Photo by Susan Madden Lankford
Pregnancy among inmates is a unique challenge. According to a 2008 report from the Bureau of Justice Statistics, 4% of state and 3% of federal inmates were pregnant at the time they began their incarceration. The needs of mothers during pregnancy and childbirth often conflict with the demands of the prison system.
The U.S. prison system was designed to accommodate male inmates, so the rising rate of female incarceration poses challenges on a variety of levels, including health care. It is estimated that 9% of women in prisons give birth while completing their sentence. In spite of a Supreme Court ruling which declared entitlement to basic health care for all people who are incarcerated, provision of adequate prenatal care in U.S. prisons has been inconsistent at best.
Women in jail or prison often have very high-risk pregnancies due to a higher prevalence of factors which can negatively influence both pregnancy and delivery. Among these are the mother’s own medical history and exposure to sexually transmitted infections, her level of education, mental health, substance use/abuse patterns, poor nutrition, inadequate prenatal care, socioeconomic status and environmental factors, such as violence and toxins.
Prenatal care in prisons is erratic. The Federal Bureau of Prisons, the National Commission on Correctional Health Care, the American Public Health Association, the American Congress of Obstetricians and Gynecologists and the American Bar Association have all outlined minimal standards for pregnancy-related health care in correctional settings, but only 34 states have established policies for provision of adequate prenatal care. However, the services can vary widely, and there is no reliable reporting measure to ensure services are delivered.
Prenatal care for incarcerated women is a shared responsibility between medical staff in the prison and community providers, but specific delineation of care is determined locally, depending on available resources and expertise. Women must often be transported for prenatal care and delivery, which can cause stress for the mother. In addition, some states continue to use shackles for security during transportation, labor, delivery and postpartum care. The use of shackles is highly controversial, and it is reported as both dangerous and inhumane.
Shackles can also interfere with labor and delivery, prohibiting positions and range of motion for the mother, doctors and nurses. Following delivery, shackles interfere with a mother’s ability to hold and nurse her infant child. In addition, women feel ashamed and discriminated against when they are shackled in a community hospital. Eighteen states in the U.S. currently have laws either prohibiting or restricting shackling pregnant prisoners, and only 10 states prohibit use of shackles by law.
The structure of U.S. justice systems makes development of maternal attachment to children nearly impossible. After the birth of their child, many women are returned to the jail or prison, and their infant immediately enters foster or kinship care. However, within many state policies, relatives are given less financial support, which can leave foster care to be more viable than kinship placement.
In 2009, A.N. Chambers wrote in Nursing Practice magazine:
For 50% of all incarcerated mothers, this separation becomes a lifelong sentence of permanent separation between mothers and their children.
Some prisons have nurseries for the mother and child, but women are only eligible to participate in a prison nursery if they are convicted of non-violent crimes and do not have a history of child abuse or neglect. Prison nurseries vary widely, but they provide an opportunity to breast-feed during a sensitive stage in development. They also provide time for a maternal attachment to be formed. Rates of recidivism are less for women who participated in prison nursery programs. However, prison nurseries still leave many gaps in care.
A 2010 report from the The Rebecca Project for Human Rights & The National Women’s Law Center said:
Reports from mothers with children in prison nurseries indicate that their babies’ close proximity allows prison staff to coerce and manipulate a mother by threatening to deny her access to her baby.
Some advocacy groups argue for alternative sentencing, such as family-based treatment centers, where mothers convicted of non-violent crimes can learn parenting skills while receiving services and support to foster positive child development and build a foundation to re-enter society following her term, with decreased risk for future incarceration.
In some cases imprisonment means the loss of choice over abortion or sterilization. Imprisoned women have undergone forced sterilization which prohibited them from having children later in life. Other women in prison have not been given the option of having an abortion, although they may have desired one. These situations force women to have unwanted children, and then they must find someone to keep their child until they are no longer incarcerated.
One major effect of prison includes the assault on relationships between prisoners and their children. About 2.4 million American children have a parent behind bars today. Seven million, or 1 in 10 children, have a parent under criminal justice supervision—in jail or prison, on probation or on parole. Many of the women incarcerated are single mothers who are subsequently characterized as inadequate, incompetent and unable to provide for their children during and after imprisonment. At the same time, separation from and concern about the well-being of their children are among the most damaging aspects of prison for women, and the problem is exacerbated by a lack of contact. Obstacles that inhibit contact between mothers and their children include geographical distance, lack of transportation, lack of privacy, inability to cover travel expenses and the inappropriate environments of correctional facilities.
The intellectual development of the kids of incarcerated mothers is often compromised. A majority of parents in state and federal prisons are held over 100 miles from their prior residence, while in federal prison 43% of parents are held 500 miles away from their last home, and over half of female prisoners have never had a visit from their children. Very few mothers speak with their children by phone while incarcerated.
Recent legislation has further impeded incarcerated mothers. The Adoption and Safe Families Act of 1997 authorizes the termination of parental rights once a child has been in foster care for 15 or more months of a 22-month period. Incarcerated women serve an average of 18 months in prison, therefore, the average female prisoner whose children are placed in foster care could lose the right to reunite with her children upon release.
There are limited employment opportunities after incarceration, and so their children cannot access those resources denied to their parents, such as food stamps or employment. Single mothers with low income go into the “underground economies” because of their inability to find a job that is stable and provides a good earning. Many mothers end up trapped on drugs, prostitution and theft. In most cases incarcerated women who committed acts of violence did so for self-defense against abusive partners.
Children are at risk of following their parents footsteps where they might become criminals by learning antisocial and criminal behavior. Caregivers and teachers see the child of inmates fighting more and becoming aggressive leading them to have a higher risk of conviction.
Most prisons do not have public transport but do have restrictive policies governing visits and phone calls. Prisons have policies such as the removal of infants born to women in prison, speedy termination of child custody for incarcerated women and restrictive welfare policies that make it difficult for families to be reunited.
Activists are trying to make a change and pass reforms that are going to help children and mothers deal with these consequences that are affecting them. One guideline that would help is a family-connections policy framework to support and strengthen the relationship between incarcerated women and their children. If women are able to see their children, it gives them motivation to try to get their lives back on track.
