Congress Blog

Criminal Justice reform must include pregnant women

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Criminal justice reform has had a spot in the limelight recently, but pregnant people in prisons are still overlooked. "There are pregnant people in prison?" you may ask. Yes. Most of the over 110,000 women in U.S. prisons are younger than 45. Some of them will be pregnant when they enter prison. Yet until now we had no idea how many women are pregnant while incarcerated or what happens to those pregnancies.  

There are barely any data, aside from a 2004 survey, on prison pregnancy rates. The only publicly available statistics about prison births are from a 1999 report. And there is no systematic information, not even outdated data, about miscarriages, stillbirths, abortions, maternal deaths or other pregnancy outcomes in prison.

This is a profound omission. Women who don't count don't get counted. And women who don't get counted don't count.

This lack of statistics shows just how little we care for incarcerated pregnant people. And when there is no statistical data documenting these pregnancies, when no one is paying attention, anything can happen. Pregnant people can be placed in solitary confinement, shackled, and receive substandard prenatal care. They can be forced to detox from opioids instead of receiving methadone or buprenorphine (the established standard of care). And they can be denied their constitutional right to an abortion for no other reason than they are incarcerated.

That's why from 2016 to 2017, my research team collected one year of pregnancy data, published today in the American Journal of Public Health, from 22 state prison systems and the Federal Bureau of Prisons. Our data represents over half of all imprisoned women in the U.S.  

In total, there were nearly 1400 admissions of pregnant women, over 750 live births, 46 miscarriages, 11 abortions and four stillbirths. There were no maternal deaths, but there were three newborn deaths.

And these data shed light on some troubling trends. For example, we found that only about 1 percent of the pregnancies ended in abortion, while miscarriages, which happen at the same time-points in pregnancy as abortion, accounted for 6 percent of outcomes. This discrepancy could indicate that some women are being denied access to abortion in prison.

Our study also found huge variability from state to state. For example, preterm birth rates ranged from 0 percent to 16 percent, and c-section rates from 0 percent to 58 percent (the national preterm birth rate is 9 percent and c-section rate is 32 percent). That means if you are pregnant and incarcerated, you could have a wildly different experience if you are in, say an Oklahoma prison, compared to an Alabama prison.

Institutions of incarceration are constitutionally mandated to provide health care to incarcerated persons. Yet there are no mandatory standards or oversight for what health care services prisons must provide. This is exactly why we have such profound differences in pregnancy care across prisons. Services are provided based on discretion of the local administrators and that can lead to dangerous departures from standard of care.

So why, until now, is there no systematic data on pregnancy outcomes among imprisoned women? Quite simply, no one was paying attention. The Centers for Disease Control and Prevention collects national statistics on pregnancy outcomes in the U.S. But their statistics do not account for incarceration status. The Bureau of Justice Statistics collects national statistics on incarcerated people. But they do not collect any information about pregnancy.

We are finally seeing growing recognition of pervasive and deeply racialized inequities in maternal mortality and other pregnancy outcomes. It's time to include pregnant people behind bars-who are disproportionately women of color-in the conversation.  

To be sure, some progress is being made. The First Step Act recently banned shackling of pregnant women in federal custody, for example. Yet only 26 states have laws prohibiting the practice. Even when there are laws, it still happens.

Of course, we must work towards a larger goal of not locking up so many women, especially pregnant ones. But in the meantime, we should ensure all pregnant people behind bars get quality, comprehensive pregnancy care. That includes: mandating routine pregnancy statistics data collection by a federal agency; formalizing pregnancy health care standards in institutions of incarceration with mandatory accreditation and oversight, including assurance that women can access abortion; and passing laws prohibiting solitary confinement and shackles during pregnancy, childbirth and the postpartum period, with trainings to ensure compliance.

We must make concrete changes in the health care incarcerated women receive in order to become a more just and civil society. It's the right thing to do.

Carolyn Sufrin is an obstetrician-gynecologist and medical anthropologist at Johns Hopkins School of Medicine and the author of Jailcare: Finding the Safety Net for Women Behind Bars. She is a member of the Scholars Strategy Network.

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