• Dani Bukacheski

Reproductive Justice: An Outlook on the Failed Prison Health Care System

Updated: Nov 18, 2020

In 1976, the Supreme Court case Estelle v. Gamble established that incarcerated individuals have a right to health care under the Eighth Amendment’s Cruel and Unusual Punishment Clause (NCBI, 2013). In other words, prisoners are the only population that possesses a right to health care in the United States.

It was not until I came to the University of Michigan that I uncovered this fact and its ironies. I was exposed to the reality of this so-called health-privileged population in an introductory public health course. While inmates are constitutionally guaranteed health care, no standards for the quality and quantity of care, providers, or medical facilities exist. As you can imagine, this ambiguity has paved the way for what is now a public health crisis: under-nutritious meals, high rates of smoking, and exorbitant stress levels, all of which are accompanied by overcrowded conditions (among countless other indignities) (NCBI, 2013). Additionally, the practice of 23/1 solitary isolation (in which prisoners are allowed 1 daily hour outside of their cell) often results in the development or worsening of pre-existing mental health conditions that the individual must deal with upon their release (NCBI, 2013).

While the state of prison health care can be attributed to many factors, the strongest culprit is the evolution of the Prison Industrial Complex. Since 1980, “tough on crime” policies have resulted in a dramatic increase in the rate of incarceration: 500,000 individuals behind bars has skyrocketed to now become 2.3 million (Arabella, 2018). This large influx is what incentivized public and private corporations to invest in the prison industry. Having been entrapped within the Prison Industrial Complex, incarcerated individuals were now at the mercy of companies who focused on increasing their profit margins. One area that saw dramatic cutbacks is health care: in one report, the Department of Justice found that prisoners in private facilities are less likely to be given basic health care treatment (Arabella, 2018).

Through my Women's Studies education focusing on the intersection of gender and health, I continued to research the inhumane quality of prison health care. I was equipped with a lens that allowed me to understand that the experience of an incarcerated individual is not one size fits all. In order to understand where incarcerated women fit into the Eighth-Amendment-equation, it is essential to also take reproductive health into consideration. I found that the term Reproductive Justice provides a framework that encompasses the truly devastating effects of incarceration on women’s reproductive health. Coined by scholar/activists Rickie Solinger and Loretta J. Ross, Reproductive Justice is “(1) the right not to have a child, (2) the right to have a child, and (3) the right to parent a child in safe and healthy environments” (Ross & Solinger, 2017).

Utilizing the Reproductive Justice framework to evaluate the prison health care system uncovers disheartening results. Statistics on health care practices in prison facilities and on incarcerated mothers reveal that:

The required shackling of pregnant woman by their arms, legs, and waist still persists. Several implications of shackling include emotional and physical trauma for the laboring individual as well as their fetus (Clarke & Simon, 2013).

Postpartum care is non-existent. For example, screening and proper treatment for postpartum depression or access to appropriate contraception (Women’s Health Care Physicians, 2016).

Newborns are commonly separated from their mothers within 24 hours of birth (Clarke & Simon, 2013).

78% of incarcerated women are likely to have been the head of their household unit forcing their children into foster care (Talks, 2018).

36,000 pregnant women enter the United States prison system every year. This number excludes the population that has been flushed through the criminal justice system via county jails, forced to appear before courts, and lived under increased government surveillance while coping with the stress of birthing and caring for a newborn child. Focusing our attention on the incarcerated population reveals that the prison health care system has failed to provide pregnant prisoners with the resources and education that allow them to not have a child, to have their child, and surely the ability to parent their child. In contrast, an idealistic vision of Reproductive Justice-friendly conditions would include access to healthcare services such as abortion, contraception, prenatal resources, and postpartum care.

As a fervent advocate for Reproductive Justice, I found my niche in the Prison Birth Project—the ideal junction of maternal rights and the carceral state. The University of Michigan Prison Birth Project operates under the non-profit Michigan Prison Doula Initiative, which operates to bring doulas into Michigan Prisons. A doula is an individual who is given the task of emotionally, physically, and mentally supporting a pregnant individual before, during, and after her birth. Doulas do not require formal medical training; they simply act as a bridge between the pregnant person and medical professionals. As an advocate for the pregnant individual, the doula assists in preparing for the birthing process, supports the mother during her 24 hour-period with the newborn, and retains contact with the individual once they return to prison (MPDI, 2018). Not only does a doula alleviate the gap in postpartum care, but they also equip the individual with information and resources to develop their identity as a mother. The Michigan Prison Doula Initiative is hopeful that the doula’s care will translate to increased visitation, thus allowing the individual to bond with the child.

The Michigan Prison Doula Initiative, along with the Prison Birth Project, works through a partnership with the Women’s Huron Valley Correctional Facility. Huron Valley is the only prison in Michigan that houses female inmates. Unsurprisingly, recent cases have been filed in federal court which allege severe overcrowding and inadequate medical treatment, causing a deterioration of inmate mental health. All of these cases were brought as violations of the Eighth Amendment’s Cruel and Unusual Punishment Clause (Egan, 2018).

In late 2018, the Michigan Prison Doula Initiative hosted a panel event on campus. Included among the Reproductive Justice-oriented panel was an OB/GYN specialist, as well as formerly incarcerated individuals who personally experienced or witnessed the inadequacy of maternal prison health care. The speakers attested to the insufficient resources and medical practitioners within the facility, Huron Valley has one OB/GYN on staff for approximately 2,400 inmates resulting in month-long wait times (Kunkel, 2018).

Through my experiences with the Prison Birth Project and the University of Michigan, I know that the current state of prison health care is a violation of the Eighth Amendment. While I have focused my attention on the Reproductive Justice movement, it bears mentioning that the failed prison health care system affects all incarcerated individuals in the United States. It is clear that the Supreme Court’s incentive for ruling in favor of a right to prison health care is due to the unique circumstances of the population: incarcerated individuals are legally stripped of their bodily autonomy. Utilizing this same outlook reveals how the obvious failure of prison health care exemplifies a system that actively devalues the bodies of incarcerated individuals.

Every day, incarcerated individuals are denied their Eighth Amendment right to health care. By continuing the conversation, you can aid in shedding light on this injustice. Change can begin by:

Checking out Michigan Prison Doula Initiative and Prison Birth Project.

Keeping an eye out for Reproductive Justice events on campus.

Educating others about the movement.

About the Author: Dani Bukacheski is a senior at the University of Michigan in Ann Arbor, Michigan. She is majoring in Gender and Health, with a minor in Crime & Justice, and she serves as a Field Notes editor for the Undergraduate Journal of Public Health.


Arabella Advisors. (2018, October). Understanding and Confronting the Prison-Industrial

Complex: An Overview for Philanthropists. Retrieved from

Committee on Causes and Consequences of High Rates of Incarceration. (2013, August 08). Introduction. Retrieved from

Clarke, J. G., & Simon, R. E. (2013, September 01). Shackling and Separation: Motherhood in Prison. Retrieved from

Women's Health Care Physicians. (2016, November 11). Retrieved from

Egan, P. (2018, September 06). Women say conditions at crowded Michigan prison 'cruel and unusual'. Retrieved from

Ross, L., & Solinger, R. (2017). Reproductive Justice: An Introduction. Oakland, CA: University of California Press.

Talks, T. (2018, October 23). Moms Beyond Bars: Pregnancy and Parenting through Incarceration | Jacqueline Williams | TEDxYDL. Retrieved from

Kunkel, S. (2018, December 3). Panel Examines Intersection of Reproductive Justice and Mass Incarceration. Retrieved from

Michigan Prison Doula Initiative. (2018). Retrieved from

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