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Markkula Center for Applied Ethics

Violations of Ethical Standards in Reproductive Healthcare in the U.S. Incarceration System

This 2013 AP Photos file photo shows a secure patient treatment room in a housing unit at the California Correctional Health Care Facility in Stockton, California.

This 2013 AP Photos file photo shows a secure patient treatment room in a housing unit at the California Correctional Health Care Facility in Stockton, California.

Kendall Moore ’22

Rich Pedroncelli/AP Photo

Kendall Moore ‘22 is a neuroscience and ethnic studies double major and a 2021-22 health care ethics intern at the Markkula Center for Applied Ethics. Views are her own.

There is a current inexcusable lack of access to healthcare for pregnant women who are incarcerated in the United States. This ethical problem exists in a nation with a lack of widespread access to healthcare, as well as a nation that heavily and disproportionately incarcerates BIPOC individuals, with Black women being incarcerated at twice the rate of white women. Women who are thrust into the United States incarceration system at alarming rates have a right to basic medical care, and this extends to pregnancy. 

According to the Bureau of Justice Statistics, based on a 2004 survey, 4.1% of women are pregnant when admitted to state prisons and 2.9% of women are pregnant when admitted to federal prisons. Out of the women who were pregnant upon admission to state prisons, only 53.9% received any pregnancy care at all. There are no statistics for women in federal prisons. Official nationwide statistics and numbers on women who are pregnant upon admission to jails and prisons in the United States are hard to find, don’t exist, or are not current. The Pregnancy in Prison Statistics Project estimates that 58,000 pregnant women are admitted to jails and prisons each year, based on data from 2016-2017. Some of these women, such as Diana Sanchez, were forced to give birth alone in their cell while in prison. Diana Sanchez, in an interview with KDVR stated “That pain was indescribable, and what hurts me more is the fact that nobody cared.” Women across the United States are continually reminded through lack of care before, during, and after birth, that the United States incarceration system does not, under any ethical standard, care about or for their health. This is further emphasized by the fact that the rate of miscarriages and preterm births are also well above the national average

Policy across prisons is inconsistent and vague, and does not clearly outline the care that pregnant women must receive while incarcerated. A baseline standard of care must be established and monitored, and should include reproductive and sexual care for pregnant women and all other women while incarcerated. In this post I analyze how current reproductive care for pregnant incarcerated women does not meet various ethical standards, as well as potential steps that can be taken to improve and establish ethical care. 

A core area where prenatal care does not meet ethical standards for women who are incarcerated is in the nutritional standard for pregnant women and the availability of needed prenatal vitamins, nutrients, and overall food. There is a gaping lack of policy in this area that leads to many incarcerated pregnant women having clear deficits in their diets during pregnancy. The Prison Policy Initiative details that there is only one state, California, that has any sort of detailed breakdown in the extra food and nutrients that must be given to a woman who is incarcerated during her pregnancy. Other states offer vague policy or no policy at all, directly preventing women from seeking out the nutrition they need to support themselves and their baby. 

During pregnancy there is also a lack of access to various medical screens in prisons and jails, even though many women who are incarcerated have a high risk for various medical problems. Medical screens and regular checkups are an important and necessary part of any pregnancy, especially high-risk pregnancies. Infant mortality has been shown to be 40% more likely to occur in women that have a lack of access to prenatal care and checkups. This, plus access to the nutrients and food needed to support a woman through pregnancy, are bare minimums that must be provided for women while incarcerated. It is an extraordinary violation of the principles of justice and beneficence to deny these women and their children access to these rights.

Beyond prenatal care, the current birthing conditions and post-natal conditions in the United States incarceration system are also a clear violation of the ethics that should guide our healthcare. Across the United States, 27 states regularly allow and have minimal restrictions on shackling a woman during pregnancy, resulting in many women being forced to give birth in uncomfortable positions, shackled to their bed. Healthcare in general, and healthcare during pregnancy and birth, should offer respect and justice, and this extends to individuals who are incarcerated. Such conditions during birth violate all ethical guides behind healthcare, including beneficence and non-maleficence as these practices often result in worse birth outcomes and more pain. This also violates the autonomy and justice that these women deserve to have over their health, as well as that of their children. 

After what is often a trying birth that does not meet clear ethical standards, many women are separated from their newborn babies within 24 hours of giving birth. For the babies, this can cause long-lasting trauma they carry with them for the rest of their lives, leading to a much higher risk of emotional and mental health problems later in life; the mother also has an increased risk of psychological trauma and postpartum depression. This can have even more dire consequences, as CDC data from 2008-2017 lists mental health conditions as one of the leading causes of pregnancy related deaths. 

Clearly, reproductive care for women who are incarcerated does not meet ethical guidelines. There are many solutions to be considered, and some that are being tested, such as having doula programs for women who are incarcerated, allowing women to have additional education and help navigating their pregnancy, as well as an advocate for their pre- and post-natal needs. 

Another needed reform is clear and specific nutritional guidelines and standards for women who are incarcerated while pregnant. There should not only be a baseline standard and clear extra food allocations for these women, but they should be given multiple meetings with physicians to ensure their dietary needs are being met. Importantly, there should also be an overarching policy change that ensures that pregnant women are not restrained unless absolutely necessary for their own safety or the immediate safety of those around them. Women should also not be restrained during the labor process. 

The almost immediate separation of many children from their mothers also needs to be addressed. Options could include nursery programs that house women who are incarcerated and their newborns in special units, as well as “community-based” alternatives where women can stay with their babies in residential programs. 

Current prison nursery programs offer the opportunity for mothers to stay with their children, as well as receive parenting classes, support groups, substance abuse programs, and even vocational help, but there are often very limited spots, and these do not exist on a nationwide level. 

Community based residential programs allow women to live in the community with their children, where they can request permission to leave the home for things such as appointments, and also receive support and classes such as those seen in the prison nursery programs. These programs often have varying limits on the length that the children can stay with the mother depending on the length of their sentence, and varying requirements for which mothers can participate. These programs should be expanded and established on a more nationwide level, to allow more women access. All of these solutions should also be closely monitored and enforced by an institution external to the prison itself, as abuse and misconduct may occur even when policies along these lines are in place. 

Some institutions may cite safety concerns as reasons that shackling or restraints need to be used, or why newborns should be immediately separated from their mothers. However, a 2011 report by Amnesty International states that only 25% of women are in prison for committing a violent crime. Clearly many women who have posed no safety concerns have been restrained, and even the women who are incarcerated for more violent crimes are in no state to cause harm while actively in labor. Forty percent of women are in prison on drug-related charges and this simply points to a clear need for true rehabilitation programs, especially since drug charges have a disproportionate impact on minority women. 

Ultimately, while these solutions may be able to fix individual problems and provide a standard of reproductive care in prisons and jails that is clearly more ethical and that respects the principles of the autonomy, justice, beneficence, and non-maleficence that should govern the medical care these women receive, a more holistic and overarching approach needs to be taken. Policy makers and the justice system need to consider why women are being incarcerated at such high rates, how this affects families and future generations, and how incarceration does not function as rehabilitation. This health crisis should be a driving force to urge us to reconsider what crimes warrant jail time, and what crimes display a need for economic and financial support, mental health services, and actual community care. By addressing the larger systemic issue at hand, many of these women can have healthier birth outcomes, and be supported in a way that allows them to escape cycles of injustice and build more equitable communities.


May 4, 2022

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