Care of Pregnant Women in the Criminal Justice System Regina Cardaci, MS, RN, CNM, PhD©
Purpose X
The purpose of this presentation is to broaden knowledge of practices used in the transfer and treatment of pregnant women who are incarcerated….Some of which may negatively affect maternal and fetal health or well-being.
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Some of the current practices conflict with standards of obstetric care, violate state or federal laws, and are considered unethical and inhumane by such organizations as the ACOG, ACNM, Amnesty International, and the World Health Organization.
Introduction/Background X
The health care of incarcerated women has been overlooked largely because correctional facilities have been structured to meet the needs of incarcerated males.
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With introduction of “gender neutral” policies in the 1970s, nonviolent female offenders were treated in the same way as violent male offenders, which meant that they were shackled during hospitalization, including labor and delivery.
Structural Problems X
Providing reproductive health care to female offenders is supported by the National Commission on Correctional Health Care and the World Health Organization
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However, only 54% of incarcerated pregnant women receive prenatal care, according to the Bureau of Justice Statistics.
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Even when care is provided, the quality varies widely.
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Environmental risks, including inadequate ventilation and poor temperature control.
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Work-related health risk: workloads and schedules inappropriate for pregnant women
Prior Unmet Health Needs
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Many women enter correctional facilities with poor, prior unmet health care needs.
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Hypertension, diabetes, asthma, depression
Many have been victims of intimate partner violence, sexual abuse, or have issues with substance abuse.
Inadequacy of rendered care X
In a study examining health care services available to pregnant women in state prisons nationwide, investigators found that prenatal care inadequate.
50 women correctional facilities invited; only 19 responded
Survey sought to evaluate: •
prenatal care (including nutrition, rest, education)
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location of prenatal care
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use of restraints during transport, labor, delivery, recovery
Inadequacy of rendered care, cont Qualitative date: four open-ended questions regarding barriers to providing care, prison nursery programs, and alternatives to incarceration. X Specifically highlighted was lack of fresh vegetables and fruits, lack of lower level bunk, X
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Services such as childbirth education, counseling and breastfeeding support offered in fewer than half for the 19 responding facilities
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Nationwide, responsibility in providing prenatal care is shared by providers in the facility and the community, leading to gaps in care
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Few facilities have medical facilities for childbirth, requiring transport to a medical facility, which is often not a priority, resulting in delay, and sometimes unsupervised births in the facility or during transport.
Legal Considerations X
Estelle v. Gamble (1976): the US Supreme Court ruled that the government is obligated to provide medical services for prisoners under the Eighth Amendment, which prohibits federal and state governments from imposing “cruel and unusual punishment”
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“Deliberate indifference” to the medical needs of prisoners constitutes “unnecessary and wanton infliction of pain”
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This ruling has been used as the legal standard in cases of shackling and other instances related to failure to provide appropriate obstetric care to incarcerated women.
Health Risks Linked to Shackling Pregnant Women X
Shackling increases a pregnant woman’s risk of falling and reduces her ability to break her fall to protect herself and the fetus.
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Shackling interferes with and can delay assessment and diagnosis.
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Shackling limits mobility, exacerbating the risk of thromboembolic events, which is elevated during pregnancy and the postpartum period.
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Shackling in labor limits mobility and thus interferes with the normal progress of labor, reducing the likelihood of a normal, spontaneous vaginal delivery.
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Shackling can delay initiation of an emergency cesarean section, thus increasing the risk of a poor outcome for both mother and infant.
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Shackling can interfere with treatment for seizures, which commonly occur in the presence of pregnancy-induced hypertension
American Civil Liberties Union (2012).. 2012 Florida Legislative Session Wrap-Up. ACLU Public Policy Statement. Retrieved from http://www.aclufl.org/legislature_courts/legislature/2012/2012-LegWrapup.pdf Amnesty International (1999). “Not part of my sentence”: Violations of the human rights of women in custody. Retrieved from http://www.amnesty.org/en/library/info/AMR51/019/1999. Ferszt, G., & Clarke, J. (2012). Health care of pregnant women in u.s. State prisons. Journal Of Health Care For The Poor & Underserved, 23(2), 557-569.
Anti-shackling Laws X
Amnesty International takes the position that there is no reason for pregnant women, or women who have just given birth and are being guarded to be handcuffed or shackled.
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In accordance with international standards, jails and prisons should only use restraints when an inmate poses a risk of escape, of injury to themselves or others, or damage to property
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However, the majority of states in the United States continue to permit the physical restraint of pregnant inmates.
Anti-Shackling laws, cont X
During transport to a hospital for delivery, women often shackled around the wrists, as well as around the gravid abdomen.
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While in labor, women often shackled to the bed by ankles and wrists and after delivery by the ankles.
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Even in states with ant-shackling legislation, implementing these laws can be challenging
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Corrections officials are resistant to anti- shackling laws out of concern that these undermine their authority
United States Anti-Shackling Laws States Without Anti-Shackling Laws
States With Anti- Shackling Laws
Michigan, Minnesota, Missouri, Montana, Nebraska, New Hampshire, New Jersey, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, , Wisconsin, Wyoming.
New York, Hawaii, Rhode Island, Idaho, Nevada, Colorado, Illinois, New, Mexico, Pennsylvania, Texas, Vermont, Washington, West Virginia.
Privacy Concerns
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Amnesty International recommends that female prisoners be guarded by female corrections officers whenever possible
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Even in states with anti-shackling legislation, there are no clear guidelines protecting a women’s privacy during labor, delivery, and the postpartum period.
The Right to Bond X
Typically, when a female prisoner delivers a child, she is separated from the newborn soon after birth.
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Few prison hospitals have policies that allow mothers to spend time and bond in immediate postpartum period.
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Even in community based hospitals, women often place on a separate “prison ward” in the postpartum period, and may not see her newborn until discharge, at which point the child will be place in foster care or in the care of relatives or caregivers until the mother completes her sentence.
Need for Support
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In the early postpartum period, the need for support and visitation from family and friends is crucial
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This is usually restricted for these women
Programs for Incarcerated Pregnant Women Nursery programs X
According to WHO women who give birth while incarcerated or have an child in
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Their care while incarcerated should include being allowed to nurture and bond with the child
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In many European countries, newborns are allowed to reside with their incarcerated mothers, often up to age three
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In the US, prison nursery programs relatively rare; only 135 available placements
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Prison nursery programs reduce recidivism Taconic and Bedford Prisons in NY noted a recidivism rate over three years of 13% vs. 25% for the general population in New York
Prenatal, labor and postnatal support
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Doula programs
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Childbirth education
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Breastfeeding and parenting education
How Prisons Measure Up X
The Rebecca Project for Human Rights in collaboration with the National Women’s Law Center produced a state-by-state “report card” on the conditions experienced by incarcerated pregnant and parenting women and their children
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This report card graded state correctional facilities on prenatal care services, shackling policies, and the presence of family-based alternative to incarceration programs.
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When the grades for these parameters were averaged, 21 states received grades of D or F; Another 22 states earned a grade of C; seven received a B;
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Only one state, PA, received an A-
Prenatal Care California Delaware
Statutes Banning Shackling In Labor & Delivery California Colorado
Prison Nursery Programs California Idaho
Florida Massachusetts New Hampshire New Mexico New York North Carolina Oklahoma Oregon Pennsylvania Texas Washington
Hawaii Illinois Idaho Indiana Illinois Massachusetts* New Mexico Nebraska New York New York Nevada Ohio Pennsylvania South Dakota Rhode Island Tennessee** Texas Texas** Washington Washington West Virginia West Virginia *community-based program; ** program does not focus on improving the mother-child relationship
Prenatal Care: refers to policies that meet the needs of pregnant women, including: medical examinations, screening for high risk pregnancies, adequate nutrition, preexisting arrangements for delivery, provisions for rest and safety:
Any Questions?
