Prisons are neglecting pregnant women in their healthcare policies

Our 50-state survey finds that in spite of national standards, most states lack important policies on prenatal care and nutrition for pregnant women.

by Roxane Daniel

This past August, released surveillance footage showed 26-year-old Diana Sanchez alerting Denver County Jail deputies and medical staff that she was in labor just hours before she gave birth to her son, alone in her cell. With her pleas ignored by staff, Sanchez was forced to give birth without any medical aid or assistance. Her experience is not isolated, as a number of reports by women in prisons and jails across the country have revealed a similar disregard for pregnant women’s basic needs.

What’s more, the documentation of pregnancies and pregnancy care is sparse, sometimes anecdotal, and rarely generalizable on a national level. The most recent national data was collected more than 15 years ago. In 2002, the Bureau of Justice Statistics (BJS) found that 5% of women in local jails were pregnant when admitted. For prisons, BJS reported that in 2004, 4% of women in state prisons and 3% of women in federal prisons were pregnant upon admission. No further national data has been released since.

A recent study of 22 U.S. state prison systems and all U.S. federal prisons, published in the American Journal of Public Health, found a similar pregnancy rate; roughly 3.8% of the women in their sample were pregnant when they entered prison from 2016-2017. But while the rate of pregnancy in prison may have remained stable since the early 2000s, the additional 10,000+ women imprisoned since then indicates that the number of women who are incarcerated while pregnant has grown, too. As long as the mass incarceration of women endures, incarcerated pregnancies will continue to rise.

Given the scale and stakes of this issue, it is imperative that correctional systems set policies that ensure the health and well-being of pregnant women in their custody. Provisions for adequate nutrition and prenatal medical care must be codified in policy to protect against negative health outcomes, such as miscarriages and low fetal birth weights, that can impact mothers and their children for the rest of their lives.

To see the extent to which these concerns are currently being addressed, we evaluated the policies of each state’s prison system and the federal Bureau of Prisons (BOP) to screen for adherence to nationally recognized guidelines. Troublingly, many states fail to meet even basic standards.

Most state prison policies are missing critical components of prenatal care and pregnancy planning. For a the full table with policy details on all 50 states, see the web version of this article at https://www.prisonpolicy.org/blog/2019/12/05/pregnancy/.

Most states lack important policies on prenatal care

All U.S. prisons and jails are required to provide prenatal care under the Eighth Amendment to the Constitution, but no detailed federal standards have been set to ensure that women are actually receiving the care they need.

The National Commission on Correctional Health Care (NCCHC) has published a set of standards for the treatment of pregnant women in prison, such as appropriate medical examinations as a component of prenatal care, specialized treatment for pregnant women with substance use disorders, and limited use of restraints throughout the course of the pregnancy. (The NCCHC's full position statement provides additional context.)

Often, though, states fail to make their Department of Corrections policies publicly available, or even write guidelines on the care of incarcerated pregnant women in the first place. Despite the work of advocacy groups like the Rebecca Project for Human Rights and the ACLU, who have previously attempted to track available policies state-to-state, significant information gaps remain. Informed by this prior work, we tracked which states currently provide written policy on bare-minimum health standards for incarcerated pregnant women.

The data show that the lack of codified protocols for the care of pregnant women in state prisons is a widespread issue, and even policies that do exist frequently do not include adequate provisions for basic medical needs.

• Although a majority of state prison systems require some form of medically provided prenatal care, 12 states failed to provide any policy on this vital component of a healthy pregnancy. This helps to explain why the Bureau of Justice Statistics, in the 2004 survey, found that only half (54%) of pregnant women in prison reported receiving prenatal care while incarcerated.
• Incarcerated pregnant women are particularly vulnerable to pregnancy complications related to substance use disorders, poor nutrition, and sexually-transmitted infections because they often come from precarious social and economic environments that exacerbate these risk factors. Their pregnancies are often designated as “high risk,” requiring special treatment to ensure their children are born in good health. We found that the federal BOP and 22 states have not provided any guidelines for specialized care for “high risk” pregnancies.
• Reports of women who have been forced to give birth in improper conditions, like Diana Sanchez, are far too common. In addition to reducing uncertainty and anxiety, hospital births provide a clean environment and adequate care in the event of complications. Illuminating the shortcomings of health care for pregnant women in prison, 24 states fail to codify any pre-existing arrangements for deliveries.
• The use of restraints (often referred to as shackling) has serious health impacts on pregnant women. According to the American College of Obstetricians and Gynecologists, shackling exacerbates pain, inhibits diagnosis of complications, and limits movement during the birthing process. Despite national standards condemning the practice, 12 states still provide no policy limiting restraints on women during pregnancy.

Incarcerated pregnant women require highly specific care in order to protect against adverse pregnancy outcomes. According to recent data from the Johns Hopkins School of Medicine, in some states, over 20% of prison pregnancies resulted in miscarriages; in others, preterm birth rates exceeded the national average (about 10%). The variability of these outcomes speaks to the inconsistent medical care afforded women in prisons across the country, and suggests that more universal policy standards could make pregnancy outcomes more equitable.

The above is an excerpt from our longer article about state healthcare policies neglecting pregnant women. See the full version of this article on our website.