United States: reproductive justice prison system

The United States imprisons the most women in the world. Across the United States, approximately 200,000 women are incarcerated—nearly an 800 percent increase since 1980. Women of color are disproportionately affected by the criminal justice system. In 2017, twice as many Black women and 1.3 times as many Hispanic women were incarcerated compared to white women. An often overlooked aspect of the increasing rates of women’s incarceration is the impact on the sexual and reproductive health needs of these women. “Despite being the fastest growing incarcerated population, women and girls are correctional afterthoughts,” writes Kimberly Haven, an activist and formerly incarcerated woman who had to undergo a hysterectomy—a surgical procedure to remove the uterus (and, with it, childbearing possibilities)—after being denied proper menstrual products while incarcerated.

“Prisons have been designed along a ‘one-size-fits-all’ model based on a population of men,” where uniquely female conditions like menstruation, menopause, obstetrics, and gynecologic care are not given strong consideration, wrote Jeanne Flavin in Our Bodies, Our Crimes: The Policing of Women’s Reproduction in America.

In prison, women’s reproductive justice—the human right to maintain personal bodily autonomy, have children, not have children, and parent the children they have in safe and sustainable communities—is often disregarded, even though 85 percent of incarcerated women are of childbearing age and 80 percent of women in jail are mothers.

A common reproductive injustice incarcerated women face is lack of access to proper menstrual products. Thirty-eight states have no laws to require the distribution of period products to incarcerated people.

Menstrual products are often scarce, withheld from incarcerated women at the will of correctional officers, or only available to those who can pay for them.

When menstrual products are provided to women, they are “subpar products you would never buy outside of the carceral system,” such as pads that are too thin or that lack adhesive properties to keep them in place. Women must often create their own period products to make do, which can cause infections and other health concerns.**

Prisons are, by design, a tool of social control and reduced personal freedoms and choice. This is particularly evident when it comes to a woman’s right to an abortion. Incarcerated women technically have the legal right to an abortion, but since women are incarcerated at the federal, state, and local levels, and abortion laws vary by state, the lived experiences of incarcerated women seeking abortions are also quite varied.

Prisons often exercise control over women by denying or delaying their access to abortion services. Furthermore, access to abortion in prison is a practical challenge—abortions are not performed in correctional facilities, so women must travel to abortion clinics.

Inmates are typically required to pay for the abortion, transportation, and staff time. Additionally, women have reported being coerced into having abortions, especially when they have been raped by prison guards.

Women’s reproductive health needs do not disappear when they are incarcerated. An estimated 12,000 women are pregnant while serving time (although no government agency officially tracks this) and about 2,000 women give birth while incarcerated each year. According to the Bureau of Justice Assistance, “4 percent of state and 3 percent of federal inmates said they were pregnant at the time of admission,” and an estimated 5 percent of women in jails reported being pregnant. Unfortunately, the rate of pregnancy in juvenile justice facilities is unknown, as it is not typically tracked by the facilities or any federal agency.

The majority of pregnancies of incarcerated women are considered high-risk due to pre-existing social factors surrounding poverty, including poor nutrition, limited access to prenatal care, domestic violence, mental illness, sexually transmitted infections, and drug and alcohol dependence.

While high-risk pregnancies require increased medical attention, many prisoners receive little to no education about prenatal care, lack regular pelvic exams or sonograms, and don’t have the freedom to alter their diets to address their changing dietary needs.

Until the 2018 First Step Act outlawed the use of shackles on prisoners during pregnancy, incarcerated women in labor were typically transported to a hospital in shackles and gave birth shackled to a hospital bed. “The practice of shackling pregnant women and women in labor is principally a remnant of protocols designated for male institutions and is not based on genuine security concerns,” according to the AMA Journal of Ethics, as most women are incarcerated on non-violent charges.

When incarcerated women give birth, they are almost immediately separated from their newborn child. Fewer than a dozen states have nurseries in prisons, so typically babies are separated from their mothers within 24 hours after birth.

This creates deep emotional issues for the mother and impacts the child’s health and well-being. Incarceration also affects a mother’s ability to breastfeed, which can impact mother-infant attachment, post-partum depression, and psychological benefits for both mother and child.

Incarcerated women often face sexual harassment, assault, and rape from fellow inmates, as well as prison guards. Correctional officers can use their position of power to control incarcerated women; for example, guards sometimes coerce women into sex in exchange for menstrual products or contact with their children. Sexual violence in correctional facilities can also come under the guise of reproductive health services, like pelvic or breast exams.

Most women who give birth while incarcerated are pregnant when detained, but some prison births are the result of rape by prison guards. According to federal law, consent cannot be freely given between prisoners and prison guards, as guards have complete control over an inmate’s life.

However, it is known that rape and sexual assault in prisons is common partly due to the dehumanization of female prisoners.

There remains much work to be done to ensure that incarcerated women’s reproductive needs are met. Experts recommend further research to better understand incarcerated women’s experiences accessing abortion and other health services, the establishment of standard policy guidelines to improve the overall health of incarcerated women, and increased education within the correctional system about incarcerated women’s legal rights in order to protect their reproductive rights and justice.