Maternal Difficulties: Exploring Issues Faced by Pregnant Women Behind Bars

Sudeshna Das

University of New Haven

Mothering practices for incarcerated individuals often have received little attention, despite being a critical issue in the criminal justice system. A woman’s experience in adapting to motherhood is different when the mother is incarcerated. Glaze and Maruschak (2008) discuss how most incarcerated women are mothers of children below the age of 18. Although most women in prisons are allowed visits by their children, there are many barriers that they need to overcome.

Relatedly, shackling pregnant women in prisons is perceived as a life-threatening practice, and it strips them of their basic standards of human rights. In 2009, the state of New York passed laws wherein shackling of pregnant women was prohibited during the process of birth (Garcia-Hallett, 2018). However, the Correctional Association of New York (2015) found that despite the existence of law, it seldom is implemented or enforced. Interviews with incarcerated women who gave birth between 2009 and 2013 concluded that 23 out of 27 incarcerated women were shackled during their trip to the hospital. Moreover, they were shackled right after giving birth as well. Thus, though the anti-shackling law was passed in 2009, research suggests ineffective implementation. Many imminent women’s and human rights advocates nationwide condemn such practices, namely the American College of Obstetricians and Gynecologists (ACOG), the American College of Nurse-Midwives, Association of Women’s Health, the Obstetric and Neonatal Nurses (AWOHNN), and others (Palmer & McGrane, 2018).

The negative experiences of pregnant women in prison most often result from maltreatment by correctional officers, stigmatizing attitudes of health care providers, inadequate living conditions, insufficient food, and limited programs to address emotional needs (Garcia-Hallett, 2018; Goshin et al.,2020; Pendleton et al.,2020). Many prisons lack appropriate services and do not have obstetrics and gynecology-trained physicians (Sussman, 2009).

The objective of this paper is to examine the level of knowledge and perspectives of the correctional officers (COs) and health care providers of existing programs and assess relevant policies for incarcerated pregnant women. Additionally, the essay will shed light on the experiences of mothers within prisons and the health outcomes. Intervention policies and gender-responsive policies will be emphasized to improve the treatment received by incarcerated pregnant women. Finally, the paper will augment the need for additional research to cater to the needs of pregnant women in the criminal justice system.

Literature Review

Research suggests that on average, 8000 pregnant women can be found in U.S prisons and jails (Mays & Ruddell, 2019). However, women are often neglected and underrepresented in the criminal justice system. The treatment and custodial models that are designed for serious and violent male offenders are frequently used for women as well. Few facilities address the unique health care requirement of women, and the negligence is more profound in the case of pregnant women behind bars.

Shackling in prison continues to be a problematic and controversial practice in prisons. Advocates of such practice stress that it is necessary for security. However, an efficient correctional officer can easily guarantee security when women in labor are on their way to the hospital (Sussman, 2009). Many health experts have concluded that restraints limit movement of pregnant women who are already facing discomfort. The American Psychological Association (2017) reported that restraints or shackles prevent physicians from administering epidurals. Moreover, the report cited the example of a woman during labor who experienced a hip dislocation due to restraints. This further escalated to permanent deformities, and she experienced stomach muscle tears as well as an umbilical hernia.

Shackling supports the stereotype that women behind bars are “unfit” mothers, and they do not deserve adequate medical resources. These women may be labeled as “reproductively insubordinate” (Sussman, 2009). It is crucial to change this mindset and uphold the right of incarcerated women to bear children by breaking the use of shackles. Furthermore, this practice needs more attention from policymakers and reproductive rights advocates. Although existent laws condemn the practice and are forbidden by the federal Bureau of Prisons, the U.S Marshals Service, and Immigration and Customs Enforcement, states may permit the use of shackles in special circumstances (Thomas & Lanterman, 2017).

Prison nurseries are designed to provide shelter in the correctional setting for incarcerated women to reside with their newborn babies (Byrne et al., 2012). This is done to cater to the needs of the mothers who are the primary caregiver of the infant. There are reportedly 10 prison nursery programs in the United States (Fritz & Whiteacre, 2015). The Bedford Hills Correctional Facility is known to have the oldest prison nursery, established in 1901 (Fritz & Whiteacre, 2015). Prison nurseries provide incarcerated mothers the opportunity to bond with their newborns, as supported by existing research (Byrne et al., 2010). Moreover, studies have revealed that children have a lower level of depression and anxiety when they reside with their mothers in prison nurseries, compared to those who were separated (Goshin et al., 2014). Participants in prison nursery programs showed reduced recidivism as well (Shain et al., 2007).

Prison nurseries, however, typically are terminated after 18 months. It has been reported that due to inadequate access to resources, mothers within these programs often request transfer of their infants out of the nursery and into the care of another family member (Garcia-Hallett, 2018). Furthermore, limited services are available for children residing with their mothers in prison nurseries. The concern of these incarcerated mothers when their children fall sick is ignored. A report from Legal Services for Prisoners with Children (LSPC) noted that children in prison nurseries are treated differently, since their mothers are behind bars, and they receive delayed services (Shain et al., 2010). Many critics have argued that prison nurseries should not be the setting to raise children, due to inadequate resources, which is why it is crucial to enhance the medical services in the correctional setting and cater to the needs of these children who are denied their basic rights (Garcia-Hallett, 2018).

In the prison system, African American women are disproportionately overrepresented. Although African Americans constitute only about 13% of the U.S. population, 50% of the women in prison are African American (Sussman, 2009). In Inside, this place, Not of it, narratives of thirty individuals highlighted the human abuses they faced in the U.S prison system (Levi & Waldman, 2011). One such narrative of a Black woman sheds light on the challenges faced by women who are considered a minority in the prison system (Ocen, 2012). Olivia Hamilton was pregnant when she was incarcerated for embezzling money in a Georgia jail. She reported the indifference of the guards when she needed to see a doctor. During her labor, shackles were placed around her wrists and stomach. Furthermore, she was forced to have a C-section and remained shackled throughout. She reported that she received poor medical treatment, and though she realized that what she had done previously was wrong, the whole experience was degrading (Levi & Waldman, 2011). 

Ocen (2012) further argues how the treatment of Black women during slavery shaped the stereotypes of Black women, the perception of female prisoners, and modern prison policies. Although the prison system has improved its governance of racially marginalized populations, reproductive insubordination of incarcerated women persists. Moreover, the mechanism to degrade and control Black women in one era has continued to this new era, where the same mechanism is used to control all female prisoners (Ocen, 2012). Additionally, the modern prison system continues to control the minds and bodies of women, stripping them of their sense of individuality (Craig, 2009).

Recent Research

Guards and other medical caregivers have a profound impact on the experiences of mothers inside the prison. Thus, this section will analyze three recent studies that will shed light on the policies and programs existent in the prison system. Additionally, the findings will present the correction officers' knowledge about these programs and the stigmatizing attitudes of the health care providers. Finally, the findings from these studies will explain mothering experiences behind the bars.

Mothering while Incarcerated

Kennedy and colleagues (2020) focused on the experiences of mothers before incarceration and post-incarceration using the Gendered Pathways Perspective (GPP). The GPP as a framework understands women’s interactions with both the crime and the criminal justice system (Daly, 1992; Owen 1998; Richie, 2018). GPP studies include behavior that is typically seen in women, prevalent among women, and common in both men and women, but exhibits gendered effects for women (Kennedy et al., 2020).

The data used for this study initially were collected for another study aimed at evaluating the relationship between childhood abuse and behavioral health outcomes among incarcerated women.  Samples were randomly selected using a census of all women housed in a minimum/medium supervision prison in Florida, a minimum-security prison in North Carolina, and a medium close supervision prison in North Carolina. The data were collected over two years (June 2015- July 2017). The eligibility to participate in the study included that those participants should be 18 years old and know how to speak English. The average age of these women was 38 years. The women were charged with violent, property, and drug crimes. During the interview, team members read questions out loud and recorded the responses of the participants. Initially, 306 women were randomly selected, but the analysis was completed using responses of 41 women, as their responses contained descriptions of mothering and parenting.  These women were asked two open-ended questions about their childhood experiences following the structured interview (Kennedy et al., 2020)

The findings from this study revealed that women were aware of the jeopardy that they were putting their children in prior to incarceration. This led to psychological distress, due to their criminalized behavior. Separately, it has been reported that women have more painful experiences of confinement that affect their mental health (Crewe et al., 2017). There were no prison nurseries programs or intensive parenting programs designed in the prisons where the study was conducted. The mothers argued that this reduced their opportunity to rebuild the connection with their children. The incarcerated mothers revealed how they wished there were more programs for emotional support. The responses also indicated how these women utilize their time in prison to be more self-aware and change their behavior to be better mothers (Moe & Ferraro, 2006). Since there were no programs (or lack thereof) to cater to their needs, they took their time to think of ways to repair and cultivate relationships with their children (Kennedy et al., 2020).

Stigma and Nurses’ Intentions to Provide Maternal Care

The objective of research by Goshin et al. (2020) was to examine the existence of stigmatizing attitudes of nurses to provide the recommended maternal care outlined by the Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN) for incarcerated women. In the year 2017, an anonymous online survey of AWOHNN members was conducted between July and September. Members who worked in the antepartum, intrapartum, postpartum, or mother-baby hospital units were chosen; thus, 11274 eligible nurses were recruited. However, only responses from the nurses (n=665) with experience caring for incarcerated women were taken into consideration. A total of 144 nurses reported caring for more than 20 incarcerated women throughout their careers (Goshin et al., 2020).

The study measured 5 potentially actionable drivers or facilitators of stigma in the perinatal care environment:

1. Knowledge of AWOHNN position statement
2. Knowledge of state shackling law
3. Individual stigmatizing attitudes
4. Institutional norms
5. Perceived autonomy

The results suggested 58% of the nurses practiced in a state with shackling law. More importantly, less than 10% were unaware of their state having shackling laws or not. Moreover, most of the participants were not aware of AWHONN’s position statement against shackling. In the bivariate model, each of the actionable drivers and facilitators of stigma were significantly associated with higher care intentions. In the multivariate model, the stigmatization, institutional norms, individual-level attitudes, and perceived autonomy remained significantly associated with higher intention scores, with individual stigmatizing attitudes having the strongest association (Goshin et al., 2020). The negative impacts of stigma in the nurses’ intentions to provide standard maternal care were observed. Stigmatizing attitudes and institutional norms were confirmed significant and suggested negativity among nurses towards incarcerated women.

Corrections Officers’ Knowledge and Perspectives

The Minnesota Department of Corrections (2019) defines that a CO’s job is to ensure the safety, welfare, and security of the public, facility, on-site personnel, and offenders. During delivery of an incarcerated woman, the presence of COs guarantees the safety of the public, on-site personnel, and the pregnant woman under custody (Kelsey et al., 2017; Wismont, 2000). Research by Pendleton et al. (2020) was conducted with COs at one state prison utilizing a successful doula program. Doulas provide physical and emotional comfort to incarcerated women. The Minnesota Prison Doula Project (MnPDP) permits the doula to meet the woman twice before birth and to attend her labor and delivery. Thereafter, the doula is present when the mother is separated from the child, and the doula returns to prison twice after birth (Shlafer et al. 2014).

An online survey was used to collect the quantitative data from COs, and in-person interviews were used to understand CO's perspectives. Survey collection occurred over two weeks. In the end, 38 individuals completed the survey, and 8 agreed to the interview. The interview ranged from 23 to 53 minutes. The survey consisted of 91 items to measure demographic characteristics, job stress, knowledge of the program, and policies available for pregnant women in prison. The semi-structured interview allowed insight to be gained from COs regarding policies and if they have changed over time. Also, questions were asked to understand COs' perception of MnPDP, how it influenced their job responsibilities, and what effect it had on pregnant women (Pendleton et al., 2020).

The findings suggested that 58% of the participating COs attended the birth of incarcerated women. Most COs attended five births or less. Moreover, COs reported that they had varied levels of knowledge on maternal and child health (MCH) policies and programs. COs were aware of supplemental nutrition, prison doula programs, prenatal health care services, and more. However, they were less aware of adoption, abortion services, and breastfeeding support. The study found that most COs supported the doula program and policies of not restraining pregnant women. The interviews clarified that the COs realize that pregnant women have special needs, but further revealed that they do not feel the need to treat them differently, because it hinders their duty to maintain security (Pendleton et al., 2020). COs reported that they do not find prison policy to not restrain women to interfere with their ability to maintain safety and security.

Policy Implications

Richie (2018) concluded that women of color are often the recipients of additional judgments and stigma in the prison system, as well as from the White stakeholders in the justice system. Researchers thus suggested that policies should incorporate the convergence of race, gender, and class and its impact on mothering (Link & Oser, 2018). Additionally, gender-responsive policies and programs should be separately designed to cater to the unique requirements of pregnant women in prison (Goshin et al 2017; Sufrin, 2017). Moreover, an evidence-based and gender-responsive risk-needs assessment should be integrated, to gain an understanding of those requirements (Van Voorhis et al., 2008). Furthermore, COs and healthcare providers should go through stigma reduction interventions to gain insights on the negative impacts of mass incarceration-related stigma, as well as honing skills to care for incarcerated pregnant women (Goshin et al., 2020).

Goshin and colleagues (2020) further suggest designing a training where health care providers and custody staff both are present. This would result in understanding the roles of each other. The stigma reduction intervention with formerly incarcerated women allows the health care provider to understand the perspectives of mothers. This initiative helps change societally imposed perspectives about incarcerated mothers and humanizes them. Thus, a blended intervention and the in-person session could be beneficial without sacrificing the responsibilities and time of the staff (Goshin et al, 2020). Finally, prison facilities should also provide opportunities to COs to present their feedback regarding MCH programs, to guarantee better outcomes (Pendleton et al., 2020).

Conclusions and Future Research

Studies suggest the majority of incarcerated women have prior experiences of physical and sexual abuse in their childhood (Asberg & Renk, 2013) Women often link their criminalized behaviors to these experiences of abuse (Kennedy et al., 2020). Many get involved in drug crimes to cope with these experiences of abuse, and abject poverty and childcare responsibilities lead many to commit property crimes and fraud (DeHart et al., 2008; Lynch et al., 2012). Past studies showed how women are more likely to be the victims of domestic violence than men (Kennedy et al., 2020). Moreover, the probability of their incapacitation often is increased through intimate partner entanglements (Barlow, 2016; Richie, 2001). These women find themselves forced to engage in substance abuse, prostitution, and other criminal offenses (DeHart et al., 2014, Fedock, 2018).

Motherhood often is viewed as a mere biological process, but motherhood, while incarcerated, is perceived with both sympathy and stigma. Motherhood behind bars often includes an all-consuming desire to protect children, but from a distance. In prison, there is a lack of opportunity for mothers to connect with their children residing outside. Bedford Hills facilities permit guardians to visit the prison nurseries, to minimize separation anxiety among the child and the mother (Garcia-Hallett, 2018). Subsequently, transitional planning reduces separation difficulties. As a result, more such planning should be introduced in other prison nursery programs.

Future studies should analyze the trauma faced by incarcerated women in their childhood, and the influence these experiences have on their role as mothers. Moreover, treatments that help women with substance abuse issues can lead to better outcomes for the mother and the child. Finally, mothering practices behind bars should be studied through an intersectional lens to consider the impact of race, gender, and class (Kennedy et al., 2020). Additionally, future studies should also investigate the caretaking responsibilities of mothers as a factor in determining their sentence (Kennedy et al., 2020).

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