlik 524). Unfortunately, cases like this occur too often.

Since the war on drugs started in the 1980s, the rate of prisoners has skyrocketed, especially for women, which increased by 646% (Kelsey 1260). This reaffirms that most women are incarcerated for non-violent and often drug-related crimes. Women in prison bring a unique challenge to the prison system in reproductive healthcare, specifically when it comes to pregnancy. It is estimated that 6-10% of women sent to prison are pregnant at arrival (Kelsey 1261). Unfortunately, many will leave without a child due to the high rate of miscarriage in prison and the frequent termination of parental rights. Prisons for female inmates need to be reformed so they can properly provide care to pregnant women. These reforms should include 1) changing prison policies that both intentionally and unintentionally hurt pregnant women and understanding how the prison environment hurts pregnant women, 2) increasing the amount of reproductive healthcare that women in prison have access to, 3) fostering a relationship with the child and the mother after birth, and 4) outlawing the shackling of pregnant women. When these things are accomplished, we will see a greater rehabilitation success rate for these prisons.

Many prison policies were put into place with good intentions but had unintended consequences when it comes to women, pregnant women specifically. One thing that affects nearly all female inmates is the methods of birth control available in prisons. Because prison guards are worried about inmates selling pills, many prisons only offer the depo-shot as an option even though it has more severe side effects than the pill and can cause women to be sterile for up to 10 months after they stop using it (Kuhlik 512). Women should not have to deal with extra side effects because of fear of selling pills, which could be controlled by having inmates take the pill in front of guards. Reproductive healthcare is not something that should be compromised.

Another policy that hurts female inmates regarding their pregnancies is that women who give birth naturally are allowed less time with their children than women who give birth through a cesarean section (Kuhlik 512). Some women will request a caesarian section even if they do not need one because they want more time with their children. These requests put these women at unnecessary risk. This policy should be eliminated and replaced with a policy that gives all women adequate and equal time to recover and bond with their babies. This will help protect women from complications during child labor.

Many women are incarcerated for drug-related crimes. Therefore, addiction and withdrawal protocols are very important. Many prisons have a policy of making prisoners stop drugs immediately, and this results in prisoners entering the phase of withdrawal. Withdrawal can be a dangerous process, and for pregnant women, it has another serious possible side effect, miscarriage. Medications can help control the symptoms of withdrawal and reduce the risk of miscarriage, yet many prisons do not offer them because these side-effect blockers contain trace amounts of opioids. While these medications are controversial, it would be safer for pregnant women than going through withdrawal without this treatment (Sufrin 213). Putting pregnant inmates at risk could easily be avoided if people informed themselves more about the benefits of this side-effect blocker so that it would become less controversial and more widely accessible.

Several women have ended up giving birth in their cells because of going into pre-term labor and guards refusing to believe them. Guards do not trust prisoners and are often skeptical of many of their actions. While the guards’ caution is warranted, women who say they are in labor should always be evaluated by a medical professional because of the profound consequences that can occur from waiting too long to get medical help, especially in the case of pre-term labor. According to the article “Reproductive Justice, Health Disparities and Incarcerated Women in the United States” by Carolyn Sufrin, in one recent case, a Texas woman went into pre-term labor and screamed for 12 hours for somebody to help her. Despite her pleas for help, she ended up giving birth alone in her cell. The baby was born with the umbilical cord wrapped around its neck and unfortunately passed away before the paramedics arrived. Another case, Goebert vs. Lee County, made it all the way to the Supreme Court. In this case, a woman arrived in prison and explained that she was leaking amniotic fluid. The jail doctor did not believe her and sent her back to her cell. Several hours later she miscarried alone in her cell at five months pregnant. Luckily, the Supreme Court held the prison accountable (Luhlik 523). While these policies may have had good intentions, the people who created them obviously did not think about the unintended consequences. These policies need to be changed so that these consequences do not occur.

The environment of prison in and of itself is worse for pregnant women than being in the outside world. Women in prison experience much higher rates of abuse, including verbal, physical, and sexual abuse, both from other inmates and prison guards. The STD rates in women’s prisons are also much higher than the overall STD rate of the general population and higher even than in facilities for incarcerated men (Sufrin 214). Finally, just being in prison can trigger the onset of depression, which can harm a pregnancy. It is said that “these health disparities can lead to serious pregnancy and delivery complications” (Kelsey 1261). Despite these complications, some studies have collected data that indicates that the prison environment is best for the unborn child. They found that some birth weights of children went up the longer the women were in prison in relation to the birth weights of their siblings that were not developed in prison. The study claimed that “each day of a woman’s incarceration was associated with an increase of approximately 1.5g in her baby’s weight” (Hollander 199). While this data may be accurate, this does not consider the additional dangerous issues that the mother and the unborn child face while in prison. Ultimately, having the birth mother be in a physically and mentally healthy environment is what is going to influence the unborn child the most. Prisons need to create an environment that accommodates their pregnant inmates and keeps them safe.

The lack of prenatal care available to inmates is also harmful. “Many state correctional facilities do not require medical examinations as part of prenatal care” (Kelsey 1261). Prenatal care without medical examinations is not effective prenatal care. One phone survey done of U.S. female correction facilities found that “fewer than half of the jails reported that they give pregnancy tests to all women” (Kelsey 1263). Additionally, less than three-fourths of all prisons provide testing for sexually transmitted diseases. This lack of testing is very dangerous as pregnant women who are exposed to STDs and do not receive medical care can pass that STD onto their unborn child. While most women will receive several ultrasounds before they give birth, most pregnant inmates will not receive one. Most prisons have not invested in an ultrasound machine and would have to transport women to an off-site facility. This would cost the prison both money and resources that they do not have and do not want to spend. The same excuse is used when providing healthier food for women in prison. Only 51% of prisons provide healthier diets for pregnant women. One prison administrator went as far as to say, “[W]e don’t alter it for diabetics, let alone pregnant women” (Kelsey 1263).  Incarcerated pregnant women are not even given proper maternity clothing. Instead, they are often given prison garbs that are a few sizes too big. These oversized garments can create a falling hazard that is very dangerous for pregnant women (Luhlik 517). Cost-effectiveness cannot continue to be the only concern when it comes to the standard of care for inmates.

One form of reproductive healthcare often forgotten or ignored in prison is a woman’s legal right to an abortion. Many women in prison do not even realize this is an option. A telephone survey of U.S. female correctional facilities stated, “fewer than 30% of the surveyed facilities informed women of options” (Kelsey 1263). Even when a woman asks for an abortion, different prisons have varying policies. Some of these policies don’t even stay constant within the same facilities. In one prison, the following confusion was reported, “Anne reported that the inmates were able to receive the abortion, but in one case, the institution paid for the procedure and in the other, it refused to do so” (Luhlik 515). These inconsistencies make access to abortion unpredictable for women. Some prisons go so far as to make women obtain court orders before they can go to an off-site facility to receive an abortion. Women who were considered high-security prisoners often had a challenging time obtaining these court orders. Despite this, in the fifth circuit court case Victoria W. vs. Larpenter, the court upheld the prison’s right to force the women to request court orders. The consequences of the court’s decision were described as the following, “[I]n practice the requirement had the effect of preventing the plaintiff from accessing abortion” (Luhlik 528). While women do technically have the right to an abortion, prisons and courts can have the women go through many barriers before they are able to access one.

There are many ways to help create a relationship between a mother and her child while she is in prison. One method that has become rather popular in other developed countries is prison nurseries. Despite the numerous advantages to prison nurseries, most prison administrators do not want to implement one because of the costs associated and the environment that the children would be developing in (Campbell and Carlson 1071-72). Most prisons would need to undergo huge changes to have a safe space for the children, and even then, there are risks. While prison nurseries might not be the answer, half of all mothers in prison never receive a single visit from their children. In many cases, they do not have anyone to bring their child to see them. Additionally, phone calls can cost up to a dollar a minute. Children that are born in prison and do not have relatives to go to are placed into foster care. After fifteen months, they are eligible for adoption (Sufrin 214). If a woman’s prison term is longer than fifteen months, she will most likely have her parental rights terminated. To help women become rehabilitated, prisons need to help them bond with their children so that they have something that they are fighting for.

One of the most talked about topics when it comes to pregnant inmates is the shackling of pregnant women during and after labor. Unfortunately, the use of these restraints during labor is quite common. One published study found “that approximately a third of prisons…use chains” (Ocen 1256). Currently, 29 states have no laws outlawing the use of shackles during labor, and the 21 states that do have laws against them rarely enforce them because many people are misinformed about the law (Sufrin 216). The misunderstanding comes from the question of which parts of pregnancy women are allowed or not allowed to be shackled. A study of women’s jails in Massachusetts discovered that “[i]n jails, many employees mistakenly believe that handcuffing is permissible up until the point at which a patient is in active labor” (Luhlik 517). Women must endure being shackled by their arms, legs, and sometimes even their stomachs both when they are in labor and later when trying to bond with the baby. This interferes with mother/child bonding after birth (Kelsey et al. 1261).  In addition to shackling being extremely uncomfortable for pregnant women, it can also be dangerous as it can make it hard for doctors to medically intervene in the case of an emergency. Labor and delivery should be a time of triumph for women, not a time where they feel dehumanized. Prisons that shackle women during pregnancy, including labor and delivery, use this method because they explain it is the only way to keep prison guards safe. However, pregnant inmates have rarely, if ever, attacked prison guards, and shackling women while they are in labor should not be allowed just because there is a remote possibility of violence.

While many people may care about this issue, most people probably don’t know how they can even start to solve it. This is especially true if people are not associated with the prison system. The first and most important thing people can do is care about this issue and want to do something to change it. Sometimes, it might be hard to be sympathetic towards a prisoner, a person who has done something wrong. When people think that, they should also think about the fact that everyone makes mistakes in their lives and that does not necessarily mean they are bad people. It just means they did a bad thing. Fiscally, it is the responsible thing to do. At the end of a study on the treatment of pregnant inmates, it was stated that “improving the well-being and health of pregnant incarcerated women and their unborn children will reduce birth and other long-term complications” (Kelsey et al. 1266). These complications can be costly and avoiding them will help save the prisons money. The next thing that people can do about this issue is to vote. Vote for people who care about the prison system and reproductive healthcare and want to reform both. This way, prisons will be reformed in ways that will change harmful policies, improve the prison environment, create effective reproductive healthcare, foster the relationship of inmates and their children, and finally outlawing the shackling of pregnant women. Additionally, support women’s rights outside of prison because if women don’t have basic rights in the general population, then the women in prison really don’t stand a chance.

Works Cited

Campbell, Julie and Joseph R. Carlson. “Correctional Administrators’ Perceptions of Prison Nurseries.” Criminal Justice and Behavior, vol. 39, no. 8, Aug. 2010, pp. 1063-1074. EBSCOhost.

Hollander, Dore. “Jail May Improve Birth Weight.” Family Planning Perspectives, vol. 29, no. 5, 1997, pp. 198-199. EBSCOhost.

Kelsey, C., et al. “An Examination of Care Practices of Pregnant Women Incarcerated in Jail Facilities in the United States.” Maternal & Child Health Journal, vol. 21, no. 6, June 2017, pp. 1260-1266. EBSCOhost.

Kuhlik, Lauren. “Pregnancy Behind Bars: The Constitutional Argument for Reproductive Healthcare Access in Prison.” Harvard Civil Rights-Civil Liberties Law Review, vol. 52, no. 2, 2017, pp.501-535.

Ocen, Priscilla A. “Punishing Pregnancy: Race, Incarceration, and the Shackling of Pregnant Prisoners.” California Law Review, vol. 100, no. 5, Oct. 2012, pp.1239-1311. EBSCOhost.

Sufrin, Carolyn, et al. “Reproductive Justice, Health Disparities and Incarcerated Women in the United States.” Perspectives on Sexual & Reproductive Health, vol. 47, no. 4, Dec. 2015, pp 213-219. EBSCOhost.