pregnancy and childbirth

Every mother and child should bond in a safe and healthy environment–not be handcuffed and separated at birth in custody.

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When an individual is pregnant and gives birth, they need a proper diet, prenatal vitamins, regular medical check-ups, exercise, emotional support, a birth plan, and continuing connections to their child to nurture a new life. Instead, some women in the custody of the Department of Corrections (DOC) have experienced forced separation from their children, lacked consistent prenatal and postpartum care, been handcuffed late in their pregnancies, and had Correctional Officers in the delivery room after doctors asked them to leave.  These types of conditions can make it more challenging for someone to navigate a high-risk pregnancy and increase the risk for Black women who already face higher rates of maternal mortality.  Unlike DC, laws, policies, and practices were changed so that women who are pregnant in Minnesota, Tennessee, and Missouri may be diverted or released to the community to avoid the dangers that exist in jail or prison. DC should fund and implement the Safe and Supported Pregnancy and Delivery for Incarcerated Individuals Amendment Act of 2024 and also pass legislation to create exclusive community alternatives to incarceration for people navigating childbirth and pregnancy as exists in nine states and reflects best practices.

What you need to know

Most women who are incarcerated have children – many in America's jails.

According to the Prison Policy Initiative, 190,600 women are incarcerated in the United States. This number includes local jails, state prisons, juvenile detention, immigration detention, and federal jails and prisons. Specifically looking at state prisons, over half of the incarcerated women have children under the age of 18. Looking at jails, where over 2 million women will spend at least one day a year, 80 percent have children under 18. These women are often the primary caregivers for their children and are charged with lower-level offenses. Fifty-eight thousand women enter the jail system while pregnant. 

Incarceration negatively impacts maternal health.

The conditions and the lack of adequate care in jails and prisons make incarcerated mothers a high-risk maternal health group that is more likely to have premature births and babies with low birth weights.  One mother incarcerated in New York State said she experienced poor treatment throughout her pregnancy and was shackled to her bed during labor, elevating the chance of a high-risk birth. In a correctional setting, most mothers are separated from their children.  For the mother, this leads to postpartum depression and feelings of extreme grief.  Separation from their child has been shown to increase recidivism for the mother. Racial disparities in maternal health and incarceration compound the problem for Black women, who are two to three times more likely to die due to obstetric causes in the community than white women. In jail, these risks are more concentrated on Black women, who at a minimum make up, at a minimum,  79.6 percent of the DC Department of Corrections female population.

Separating mothers from their children negatively impacts the child's health and their long-term trajectory.

For the child, separation from their mother causes an immediate and permanent increase in the baby’s stress levels, which can lead to mental health issues later in life. The Texas Center for Justice and Equity has shown the impacts of the incarceration of a mother on the child can lead to mental, physical, emotional, and behavioral health problems, including psychological strain, depression, and antisocial behavior.   All of these mental health challenges can lead to economic hardship and substance use.  Incarcerating a mother is much more likely to lead to a child’s placement in foster care.  Research shows that children whose parents serve time have more difficulty in school than those who do not weather such an experience. Along with poor school performance, according to a report by Central Connecticut State University, children of incarcerated parents are three times more likely than children without incarcerated parents to be arrested, convicted, or incarcerated themselves.

In the DC DOC, women are generally incarcerated pretrial and then return to the community.

The DC DOC does not publish statistics on the number of women who are pregnant or deliver a child while under their jurisdiction.  The DOC reported to Councilmember Christina Henderson the following: in 2020, the DOC had 95 people under their jurisdiction who were pregnant, had 29 individuals in their custody in 2023 who were pregnant, and had at-least one woman navigating pregnancy in the system in each of the last nine years. Other  statistics that are published annually show that most women who are incarcerated in jail are not subsequently admitted to the Bureau of Prisons, so their jail exposure is the only incarceration experience they will have. The DOC reports that the median length of stay for women in the DC jail is 61 days, and 61.3 percent had unresolved charges. Only 7 percent of the women incarcerated in the DC jail were sentenced to felony charges in fiscal year 2024, and 74 percent were released back to the community.

The DOC’s policies do not go far enough to protect women's and children’s health.

The National Commission on Correctional Health Care and the American Correctional Association have issued standards of care and recommended resources that should guide the care of individuals who are pregnant while incarcerated. The American College of Obstetricians and Gynecologists also has standards relevant to serving pregnant individuals effectively, wherever they are.  These standards include testing for pregnancy upon entry to incarceration; proper prenatal care, nutrition, and activity; mental health services; prohibitions on the use of restraints; childcare arrangement; and fostering child-mother bonding. While some of these standards are referenced in writing in the DOC policies and handbooks, most of the DOC published policies on the issue of pregnancy in the jail focus on limiting restraints.  There is no published policy on how to limit the incarceration of pregnant mothers or speed someone’s return to the community,  on the need to foster a bond between the mother and child, support the mental health of both the mother and child, or provide pregnant mothers access to doulas.  The public DOC website listing women’s services is more than twelve years old and lists partnerships with nonprofits that no longer exist.

The DOC does not always follow its stated policies on childbirth and pregnancy.

While the DOC published policies state, “pregnant patients will be counseled, examined, and treated according to national guidelines,” two clients represented by the Washington Lawyers’ Committee for Civil and Urban Affairs (WLC)  have offered perspectives that run counter to some of these standards or best practices, and DC’s published policies. A memorandum summarizing DOC’s published policies,  national best practices, and these two clients’ experiences are provided below.

Client Experiences
One client experiencing a known high-risk pregnancy was supposed to be taken to an outside OBGYN appointment twice a week for fetal monitoring but was only taken once a week because DOC did not schedule her appointments correctly. On some weeks, she was not taken to these appointments at all.
One pregnant client went into labor and was not transported to the hospital until nearly an hour after her water broke, and both clients had Correctional Officers in the room during both labor and delivery. Correctional Officers did not leave the room when doctors asked them to during both clients’ labor and deliveries – including during one client’s cesarean (C-section) surgery.
Both pregnant clients were handcuffed in their third trimesters. One client was handcuffed at seven months pregnant for every outside medical appointment. Correctional Officers attempted to handcuff both clients while at the hospital after giving birth.

Other places are more fully addressing issues that pregnancy behind bars causes.

Minnesota recently passed the “Healthy Start Act,” which aims to support incarcerated women with newborn babies. The Healthy Start Act places pregnant or immediately postpartum individuals into community alternatives to incarceration for one year to allow the child to be with their mother for the first year of their life.  Seven states, including Louisiana, Tennessee, and Missouri, have enacted caregiver diversion laws to create specialty programs for parents or give parents priority access to diversion or drug treatment programs, electronic monitoring, or other ways they can be in the community. Five states changed practices to create a maximum distance allowed between incarcerated parents and children when in prison. There are also nonprofit organizations working to help mothers and children through the childbirth process while they are incarcerated: right across the Potomac River from DC, the Virginia Prison Birth Project works to provide support for pregnant and postpartum women in prison with trained doulas, information sessions, and advocacy for proper visitation.  The Alabama Prison Birth Project, Illinois Birth Justice, and the Minnesota Prison Doula Project do similar work with incarcerated women navigating pregnancy and childbirth.   The United Nations standards state that “non-custodial sentences for pregnant women and women with dependent children shall be preferred where possible and appropriate…..”

DC has taken some steps to protect mothers and their children during childbirth.

In late 2024, the Council passed the Safe and Supported Pregnancy and Delivery for Incarcerated Individuals Amendment Act of 2024, legislation that would improve how pregnant people are treated while under the custody of the DOC.   The legislation requires the DOC to provide pregnancy testing and pregnancy and abortion counseling options to incarcerated individuals who are or may be pregnant; provide a minimum standard of pregnancy-related healthcare, including specialized healthcare and providing medical and personal care supplies to incarcerated individuals who are pregnant and postpartum; establish a process for a pregnant individual to request the presence of a support person while hospitalized for labor, delivery, a cesarean section, a pregnancy termination, and during postpartum recovery while hospitalized; establishes rights of the support person during the time they are present with the incarcerated individual. The bill also increases privacy rights by restricting the presence of corrections officers in the delivery room except under extraordinary circumstances; requires the DOC to assist in facilitating a connection between an incarcerated pregnant person and a family attorney who can make custody arrangements, establish paternity, and assist with other matters; requires DOC to improve its policies regarding breastfeeding and breast milk pumping and storage; and requires additional visitation time for incarcerated mothers and their babies. Finally, the amended legislation adds a training and reporting requirements, also relating to DC law l limiting the use of restraints, and creates a private right of action so that someone can sue the DOC if the law isn’t followed.

Counter to best practices, DC has not created alternatives to incarceration for people navigating pregnancy and childbirth.

The Safe and Supported Pregnancy and Delivery for Incarcerated Individuals Amendment Act of 2024  does not include several provisions that are the hallmarks of the best practices seen elsewhere in the country:  The law, as currently written, does not provide new alternatives to incarceration pathways where pregnant and postpartum women could be on home confinement, as is the case in nine other jurisdictions. Alternatives to incarceration for pregnant individuals have been shown to reduce recidivism rates and promote long-term success for both the mother and the infant.  The American College of Obstetricians and Gynecologists’ Committee on Health Care for Underserved Women strongly supports community-based alternatives to incarceration, noting that an incarcerated mother’s separation from her newborn “can potentially have devastating maternal effects.”

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