Pregnant Women In Custody Act
Mr. Speaker, I rise in support of H.R. 6878, the Pregnant Women in Custody Act, because women's lives matter, pregnant women's lives matter, their babies' lives matter, as do the lives of incarcerated women and their babies. I have worked…
Mr. Speaker, I rise in support of H.R. 6878, the Pregnant Women in Custody Act, because women's lives matter, pregnant women's lives matter, their babies' lives matter, as do the lives of incarcerated women and their babies.
I have worked on this issue for a very long time and am delighted to be able to support this legislation introduced by my friend and colleague, Congresswoman Bass.
This works to ensure that we recognize the increasing population of women incarcerated. Unfortunately, women are the fastest-growing segment of the incarcerated population in the United States. Conversations about criminal justice reform often overlook their unique experiences and the needs of women and girls within the criminal justice system.
For instance, Mr. Speaker, the United States has the second highest rate of women incarcerated in the world, with 64 women per 100,000 in custody and nearly 60,000 pregnant women admitted into American jails and prisons every year. That is a lot.
Some States have yet to prohibit the shackling of women when they are giving birth. We have to do something.
This bipartisan legislation would establish Federal policies to prohibit the use of restrictive housing on incarcerated pregnant women and develop a national standard of care to add to the pregnancy-related needs of incarcerated women, including access to prenatal and post- delivery care and support.
My legislation, the SIMARRA Act, also complements this by creating a pilot program in the Federal system for mothers to stay with their infants for a period of time. This humane response and the humane response of this bill are what we need to do.
Oftentimes, pregnant women lack access to appropriate nutrition while incarcerated, and the use of restrictive housing can have detrimental effects on a woman's health, as well as the health of her baby. While women of color are disproportionately impacted by incarceration, they also face higher risks of both miscarriage and maternal mortality.
This bill would make certain that incarcerated pregnant women receive vital prenatal healthcare and postpartum support and ensures the Bureau of Prisons and the Marshals Service protect the health and safety of incarcerated women through their pregnancy, when they deliver their child, and as they receive postpartum care. They should not be shackled, and they should not be intimidated or frightened.
The one thing I want to say, Mr. Speaker, even though many of us have different views--and I am an avid supporter of the right to choose-- this is not an abortion bill. This is a healthcare bill.
We also know that the prisons make their determinations on how they help women in their contraceptives. H.R. 6878 would allow BOP to collect data on healthcare needs of pregnant women so that we may have a better understanding.
Let me clearly say that separating a newborn from its mother gives it less chance for both survival and success in life.
We know in Harris County, Texas, there are approximately 1,000 women incarcerated in the Harris County Jail. This bill would require a GAO study, setting national standards, and endeavor to do a landscape to understand reproductive freedom in this country.
Mr. Speaker, that is why I was glad to see my bill, the Stop Infant Mortality And Recidivism Reduction Act of 2021, or the SIMARRA Act, included in the Violence Against Women Act, which passed earlier this year. That bill established a pilot program to allow women incarcerated in Federal prisons and their babies to reside with each other while the mother is incarcerated for a period of time.
Mr. Speaker, let us continue to be innovators in the treatment of those who are incarcerated, and let us make sure that we give every newborn a healthy life. I ask my colleagues to support the underlying legislation.
Mr. Speaker, I rise in support of H.R. 6878, the ``Pregnant Women in Custody Act,'' because women's lives matter, pregnant women's lives matter, their babies' lives matter--as do the lives of incarcerated women and their babies.
Although women are the fastest growing segment of the incarcerated population in the United States, conversations about criminal justice reform often overlook the unique experiences and needs of women and girls within the criminal justice system.
The United States has the second highest rate of women incarcerated in the world, with 64 women per 100,000 in custody, and nearly 60,000 pregnant women admitted into American jails and prisons every year, while some states have yet to prohibit the shackling of women when they are giving birth.
This bipartisan legislation would establish federal policies to prohibit the use of restrictive housing on incarcerated pregnant women and develop a national standard of care to address the pregnancy- related needs of incarcerated women, including access to prenatal and post-delivery care and support.
Oftentimes pregnant women lack access to appropriate nutrition while incarcerated and the use of restrictive housing can have detrimental effects on a woman's health as well as the health of her baby. And while women of color are disproportionately impacted by incarceration, they also face higher risks of both miscarriage and maternal mortality.
This bill would make certain that incarcerated pregnant women receive vital prenatal healthcare and post-partum support and ensure the Bureau of Prisons and the Marshal's service protect the health and safety of incarcerated women throughout their pregnancy, when they deliver their child, and as they recover post-partum.
H.R. 6878 would also require BOP to collect data on the healthcare needs of pregnant
women, so that we may better understand the challenges incarcerated women face and determine how to address the needs of this vulnerable population.
In Harris County, Texas, on average, there are approximately 1,000 women incarcerated in the county jail and on average 25 to 30 of them are pregnant. The jail offers specific programs for mothers to reduce recidivism and help them support their families upon release.
This bill would require GAO to study state and local corrections facilities to understand the services and protections provided for pregnant women, like the program offered in Harris County.
Setting national standards for the treatment of incarcerated pregnant women in federal custody would set an example for state and local facilities to follow and the data collected by BOP would farther inform Congress of the additional health and safety needs of this vulnerable population.
As we endeavor to navigate a new landscape for reproductive freedom across the country, we must recognize that incarcerated women will continue to face challenges in carrying healthy pregnancies to term.
That is why I was glad to see my bill, the ``Stop Infant Mortality and Recidivism Reduction Act of 2021'' (or the ``SIMARRA Act''), included in the Violence Against Women Act which passed earlier this year. That bill established a pilot program to allow women incarcerated in Federal prisons and their babies born during their incarceration to reside together with while the mother is incarcerated.
Let us continue to be innovators in the treatment of those who are incarcerated. And let us make sure women receive proper health care and humane treatment whether they are incarcerated or not--because all women deserve proper health care and to be treated with dignity--no matter their circumstance.
I thank Representative Karen Bass for her steadfast commitment to addressing this important issue. I urge my colleagues to join me in support of this long overdue legislation.
I include in the Record a Prison Policy Initiative document titled: ``Unsupportive environments and limited policies: Pregnancy, postpartum, and birth during incarceration.''
[From Prison Policy Initiative, Aug. 19, 2021]
Unsupportive Environments and Limited Policies: Pregnancy, Postpartum,
and Birth During Incarceration
(By Leah Wang)
Making up for a serious gap in government data collection
and understanding, researchers are discovering what pregnant
incarcerated women should expect when they're expecting (or
when they give birth while in custody). Findings indicate
that jails, prisons, and youth facilities have yet to
adequately recognize pregnancy and postpartum needs either in
policy or in practice.
Recently published findings from the groundbreaking
Pregnancy in Prison Statistics (PIPS) Project and other
datasets shed light on a common but rarely discussed
experience: being pregnant, postpartum or giving birth while
incarcerated. Spearheaded by Dr. Carolyn Sufrin of the Johns
Hopkins University School of Medicine and School of Public
Health, this series of studies is our best look yet at
pregnancy prevalence and outcomes in U.S. jails, prisons, and
youth facilities.
In total, 22 state prison systems, all federal prisons, 6
jails, and 3 youth confinement systems participated in the
PIPS Project, a systematic study of pregnancy and its
outcomes among incarcerated women. Historically, the
government has not collected data about carceral pregnancy on
a regular basis, meaning no national effort has been made to
understand maternity care for thousands of incarcerated
pregnant women. The project's sample represents 57 percent of
all women in prison, 5 percent of all women in jail and about
3 percent of young women in youth facilities.
Our takeaway: Carceral pregnancy, whether in jail, prison,
or youth confinement, is characterized by a lack of
supportive policies and practices. Some of the major findings
to come out of these publications are:
There are an estimated 58,000 admissions of pregnant women
into jails and prisons every year, and thousands give birth
or have other outcomes while still incarcerated. Pregnancy
rates among confined youth were similar to those among
adults.
In some state prison systems, miscarriage, premature birth,
and cesarean section rates were higher than national rates
among the general population.
Only one-third of prisons and jails had any written policy
about breastfeeding or lactation, and even where policies
supporting lactation did exist, relatively few women were
actually breastfeeding or pumping.
There are an estimated 8,000 admissions of pregnant women
with opioid use disorder (OUD) into prisons and jails each
year, but long-term treatment using medication is the
exception, not the rule.
A related (non-PIPS Project) study finds paternal
incarceration is also linked to adverse birth outcomes like
low birth weight, which are widely known to impact long-term
health.
The researchers' findings add complexity to a growing body
of literature and consensus linking incarceration to negative
health impacts. And although PIPS Project data can't be
broken down by race, ethnicity, or gender identity, measuring
the scale and outcomes of pregnancies in prison and jail is a
major public health research accomplishment. The fact that
academic researchers had to conduct this research to fill the
data gap--and the shortage of appropriate policies they
found--makes it clear that many correctional agencies have
yet to even acknowledge the needs of pregnant incarcerated
women.
every year, thousands of incarcerated expecting mothers and babies face
adverse outcomes from exposure to incarceration
Over the 12 months of the Pregnancy in Prison Statistics
(PIPS) study period, there were nearly 1,400 admissions of
pregnant women to participating state and federal prisons
with over 800 pregnancies ending in custody (births,
miscarriages, and others), and over 1,600 admissions of
pregnant women to jails with 224 pregnancies ending in
custody. Unsurprisingly, given the short length of most jail
stays, more pregnant women are admitted to jails each year,
but more births take place in prisons, where the average stay
is longer. Based on their data, the authors estimate that,
nationally, 4 percent of women entering prison (in line with
Bureau of Justice Statistics 2016 estimates) and 3 percent of
women admitted to jail (lower than BJS' most recent 2002
estimates) are pregnant.
Pregnancy outcomes in prisons and jails in some places were
worse than national trends across the general population.
When pregnancy did end in custody, in some states like
Arizona, Kansas and Minnesota, rates of miscarriage ranged
from 19 to 22 percent, exceeding estimates of the national
rate. In Ohio and Massachusetts, premature births exceeded
the general population rate of about 10 percent. Among live
births, which were 92 percent of birth outcomes in custody,
one-third (32 percent) of these were caesarean section
births, in line with the national average rate. In some
states, the C-section rate was much higher, suggesting that
C-sections may be taking place when not medically necessary,
risking short- and long-term health problems in babies.
pregnancy among confined youth is not uncommon, and better testing
might reveal it's even more widespread
Upon hearing about the Pregnancy in Prison Statistics
(PIPS) Project, three juvenile justice systems (one state-
level, and one county-level system) volunteered to complete a
survey about pregnant adolescents in the custody of 17 of
their ``juvenile residential placement'' facilities,
providing a window into this population for the first time.
One takeaway from the survey's findings was that adolescent
pregnancies--both in confinement, and upon release--may risk
poorer outcomes because of a lack of continuity of medical
care between confinement facilities and the community. Even
though all three state systems provided basic prenatal care,
with the typical length of stay for young women lasting a few
months or less, justice-involved youth would benefit
enormously from consistency in medical care throughout
pregnancy.
The survey also showed that the rate of pregnancy among
confined youth (3.3 percent) was similar to that of the adult
incarcerated population (3.5 percent). However, the youth
facilities reported less routine pregnancy testing,
bolstering a 2004 study revealing that only 15-17 percent of
1,255 juvenile facilities nationwide tested youth for
pregnancy at admission (with about two-thirds of facilities
providing tests only if requested). Therefore, it's possible
the youth carceral pregnancy rate is a very conservative
estimate, and that thousands of pregnant youth are going
without prenatal care when their health needs are likely
complicated.
Eight pregnancies ended among youth confined in the
surveyed facilities during the 12-month study period,
including four miscarriages, three induced abortions, and one
live full-term birth. It would be misleading to view these
outcomes as representative of all pregnant confined youth,
but the authors advise youth confinement facilities to be
prepared for high rates of miscarriage and other adverse
birth outcomes, seeing as justice-involved pregnant youth are
going through highly stressful life experiences.
Services and policies regarding prenatal and postpartum
care were variable: All three juvenile systems allowed
abortion, and some covered the cost; all three systems also
allowed lactation through either breastfeeding or pumping.
Still, the small sample size (which represented just 2.8
percent of all confined female youth) and the potential
influence of self-selecting facilities make it difficult to
draw conclusions about the experience of pregnant youth in
confinement.
breastfeeding and lactation are not guaranteed to new mothers and
babies, ignoring the enormous benefits of breast milk
When the cohort of 22 prison systems and 6 jail systems
described their lactation-related policies to the
researchers, they painted a discouraging picture of how
correctional facilities largely don't support breastfeeding,
a practice chosen by some mothers for its unique benefits.
To begin, only one-third of prisons and jails had any
written policy on lactation, leaving many incarcerated women
to the whims of facility staff who may not be
trained in this area or understand its importance. Even where
women were formally allowed to lactate, milk was sometimes
discarded at the study sites due to mother-infant separation,
providing only a benefit to the mother of maintaining milk
supply.
Because it is a matter of health equity to provide the
opportunity to lactate and breastfeed (among other parental
choices), researchers extend the ``further research is
needed'' statement in order to understand the probable racial
disparities within carceral pregnancy: ``. . . research in
collaboration with current and formerly incarcerated women,
specifically Black, Indigenous, and women of color, is needed
to fully understand breadth of experiences and perspectives
related to breastfeeding and lactation while in custody.''
opioid use disorder among incarcerated women is treated under some
circumstances, but leaves mothers without help postpartum
In addition to known medical needs during pregnancy, some
women enter incarceration with other health problems.
Researchers accessed six months of activity and policy
related to opioid use disorder (OUD) treatment of pregnant
women in the Pregnancy in Prison Statistics (PIPS) study
sites and found that 26 percent of those entering prison and
14 percent entering jail had OUD. The gold standard of care
for these women would be medication for opioid use disorder
(MOUD), which is linked to better pregnancy outcomes and
increased engagement with addiction treatment and other
medical care.
Twenty-two of 28 sites did offer this avenue for treatment
of pregnant women in some way, but the narrow window in which
they could be treated for OUD leaves much room for
improvement. In most facilities offering MOUD, it would not
be initiated in the facility; they would only continue
someone on MOUD if they were already on it. This unfairly
excludes women who were unable to begin treatment before
admission; for example, if someone was in jail before being
transferred to prison, their access would then depend on the
jail's policy. Postpartum, most facilities providing MOUD
would discontinue treatment, showing a clear disregard for
the mother's well-being after birth.
Still, one-third of surveyed sites managed OUD among
pregnant women through detoxification, some with and some
without medication to manage symptoms. Detox, or ``medically
supervised withdrawal,'' can be a painful process and has a
high rate of failure for pregnant women, increasing the risk
of future overdose.
These exclusionary policies and practices are troubling
given the fact that opioid overdose is a major cause of death
for pregnant and postpartum women in the United States, and
remains a huge concern for formerly incarcerated people. In
Rhode Island, where MOUD has been implemented comprehensively
in their unified prison-jail system, there has been a huge
reduction in post-release overdose deaths; replicating their
initiative would have a great impact on carceral pregnancy
and postpartum outcomes.
the incarceration of fathers is also linked to worse birth outcomes
As if it's not bad enough that incarceration prevents
expecting mothers from receiving care and providing care to
their babies, another recent study finds that incarcerating
fathers during pregnancy or at the time of birth is also
harmful to babies' health.
In another recent study--unrelated to the Pregnancy in
Prison Statistics (PIPS) project--Youngmin Yi and fellow
researchers matched hundreds of thousands of birth records to
jail records in New York City between 2010 and 2016,
observing trends in birth weight, preterm (premature) birth,
admission to the NICU (neonatal intensive care unit), and
more. Paternal incarceration was associated with nearly all
adverse outcomes, even after other characteristics of mother
and father were accounted for statistically. ``Exposed'' to
their fathers' incarceration--even for as little as one day--
babies were born with these vulnerabilities, such as low
birth weight, known to have an impact later in life.
incarcerated pregnant people and their babies deserve better care that
is codified in policy
The findings by Sufrin, Asiodu, Kim and fellow researchers
offer a desperately-needed look into pregnancy during
incarceration. And the findings by Yi et al. contribute to an
even more holistic picture of what it means to be a growing
family entangled in the criminal legal system. Families
experiencing pregnancy are impacted by incarceration whether
the mother or the father is incarcerated, and whether or not
the baby is born during the mother's incarceration.
Both adolescents and adults in confinement should be
afforded comprehensive prenatal care, including education,
lactation support, and opioid use disorder treatment that
continues beyond the end of pregnancy. And babies born right
after or during their parents' incarceration, who risk health
issues like lower life expectancy and social and emotional
challenges, deserve the chance to begin life with one or both
parents as much as possible. These efforts and programs
should be clearly written into agency policy so that facility
staff can be trained and expected to provide care.
One way that prisons and jails can begin to assess and
improve their care for pregnant women is by reviewing the
American College of Obstetricians and Gynecologists' recently
updated comprehensive set of guidelines for carceral
reproductive health care. Facilities should also consider
subscribing to the National Commission on Correctional Health
Care's standards for health services, which have clear ways
of addressing many of the above topics. Prisons and jails
should make their policies publicly available, and create
ways to keep healthy mothers and their babies together.
note about the language used
Throughout these publications, the terms ``pregnant women''
and ``mother'' described those people who were pregnant in
custody during the study period. While we've deferred to the
terminology used by the authors, we acknowledge that
pregnancy can overlap with multiple gender identities, and
our conclusions and recommendations apply to all pregnant
people.