America’s fastest-growing prison population is women — most in their reproductive years. At any given time, about four percent of women prisoners, or about 3,000 people, are pregnant, as reported by the medical anthropologist Carolyn Sufrin. But there is no national data collected by the U.S. government. In fact, despite the heroic efforts of people like Sufrin, pregnancy and birth behind bars are barely researched and little understood.
To fill this gap, sociologist Rebecca M. Rodriguez Carey’s Birth Behind Bars: The Carceral Control of Pregnant Women in Prison centers on 35 women who gave birth while incarcerated in the Midwest and have since been released. Rodriguez Carey describes a punitive system that she calls the “maternal web of control,” which includes not only prisons but also hospital doctors and medical staff, the so-called child welfare system, systemic poverty, and racism in sentencing and treatment. The web of control makes it virtually impossible to do what everyone claims they want the incarcerated person to do: change her life. After all, “if you don’t have any women here in these beds, these corporations are losing out on some serious money,” one interviewee told Rodriguez Carey. “They don’t like it when you know what’s going on and that you’re knowledgeable and all of that. They don’t like it. They want you to come back.”
The “degradation ceremonies that mark imprisonment” enforce women’s powerlessness and comprise an array of worst practices for pregnant people. Most women interviewed by Rodriguez Carey were denied pregnancy and parenting classes and educational materials. Emotionally meaningful planning was generally forbidden: They couldn’t choose where or how to give birth and/or plan to save any keepsakes from the hospital, like their baby’s receiving blanket or hospital bracelet. Prisons consider these items contraband. They couldn’t plan who would be in the room with them during the birth.
In theory, abortion is sometimes available. Before the Dobbs ruling, federal courts had ruled that incarcerated women had a constitutional right to an abortion; in reality, accessing it was so logistically and financially difficult that few incarcerated people who wanted one managed to get care. After Dobbs, incarcerated women, who do not have the ability to travel across state lines, are even less likely to get an abortion if they want one.
Pregnancy introduces concerns that these facilities, which prioritize control, are not equipped to handle. Tallying prisoners delays emergency care of all kinds and can be life-threatening to pregnant people. Women of color are less likely to be believed by prison guards when they report pain and complications. One woman, Latrice, who experienced heavy bleeding and abdominal pain, told Rodriguez Carey that her care was delayed for four weeks as she waited for paperwork to be approved, and then some weeks more while she waited to get approval for specialty care and an ultrasound. Her baby was stillborn, and “to this day, she still wonders if her baby would have been born alive had she had more timely medical care,” writes Rodriguez Carey. Latrice was not only denied this care, but she fell shortly before giving birth. As she was stepping into a prison van for a routine doctor’s visit, her shackled ankles caused her to trip. Because she could not catch herself due to the restraints around her wrists, she fell on her pregnant belly. She gave birth just days later.
I had waist chains, and I couldn’t move through the contractions.
Shackling pregnant women in federal prisons was prohibited in 2008 and codified into law under the First Step Act of 2018, but a number of states leave restraints up to the discretion of the officers or leave loopholes to allow officers to shackle any incarcerated person for safety concerns — “a practice fraught with racial disparity, with women of color being more likely to be perceived as a threat that must be restrained to protect the mostly White healthcare providers and correctional staff.” For pregnant women, including the women interviewed for the book, this has translated into being shackled during routine appointments and even while in active labor. One woman, Stacy, told Rodriguez Carey, “I was shackled to the bed while I was delivering my baby. You feel shamed, and it makes you feel unworthy, and it just puts a stigma on you. I had waist chains, and I couldn’t move through the contractions, so the actual part of being shackled to the bed, I felt like an animal.”
Having given birth under these traumatic conditions, some women are told by hovering correctional officers that they cannot breastfeed. One woman, Faye, who breastfed her other children, told Rodriguez Carey of her baby: “He needed those nutrients in the breastmilk, and I couldn’t even give it to him … They said no. Why? I don’t know.” For the few women whose babies are brought to visit them in the weeks and months after they gave birth — after endless waiting and security searches — prison visitation rules set limits to touching their babies. A formerly pregnant woman’s breasts leak at the sound of their crying child, but these women are not permitted to nurse.
Unlike expectant mothers on the outside, who might be making plans for extra bonding time with their newborns after birth, incarcerated pregnant women must decide who will take care of their babies while they serve out the remainder of their sentences. Some women may be able to remain with their newborn if their prison has a nursery program, but only 11 states have such facilities. One woman in the book did use a nursery program, even as her family criticized her choice to keep her baby behind bars with her. Another woman considered doing the same thing, but the cost ($350 per month) was out of reach for her family.
If the incarcerated pregnant woman doesn’t have anyone to take her baby, she is forced to give the newborn to a social worker, who will place the child in foster care — a system rife with abuse and one that makes it extremely difficult for mothers (especially Black mothers) to regain custody rights. “It’s tough with the system ’cause it’s their job to catch you and terminate parental rights,” one interviewee, Tiana, told the author. “The extreme that you must go through to get your kids back is like death and darkness closing in more and more.” Several other women whom Rodriguez Carey interviewed said that they “had been ‘in the system’ as a child and experienced sexual and emotional abuse at the hands of a foster parent, which did little to ease their anxieties around the child welfare system.” But if the mother’s designated caregiver doesn’t arrive at the hospital before she is returned to prison, the child may be put in the system anyway. Or, if the mother’s sentence exceeds 15 months, they could lose custody of their child under the federal Adoption and Safe Families Act (ASFA) of 1997. Signed into law by President Bill Clinton, ASFA “was intended to reduce the time frame and number of children in foster care by placing them in more permanent homes,” writes Rodriguez Carey, but ultimately, it has contributed to tearing apart hundreds of thousands of families, especially when women are pregnant at the time of their incarceration.
The brutality of the prison experience sets these women up for failure well beyond their incarcerations. Several of the women Rodriguez Carey interviewed ultimately lost custody of their children after being released because they were unable to secure jobs or homes, or they chose not to seek custody because the obstacles were too great. Securing these basic needs was especially difficult in their rural Midwestern communities, where there are few if any job opportunities for formerly incarcerated women. Black women, in particular, have the highest unemployment rates among the formerly incarcerated population. More than half of rural families — 60 percent — live in child care deserts, making it near impossible to both work and single-parent.
The instability can be shattering. One woman, Jasmine, explained how after she was released from prison and returned home, her daughter was deeply affected and had severe separation anxiety when she would leave the house. “Even now my little girl, she holds on to the stuff, even now like I go out, and she’s like, ‘But mommy, are you really going to come back?’ You see, you see? She thinks I’m gonna leave her and not come back, but I’ve been back plenty of times. I want my kids to know that they can depend on me,” she said.
Rodriguez Carey makes clear that the maternal web of control is not designed to support people who are trying to start over, which, for a number of these women, includes not taking substances. Rather, the parole system is designed to monitor and control every aspect of their lives so that as soon as they misstep, they can lose custody of their child and be sent back to prison. But that’s perhaps the whole point: As Rhonda says, “It all comes back to money; they’re making profits off the back of prisoners.” It’s a big business, after all, keeping moms in cages.
“Even now my little girl, when I go out, and she’s like, ‘But mommy, are you really going to come back?’”
Birth Behind Bars highlights the power of using a reproductive justice framework: Many of these women did want to parent and were not offered the resources or support that would help them succeed. To counter the maternal web of control, Rodriguez Carey suggests putting into practice a maternal web of support, involving the allyship of “doctors, correctional officers, social workers, families, parole officers, politicians, doulas, friends, and neighbors.” The harms pregnant women experience while incarcerated “are an outgrowth of the inequities occurring in communities.” Rodriguez Carey notes that the women she interviewed expressed the need for alternative forms of punishment to avoid separating women from their newborns, as well as more transition centers and reintegration resources that would encourage them to thrive after they leave prison. Despite the trauma that they have endured, the women have remained hopeful that as more people hear their stories, things might change.
However, rather than make progress toward achieving reproductive justice in the years since Rodriguez Carey began conducting her interviews in the late 2010s, conditions have only gotten worse. Recent Republican-led cuts to social services like Medicaid and SNAP will make it even harder for poor women to receive health care or support their children. In the two years after Dobbs, more than 400 people faced criminal charges and jail or prison time related to pregnancies. Republican-controlled legislatures have made every person experiencing pregnancy or pregnancy loss a suspect deserving of scrutiny, monitoring, and precarious parental rights. The experiences of the women in Birth Behind Bars show us exactly where this can go.
Regina Mahone is a senior editor at The Nation and co-author, with We Testify founder Renee Bracey Sherman, of Liberating Abortion: Claiming Our History, Sharing Our Stories, and Building the Reproductive Future We Deserve.
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