The blog of the Urban Institute
October 7, 2020

How Women’s Prisons Can Reduce Trauma for Parents and Pregnant People in Custody

Last month, the Protecting the Health and Wellness of Babies and Pregnant Women in Custody Act was introduced in Congress to create a national standard of care for labor, delivery, and postpartum periods for pregnant people in custody. This bill, along with a recent whistleblower complaint (PDF) alleging forced sterilizations of immigrants in ICE detention facilities, highlight the need to reflect on how we can better promote and ensure the safety and well-being of pregnant people and parents in custody.

Prison is an inherently traumatizing environment, and this trauma can be particularly acute for pregnant people and parents. They face heightened needs and stressors within a correctional system that is not designed to preserve their safety, well-being, or reproductive rights. We use the terms pregnant people and parents to acknowledge that not all people who are pregnant or become parents while in custody identify as cisgender women.

It is critical to examine this issue through the lens of reproductive justice, a movement pioneered by Black and Indigenous people of color that promotes “the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities.” Prison is antithetical to the core principles of reproductive justice; it is a confined environment that restricts freedom and relies on punitive measures while limiting incarcerated people’s decision-making around their rights to have children and safely raise families.

In a new Urban Institute study of 41 state departments of corrections (DOCs) and women’s prisons, we learned how women’s prisons assist pregnant people and parents as one component of their approach to addressing prior and in-custody trauma. Our study shows how prisons and DOCs are taking steps to address the harm and trauma for pregnant people and parents in custody and where they can improve to preserve and promote people’s safety, well-being, and reproductive rights.

Reducing trauma for pregnant people in prison

Pregnant people who are incarcerated are especially vulnerable to complications, given their heightened need for specialized medical services and their separation from natural social supports. They also have limited access to prenatal care and high-quality medical care, opportunities for physical exercise and prosocial activities, and adequate prenatal nutrition.

Some facilities have implemented innovative approaches to mitigate the traumatizing effects of being pregnant or delivering a baby while in prison:

  • A few facilities offer doula programs to help pregnant people prepare for labor, and they provide support throughout the experience. In one case, the doula program specifically employed a trauma-responsive lens as a core component of the work. Because pregnancy can evoke strong emotions and trauma, doulas are trained in trauma-responsive care and treat participants as worthy of autonomy and care, reinforcing the goals of reproductive justice.
  • Although medical services varied across facilities, a few had supports for those who choose to terminate a pregnancy. A couple of facilities offer counseling services to people who choose to terminate a pregnancy or partner with outside agencies to provide those services. But despite these programs, some people still experience barriers to abortion access, as many can’t pay for the procedure or for staff overtime to accompany them to the procedure.
  • Eight facilities have breastfeeding programs that allow people postbirth to pump breast milk that will be shipped to the caregiver of their child outside the facility. This provides a meaningful opportunity for the parent to feel connected with their child when they cannot share the same physical space.

However, facilities also use harmful practices on pregnant people, such as continuing to use restraints during pregnancy and labor, which can be extremely dangerous (PDF) for the parent and child. The use of restraints exacerbates negative psychological and physical health effects by inhibiting care in emergencies, complicating the process of labor and birth, and limiting aftercare. We found only 39 percent of 41 DOCs do not use restraints at any point during pregnancy, and only 24 percent reported that they stop using restraints at some point during the pregnancy, whether the first or third trimester or during labor.

Supporting connections between parents in custody and their children

The separation between a parent and child can be incredibly stressful, traumatic, and painful for families. Parents may be incarcerated hundreds of miles away from their children, and correctional facilities may limit interactions between parents and children. But some facilities offer services that help promote the connection between parents who are incarcerated and their children.

  • Some state departments of corrections and women’s prisons are addressing the needs of new parents with nurseries, including separate nursery rooms, wings, or houses, as well as through family coordination programs. One facility has a community-based program where new parents can stay postdelivery for up to six months.
  • Some facilities offer ways for parents to stay connected with their loved ones through in-person contact visits, special extended visits, and family day events. Others offer video visits, which are a particularly relevant resource during the COVID-19 public health crisis. Five women’s prisons also offer Parenting Inside Out, an evidence-based parenting program that aims to provide parent management-skills training to address the specific needs of justice-involved parents.

Moving forward to improve standards of care for pregnant people and parents in custody

These types of efforts to improve standards of care can reduce trauma for people in prison, which limits their reproductive freedom by obstructing their rights to raise children and families safely and with dignity. To ensure the health of pregnant people and parents in custody, correctional programs, policies, and practices should incorporate proactive standards of care with a reproductive justice–oriented lens.

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