Incarcerated pregnant people face grave issues

Healthy Children Project’s Liz Westwater and Judy Blatchford had the privilege of speaking with Carolyn Beth Sufrin, A.M., M.D., Ph.D. about her Pregnancy in Prison Statistics (PIPS) project in December 2017.  

The PIPS project is a multi-sector collaborative endeavor based out of Johns Hopkins to gather national scale statistics on pregnancy outcomes for people who are pregnant while incarcerated because there is a massive gap in data about pregnant, incarcerated people in the U.S.

“Recognizing that there is this gap was really important for me,” Sufrin begins in her interview with Healthy Children Project. “First of all, it signals a broader neglect of pregnant, incarcerated women: if no one is counting them, who is caring about them? We need to remedy this situation.”

The PIPS project includes twenty-two state prison systems, six jails (including the 5 five largest), and three departments of juvenile justice that report to the study database on a monthly basis the number of pregnant people, births, miscarriages, abortions, stillbirths, and other pregnancy outcomes, according to the website.

It goes on: “Findings from PIPS will illuminate the scope of the issues facing incarcerated pregnant people and will enable policymakers, correctional administrators, researchers, and others who care about improving services for incarcerated people optimize outcomes for these people and their families.”

In a two-part series on Our Milky Way, we share portions of Healthy Children Project’s interview with Dr. Sufrin. Questions and answers have been edited and paraphrased for brevity and clarity.

(Photo by Sara D. Davis)
Source: United States Breastfeeding Committee.

Q: Please talk a bit about your experience providing health care to incarcerated women.

A: I worked as an OBGYN at the San Francisco jail from 2007 to 2013.  This is the only incarceral facility that I directly provided care. Every jail and prison is its own ecosystem. When I started working there in 2007, they actually already had a policy about breastfeeding that allowed postpartum moms to express breastmilk. Even though they had a policy in place, equipment and a system for milk pick up, it was still quite a challenge for many women to express breastmilk.  When you don’t have direct contact with your baby– when you don’t have that direct feedback– there weren’t that many women who chose to do this and some who didn’t stick with it for a very long time.

Q:  In your book, Jailcare: Finding the Safety Net for Women behind Bars, you discuss how some women purposefully get re-arrested because of a lack of health care on the outside. Can you please talk about that?

A: It is startling that for some women, the only place where they access medical care, including pregnancy care, is inside jail. Now I want to be very clear, although this is something I describe based on my research findings in the book, this is not the case everywhere.  There are many prisons and jails across the country where the care inside is so horrendous that that relationship could never exist.

I’m also hesitant to say that women intentionally went back to jail,  because it’s actually in a broader context of the structure of their lives. So many of the women who are cycling through the criminal legal system have lives that are characterized by poverty, racism, gender-based violence, histories of trauma, homelessness, unemployment, mental health struggles, addiction, so many structural factors–what we in public health often think of as the social determinants of health. Access to quality health care is not even just a matter of access, but so many factors that mitigate and determine their ability to access care in the community are so profoundly unequal, that jail– a place where so many of these people come on a regular basis because they’re trapped in a criminal  legal system– is a place where they know, ‘Well, I know that when I’m in jail, I’m going to get health care.’

It’s not so much an intention; it’s that their lives are so structured by these forces of inequality, that jail by default has become a place where they know they’ll get some health care.

Q: Many prison systems have unaccredited providers. Did you see a lot of that?

A: The data we’ve collected were not about providers but were about the jails and prisons.  With healthcare for incarcerated people, the jails and prisons are actually constitutionally required to address the “serious medical needs of incarcerated people” and that comes from a Supreme Court decision, but there’s no specificity about what counts as a serious medical need and there are no mandatory standards for health care for prisons and jails. There’s no mandatory oversight.

There do exist some voluntary accreditation programs through the National Commission on Correctional Healthcare and the American Correctional Association. But accreditation is completely optional, so it’s a little hard to make distinct conclusions about that because there is no legal requirement that anyone becomes accredited. There is no  Joint Commission for healthcare facilities in jails and prisons, which is why you have so much variability.

Not being accredited does not definitively mean you have a bad health care system.  In fact, the San Francisco system where I worked was not accredited because going through accreditation is a tedious process, it’s expensive, and at the San Francisco jail, the health care system was administered through the public health department, so  they felt like the standards they were providing were equivalent to what was being provided in the community.

There are also different standards between the American Correctional Association (which doesn’t have the word ‘health’ in it. They have a health subgroup.) and the National Commission on Correctional Health Care, so it’s hard to make distinct conclusions about the proportion that are accredited and not. But it speaks to the fact that we need some standardization. There needs to be an independent body, like a Joint Commission for health care facilities in jails and prisons.

Q: What do you see pregnant people being incarcerated for?

A: What I see a lot of the pregnant women being incarcerated for corresponds to national statistics which show that at least 70% of women incarcerated are there for nonviolent offenses. Jail very often houses people who are pretrial. In most jails at least 50%, sometimes 80% of people in the jails are pretrial meaning they have not even been convicted of anything. Many of them are there on minor charges, and they cannot afford their bail. Then they wrack up fines for not being able to pay and then it compounds. Some people are arrested for petty charges of theft. One woman whom I talk about in my book had been in and out of jail over 80 times in her adult life, and all for non violent charges. One of the times during her pregnancy, she was there for shoplifting some Dove soap from a CVS. She had a prior criminal record because of the way she was profiled as a Black woman who lived on the streets so she was thrown in jail. For her, it was not an eventful thing. This was what she was used to.

There are people who are in there for selling small amounts of drugs which they often do for their survival. They have no place to stay, so they trade drugs for a place to stay. They trade drugs for money.  Most of the women that I took care of are there because of the broader circumstances of their lives, not because they are violent criminals.

This is part of the larger story of mass incarceration in the U.S. This has been looked at by a number of sociologists and academics to show that the rise in incarceration rates that we have seen over the last four decades does not correspond to a rise in violent crime and corresponds much more to issues around criminalization of poverty and locking up poor people for various conditions of their lives as well as institutional racism.

Q: Do incarcerated women have the opportunity to have their babies skin-to-skin immediately after birth?

A: This is a hard question to answer because the answer is, it just depends. It depends where they are, it depends on the hospital itself. Is the hospital Baby Friendly? Does it promote that for any woman who gives birth?

For the incarnated mother, there are some places where they’re just really restrictive  in their security requirements for reasons that don’t have any logic to them. They might say as soon as the baby is out, the baby goes to the nursery and can’t be with the mother and there’s absolutely no legitimate security concern for that.

There are some places they would very actively promote skin-to-skin especially for an incarcerated mother whom the hospital staff know is going to be going back to prison or jail and this is all they have.

It can also depend on the people taking care of and guarding the woman. This speaks to the importance of education for health care providers in hospitals who take care of incarcerated people, because often times there’s confusion over what’s allowed and what’s not allowed. Most of the time, these rules aren’t written and being prepared and being proactive and writing down policies so that skin-to- skin is allowed is important.

Q: Have you encouraged skin-to-skin contact in your facility? What is the mothers’ response?

A: When I worked at the San Francisco jail, I also worked at the county hospital where women went when they gave birth, so I was fortunate to be able to deliver some of these babies and to be with these mothers. We did allow and promote skin-to-skin contact. It was incredibly meaningful for the women. It made the birthing room feel like any other and made them forget for a time that they were incarcerated. There was not a guard in the room during their delivery. The guard was respectfully outside of the room. Sometimes they would pop their head in to say ‘congratulations’ and the women appreciated that generally. At the hospital I worked at,  we tried our best to make them feel like they were just like any other patient.

Q: Does the same apply to the opportunity to breastfeed?

A: At this hospital if a woman chose to breastfeed, then she would be provided with the necessary education and support. The lactation care provider would come see her. If for some reason her baby had to be in the nursery and couldn’t be in her room, she had to be taken over to the nursery and often times they would handcuff her wrist to the wheelchair. That would make it really hard for her to hold her baby and position herself appropriately. Even in what some might call the best of circumstances–a place where they had a policy, where they promoted breastfeeding– it was still punitive in a lot of ways.

Q: Did you ever hear incarcerated moms talk about how providing breast milk for their babies was valuable to them?

A: I did hear that occasionally, but I will be honest, not many women chose to breastfeed and express breast milk while they were in custody. I think that was just because it was just so hard to do.  I did hear from one woman that she felt like if she couldn’t see her baby or hold her baby at least she could do something. It was a difficult but constant reminder of her baby.

Q: Can you describe why it was so difficult?

A: It was so difficult because there wasn’t the immediate feedback of actually seeing your baby consume and grow from your milk. There’s also a relative lack of privacy. Handling the breastmilk and making sure that it’s safe was a concern too. Moms would pump and put the milk into the bags in their cell and then the nurse would collect the milk during pill call–which is where the nurse comes four times a day to deliver medications to people in the housing units. The mother had to trust that the milk was going to be handled appropriately, and so I can imagine that that’s one down side. Ultimately, it’s just really hard when you don’t have privacy, you have to wake up in the middle of the night. Incarcerated mothers don’t have alarm clocks, so it’s hard to keep on that schedule.

Stay tuned next week for the next installment!

Sufrin’s book, Jailcare: Finding the Safety Net for Women behind Bars, can be found here.

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