Pregnant in Prison
Available Care for Pregnant Persons in Incarceration Facilities in the US and UK
The United States’ incarcerated population is made up of some of the most vulnerable members of the country. People of color are disproportionately overrepresented in the nations’ incarceration facilities; women are beginning to be sentenced at greater rates than men. These women are typically survivors of violence and abuse, are low-income, and are the sole providers for their children. Compared to the general population of the US, these women are “in poor health when they enter prisons,” suffering more frequently from various serious diseases, such as HIV, STDs, asthma, hypertension, and diabetes… the list goes on. The proportions of psychiatric disease are also much higher than in the non-incarcerated population, with “significant histories of emotional and physical abuse, post-traumatic stress disorder, depression, [and] poor self-esteem…”
This disenfranchised population experiences high-risk pregnancies more than the general population due to “lack of prenatal care, poor nutrition, domestic violence, drug and alcohol abuse, high STD rates, HIV, hepatitis C, human papillomavirus, homelessness, psychiatric illness” and more. More dishearteningly, “miscarriage, pre-term deliveries, spontaneous abortions, low birth weight infants, and pre-eclampsia are common complications.”
While these descriptions are specific to studies done in the United States, similar, though less drastic trends have been documented in the United Kingdom. Women are in need of incredible physical, emotional, and mental support while incarcerated, and pregnant women need specific and supportive medical care. Most in the US do not receive the minimums of care; the UK’s national healthcare makes this a high priority for the women they remand in custody.
I’m writing this article in an attempt to compare the systems of care in place for incarcerated women, to discuss current programs available, as well as alternatives to these programs. I’d like to acknowledge that this article is written in a heteropatriarchal fashion. Most of what I have read is assuming the mother is the sole provider, and the father is not in the picture of the family, assuming historical gender norms. This excludes those who live contrary to these norms and excludes queer, trans, and gender non-conforming people. In an attempt to best report what I have researched, I have written mostly of “mothers”, not “birth-givers”, as I would have liked to.
The prison-industrial complex in the United States makes compiling and accessing data difficult and complicated and is not representative of the population it claims custody over. The UK does a much clearer and more accessible job with its reporting of statistics but is similarly exclusive. With that being said, I have tried my best to write and report what I have read, as I have read it, and welcome corrections and comments.
It’s no secret that the United States has been implementing tactics of mass incarceration in the past couple of decades, especially in the massive spike in arrests and sentencing of women. The United Kingdom has been experiencing increasing rates of female incarceration as well, though not to the extent of the US. As per a 2015 census, 211,870 women were incarcerated in the United States, a number that has continued to grow. At the time, these women made up 10.4% of the total prison population. From 2018 data, 3,807 women were reported as incarcerated in the UK, making up a total of 4.6% of the prison population. These numbers are hard to digest, especially with the significant differences in the total population between the US and UK.
To compare on more level grounds, 65.7 women per 100,000 of the US population are incarcerated, whereas 6.4 women per 100,000 of the UK population are incarcerated. These numbers of 100,000 are reflective of the national total population; if these rates were calculated based on solely women in the population, numbers would be doubled (130 per 100,000 and 12.8 per 100,000, respectively).
Across both of these major populations, the US and the UK, an estimated 6–10% of women are pregnant on intake. The numbers are uncertain, as not all institutions perform pregnancy tests upon intake. Despite the uncertainty, it is evident that a significant portion of the female prison population is made up of pregnant persons, and appropriate services should be available to them throughout each stage of their pregnancies.
The care offered in UK incarceration facilities is often higher quality and more regularly accessible than what is typically available to women in the US. Having standardized and universal healthcare carries into the facilities for the mothers so they have access to prenatal care, support throughout labor and delivery, and postpartum care. These services are performed most often by midwives. The Royal College of Midwives (RCM) has published various statements on their stance on healthcare access for pregnant people, detailing that they:
[Believe] that maternity care which is safe and appropriate should be available to pregnant women in prison to the same quality and standard as the non-prison population.
The RCM goes on to describe their vehement disapproval of handcuffing during any medical or midwifery examination, as well as “during intimate times, such as breastfeeding.” Additionally, they hold the government accountable for detailing and upholding a standard minimum of care and rights to pregnant persons in prison.
The association Birth Companions has a detailed code of fundamental, inalienable rights women in prison should have (including maternity leave!!!), which can be read in full, here. Birth Companions details further what the RCM begins to describe in their publication, but goes on to discuss mothers’ rights to placements in Mother and Baby Units (MBUs), especially the right to know whether or not they have secured a placement before giving birth, allowing for adequate time to arrange alternate plans for their newborn if placement is not a possibility. MBUs are facilities within the incarceration system that allow for mothers and their newborns to remain together up through the first year of the baby’s life (sometimes up to 18 months, if the mother’s release is scheduled to be before that time). After these months, the baby is either placed under the custody of a designated family member or the foster care system.
There are currently 15 MBUs in the UK, while there are only 12 traditional women’s prisons. Studies have shown that these placements significantly improve mental health, parenting skills, as well as mother-infant interaction and bonding. Early bonding between mothers and infants has shown to be incredibly important to later neurological development for the infants. Placement in these units are incredibly valuable to both mother and child, emotionally, physically, and developmentally, and normalize the process for those incarcerated.
The pregnancy and birth process in incarceration facilities across the United States is comparatively less regulated and more abusive of women’s rights and entitlement to basic healthcare. If you Google-search “birth in US prison,” the top articles include titles like “Giving Birth in Jail Can Traumatize Women for Decades” or “Giving Birth Behind Bars: 15 Things You’ll Be Shocked To Discover.” There are harrowing testimonies given by mothers abused by the system.
The typical process of birth and pregnancy while incarcerated consists of irregular prenatal check-ups, difficulty in accessing prenatal vitamins and supplemented diets, working up until a few hours before labor — forget bed-rest or maternity leave — and the list of violations of human rights goes on. When labor begins, women are transferred, often in shackles, to a nearby hospital, where they are to give birth under the complete surveillance of correctional officers, with no support person. Too many states in the US still have no legislation banning shackling. If you’re curious about your state’s legislation regarding shackling, click on the image below for more information.
Just this week, a New York Times article came out about a woman who was shackled to her bed while delivering her child, against the advice of her doctors, and against state law. Another woman, when interviewed, recalled “I started to not care about my pregnancy, because no one else cared,” after repetitive inhumane treatment. Pregnancies experienced by women in prison are traumatizing and ill-supported, to say the least.
Similar to the MBUs in the UK, the US has (very few) prison nurseries in place for incarcerated new mothers. Currently, there are only ten prison nurseries in the US, in comparison with the 80–85 women’s prisons that are open at any given time, making placement difficult. The prison nurseries are set up in the same style as the MBUs and have proven to greatly reduce recidivism rates for mothers who participate in the program. In one study, the three-year recidivism rate for program participants was 14%, comparably lower than the nation’s average of 24–66%. The decreased prospect of recidivism is indicative of the success and importance of the implementation of prison nurseries as a norm in the US prison-industrial system.
Despite common neglectful pregnancy care for women in custody of the US prison system, some states are progressively implementing programs where women can have regular access to doulas throughout their pregnancy. A doula is defined by Doulas of North America (DONA) as:
A trained professional who provides continuous physical, emotional and informational support to a mother before, during and shortly after childbirth to help her achieve the healthiest, most satisfying experience possible.
A study in a Minnesota prison offered pregnant women the services of a doula, and all accepted. The doula met with the mother twice before delivery. In these private meetings, the doula helped plan the birth and provided prenatal education and emotional support. Once the mother was transferred to the hospital for delivery, the doula was contacted to meet at the hospital. These doulas served as the mothers’ ONLY support system during labor. Though women report that hospital nurses are very accommodating, they are often very busy and cannot stay through the duration of labor.
The doula would stay to help through labor and delivery as well as during the postpartum period. They were permitted to take pictures of the mother and her newborn, which otherwise wouldn’t have been a possibility. If separation occurred after the birth, the doula provided emotional support during the separation. After the birth, when the mother had been transferred back to the prison, the doula would visit to provide further support, as well as to give the mother a small gift — a story of her birth, and five photographs taken of the mother and infant.
Through analysis of the doulas’ birth-stories, researchers concluded that the doulas were able to provide meaningful service to the women while still meeting their professional goals. They were able to establish trusting and valued relationships with their clients, one doula writing
She was happy to see me, it made my whole day! The nurse said she did not want to get out of bed or do anything until her doula arrived.
Evidently, the doula’s presence meant a great deal to the woman, making the doula feel valued during the birth process and to the mother. Doulas helped the women feel strong and empowered, and worked to normalize the birth as best as possible under the circumstances of surveillance and confinement to the hospital room. Lastly, the doulas were able to provide support for the mother during separation from their infant — the doula acting as the only support person physically available for the mother. This study goes to show that doulas are meaningful and vital to the birth process for women, especially incarcerated women, whose means of support are very limited.
Alternatives to the currently aggressive American approach to birth while incarcerated are long overdue. The methods implemented by the UK are considerably more progressive and successful and should serve as a model. Trial runs done in the US have proven to be similarly successful, with the proven lowering of recidivism rates for program participants. Washington state recently legalized modified midwifery care (in addition to the pre-existing doula care), which is a step forward, in my opinion, to centering humanity opposed to punishment, as the US “reform system” should strive to do. With the UK treating incarcerated women as full human beings entitled to high-quality healthcare (and midwives), the US should work to follow its design.
