PRISON BIRTH PROJECT
- Prison Birth Project
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Reproductive Injustice and Quality of Care: Addressing the Healthcare Crisis for Incarcerated Women
Background
The U.S. prison system has grown exponentially over the past five decades, with the population increasing from approximately 360,000 individuals in 1970 to about 2 million today (Nellis, 2024). This staggering growth reflects systemic issues in the criminal justice system, including mass incarceration and structural inequalities. Within this population, women represent a rapidly growing demographic, with rates of incarceration for women rising more quickly than those for men. Black women, in particular, have been disproportionately affected by these trends, reflecting broader societal inequities rooted in structural racism (Ghidei et al., 2018).
A significant consequence of these trends is the incarceration of women during their reproductive years. Many of these women are serving sentences for nonviolent offenses in a system that fails to prioritize reproductive healthcare. The prison system, originally designed to meet the needs of male inmates, often neglects the distinct healthcare requirements of women. This gap in care is particularly troubling given that The American College of Obstetricians and Gynecologists (ACOG) has issued clear guidelines for reproductive healthcare in correctional settings. However, the lack of mandatory state or federal regulations results in inconsistent and often inadequate care (Rajagopal et al., 2023; Ghidei et al., 2018).
This paper seeks to illuminate the barriers that incarcerated women face in accessing reproductive healthcare, with a focus on prenatal care, childbirth, and postpartum support. By addressing these challenges, this paper calls for systemic reforms to ensure equitable healthcare for this underserved and vulnerable population.
Prenatal Care
Early access to prenatal care is a cornerstone of maternal and fetal health, yet it remains far from guaranteed for incarcerated women. Many correctional facilities lack protocols for routine pregnancy testing upon intake. Of the jails surveyed in a recent study, only 38% performed universal pregnancy testing, while 45% relied on self-reported pregnancy status before conducting confirmatory tests (Friedman et al., 2020). This inconsistent approach delays the detection of pregnancies, preventing women from accessing critical prenatal care during the early stages of pregnancy.
The consequences of these delays are severe. Women who enter prenatal care late in their pregnancies face increased risks of complications such as preterm birth and low-birth-weight infants. Research highlights that incarcerated women are significantly more likely to deliver low-birth-weight babies compared to their non-incarcerated counterparts, reflecting the systemic failures in addressing their healthcare needs (Hawkins et al., 2024).
In addition to delayed care, many facilities fail to provide comprehensive education about pregnancy options. Less than 30% of correctional facilities offer information about alternatives such as adoption or abortion (Kelsey et al., 2017). This lack of information undermines the autonomy of incarcerated women, limiting their ability to make informed decisions about their pregnancies.
Even women on parole, who are no longer incarcerated, report significant barriers to prenatal care. Transportation limitations, often tied to parole restrictions, prevent these women from attending regular medical appointments. Others conceal their pregnancies out of fear of judgment or penalties, further delaying care (Hawkins et al., 2024). These compounded barriers highlight the urgent need for systemic reforms to support timely and equitable prenatal care.
Birth
The experience of childbirth for incarcerated women is often marked by dehumanization and neglect. While federal regulations have sought to limit the use of restraints during labor, enforcement remains inconsistent. As of 2024, 41 states and Washington, D.C., restrict shackling during labor, but many fail to enforce these policies, leaving women vulnerable to this harmful practice. Additionally, only 15 states have banned restraints during the postpartum period, perpetuating risks to maternal health and recovery (Thomas et al., 2024).
Shackling during labor is more than a physical risk; it is a profoundly dehumanizing experience that exacerbates mental health challenges for incarcerated women, many of whom have histories of trauma. Beyond banning restraints, federal regulations must address the broader emotional needs of women during childbirth. Allowing the presence of supportive individuals, such as family members or trained doulas, could significantly improve the emotional well-being of incarcerated women during labor. Studies have shown that emotional support during childbirth reduces the risk of birth trauma and improves maternal outcomes (Dahl et al., 2020). Ultimately, policies must move beyond merely minimizing harm to actively promoting dignity and support for women during one of the most vulnerable moments of their lives.
Postpartum Care
Postpartum care for incarcerated women is woefully inadequate, often prioritizing convenience over maternal and infant health. In most prisons, mothers are separated from their newborns within hours of birth, a practice that has profound emotional and developmental consequences. Only eight states require a minimum 72-hour postpartum bonding period, leaving the majority of incarcerated mothers with little to no opportunity to connect with their infants (Hawkins et al., 2024). Infants being separated from their mothers so quickly after birth has negative consequences on the emotional state of both the mother and child.
Mother-baby units (MBUs) represent a promising solution but remain underutilized. Available in only a quarter of U.S. states, these units allow mothers to stay with their infants in a child-friendly environment while receiving parenting education. Research has shown that children who remain in MBUs exhibit fewer signs of anxiety and depression during early childhood compared to those separated from their mothers shortly after birth (Friedman et al., 2020). Given the small number of U.S. prisons who utilize these, expanding access to MBUs could significantly improve outcomes for both mothers and their children.
Breastfeeding is another area where barriers persist. Only 16 of the 28 facilities surveyed allowed lactation, and even in these facilities, women often had to pump in front of correctional officers, an experience that can be retraumatizing for survivors of sexual violence (Asiodu et al., 2021). Physical separation from their infants and limited access to breast pumps further undermine breastfeeding efforts. Breastfeeding is an integral part of parenting and restricting the ability of incarcerated mothers to breastfeed has many negative consequences, such as an increased risk of sudden infant death syndrome (SIDS) and gastroenteritis for the infant. Mothers who do not breastfeed also have elevated risks of ovarian and premenopausal cancer (Westerfield et al., 2018).
In the long term, incarcerated mothers face significant challenges in maintaining relationships with their children. While electronic communication is often available, physical visits are limited by transportation barriers, financial constraints, and the restrictive nature of prison environments. Unlike incarcerated fathers, who often rely on their children’s mothers for caregiving, incarcerated mothers are typically single parents, leading to higher rates of foster care placement for their children (Friedman et al., 2020). As long as prison visits remain difficult and restrictive, incarcerated mothers will continue to face separation from their children. Separation from children due to the difficulty and costly nature of visits has long term impacts on the relationship between mother and child.
Call to Action
The disparities in reproductive healthcare for incarcerated women reflect a systemic failure to recognize and address their unique needs. The prison system, designed primarily for men, must be reimagined to accommodate women’s reproductive health. Standardized, mandatory pregnancy testing upon intake is essential to ensure timely access to prenatal care. Additionally, access to contraception and abortion services must be protected to uphold women’s autonomy and health. Restraints during labor should be universally abolished, and incarcerated women must be granted the right to emotional support during childbirth, such as the presence of family or doulas. Postpartum policies should prioritize mother-infant bonding through extended contact and the expansion of mother-baby units. Lactation support must also be improved, with facilities providing private and accessible spaces for breastfeeding or pumping. By implementing these reforms, we can begin to address the systemic inequities faced by incarcerated women and affirm their right to equitable and humane healthcare. The call to action is clear: policymakers, correctional facilities, and advocates must work collaboratively to ensure that reproductive justice extends to even the most marginalized members of society.
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