Most Americans rarely think much about people in prison unless they have a direct family connection. And even less about the women who are incarcerated, even though that population has been growing rapidly in recent years. According to The Sentencing Project, between 1980 and 2019, the number of incarcerated women increased in the U.S. by more than 700 percent, rising from a total of just over 26,000 in 1980 to more than 222,000 in 2019. A subset of women in prison are individuals who are pregnant and/or deliver their babies while incarcerated.
The Prison Policy Initiative has compiled findings from the Pregnancy and Prisons Statistics Project spearheaded by Dr. Carolyn Sufrin of Johns Hopkins Medicine, which published several recent papers about the prevalence of pregnancy in prisons, jails and youth facilities, as well as breastfeeding policies and opioid use disorder policies.
Between The Lines’ Melinda Tuhus spoke with Leah Wang, a research analyst with the Prison Policy Initiative, which works to expose the harms of mass incarceration to those inside as well as outside prison walls. Here she talks about the harms pregnant people face in jails and prisons, and what can be done to reduce the risks to both mothers and their infants’ health and well-being.
LEAH WANG: Extrapolating to the larger population, we know that women are entering jails and prisons more and more. The population is exploding. So, if we have three or four percent of people inside who are pregnant, that number has stayed roughly the same since maybe the 1990s or early 2000s, but because we know the number of women in prisons and jails has exploded, imagine how many more pregnant people we’re talking about each and every year.
The researchers estimated about 58,000 admissions of pregnant women into jails and prisons, then thousands and thousands giving birth or having other pregnancy outcomes while still incarcerated, so these are people we need to pay attention to, because this is where the policies and practices come into play, and we can figure out whether or not these women are being treated with quality medical care.
The researchers were tracking outcomes, like live births, full-term or pre-term births, miscarriages, C-sections; that’s something that historically has never been looked at. And because only so many pregnancies concluded inside during the study period, we have somewhat of a small sample size. But in some states the miscarriage rates, the C-section rates, the pre-term rates were higher than the national rates among our general population, so that’s something to look forward to.
One other thing was about breastfeeding and lactation, so breastfeeding is generally impossible when someone is incarcerated, given the physical separation between mother and child. So, researchers asked about policies related to breastfeeding and pumping, and only about one-third of the sites had anything written down about whether mothers would be able to breastfeed or to lactate in general. In many cases, lactation was allowed simply for maintenance purposes, meaning that the breast milk was eventually discarded; it would not reach a child for its intended benefits. So, there is some troubling data relating to post-partum women and lactating women, and when they are different, it brings up questions about the way that policies and practices are seen in these facilities, where if a woman is suddenly not allowed to lactate that is generally a painful process and can lead to further medical issues.
MELINDA TUHUS: Does that mean there are some cases where women are allowed to keep their babies with them?
LEAH WANG: There are very few instances of nursery programs where babies are allowed to stay on site, maybe for six months or a year. That’s a very rare case. And another option is to have breast milk somehow safely transported to a child outside. I’m not aware of a county or a state that allows that, but at least that would allow for the breast milk to reach its intended child. I’m not aware of any instance of that; I would love to know. But nursery programs or other diversion programs that allow mothers to be with their child during that critical period if they choose to breastfeed are popping up in local spots, are being piloted in certain jurisdictions, but otherwise it’s certainly the exception, not the rule.
MELINDA TUHUS: Leah Wang, does the Prison Policy Initiative have any suggestions for how to improve these outcomes?
LEAH WANG: So, prisons and jails and youth facilities are not famous for their high quality medical care. When we talk about health care in custody, we always have to say that there’s really no set of standards that facilities are held to with regard to medical care. So the most basic way of sort of hopping on that bandwagon is to review standards and guidelines that have been published that are recommended, but not required for these facilities to adopt. So, there is a national commission on correctional healthcare; they have a set of standards for health services which includes a whole variety of policies related to pregnancy, birth and post-partum. The American College of Obstetrics and Gynecology recently published an updated version of their guidelines for reproductive health care in carceral settings – jails and prisons. Those are some of the basic ways to review and implement policies so they can hold staff accountable, so that people who are incarcerated can know what to expect if they are suddenly incarcerated and experiencing one of those circumstances.
Beyond that they should be making their policies public. It’s really hard for the researchers and the public to understand what policies and practices are there if they’re not accessible.
And then, finally, just chipping away at the number of pregnant people and post-partum people inside by creating programs and incentives for keeping mothers and babies and families generally together instead of separating them with incarceration.
Learn more about groups advocating to improve conditions in prison for mothers-to-be and their infants by visiting the Prison Policy Initiative at prisonpolicy.org.
