pregnant and imprisoned in the united states

266 BIRTH 27:4 December 2000

Pregnant and Imprisoned in the United States

Amnesty International

ABSTRACT: This article is excerpted from a report by Amnesty International, entitled‘‘Not Part of My Sentence’’: Violations of the Human Rights of Women in Custody, March1999. The article describes violations of the human rights of pregnant women and motherswho are incarcerated in prisons and jails in the United States. Many of the practicesemployed are not in compliance with international standards and are also prohibited byfederal and state laws in the United States. In 1997–1998, more than 2200 pregnant womenwere imprisoned and more than 1300 babies were born in prisons. In at least 40 states,babies are taken from their imprisoned mothers almost immediately after birth or atdischarge from the hospital. International standards restrict the use of restraints to limitedsituations. Restraints are used as a matter of course in the United States, including onwomen in labor or immediately after birth, who may be taken to a hospital in handcuffsand chained by a leg to the bed. Amnesty International calls for governments and authoritiesto take urgent action that will ensure that the laws, regulations, policies, and practices forwhich they are responsible rigorously conform to international standards and respect thehuman rights of women deprived of their liberty. (BIRTH 27:4 December 2000)

Violations of the internationally guaranteed human human rights standards articulate the criteria againstwhich the conduct of the authorities of any nation,rights of incarcerated women in the United States have

been reported by Amnesty International in a 1999 pub- including the United States, should be measured.The United States made a significant contributionlication, ‘‘Not Part of My Sentence’’: Violations of the

Human Rights of Women in Custody (1). This article to the development of the international standards andmechanisms of human rights protection. However, itexcerpts portions of the report that describe the treat-

ment and experiences of mothers behind bars, and of has declined to ratify key human rights treaties, hasreserved the right not to implement important provi-women prisoners who are about to give birth.

During the last 50 years, the international commu- sions of treaties that it has ratified, and has refusedto permit people within the United States to bringnity has adopted a number of standards and mecha-

nisms to protect the human rights of individuals in complaints about alleged violations of their humanrights to international monitoring bodies (2).relation to the governments within whose jurisdictions

they reside. The standards are based on the precept In relation to women, the most striking instance ofUnited States resistance to international human rightsthat human rights are universal and an international

responsibility, not simply an internal one. International commitments is its failure to ratify the Convention onthe Elimination of All Forms of DiscriminationAgainst Women. This Convention includes several

Amnesty International is a nongovernmental organization that col- rights and freedoms that are of particular importancelects and disseminates information of a variety of human rights to incarcerated women, including the right not to beissues worldwide.

subjected to gender-based violence. It also upholds theright to health care services. International standardsThis article contains material from an Amnesty International report,

‘‘Not Part of My Sentence’’: Violations of the Human Rights of specify that medical care must be provided wheneverWomen in Custody, March 1999. It is copyrighted by Amnesty

necessary, free of charge.International, and material from it is used with permission. Thefull report can be ordered from Amnesty International USA at the In addition, with respect to incarcerated peopleaddress below. many human rights requirements are contained in stan-

dards that have been adopted by the international com-Address correspondence to Amnesty International USA, 322 EighthAvenue, New York, NY 10001; http://www.amnestyusa.org. munity. Although the United States played a major

267BIRTH 27:4 December 2000

part in drawing up the standards and agreed that they than half of the states offer community-based facilitiesthat allow mothers to live with their children whileshould be adopted, it has failed to ensure the implemen-

tation of some provisions by its jails and prisons. This serving all or a portion of their sentence or part oftheir parole immediately after release (6).reluctance to fully accept international human rights

treaties and standards denies women in the United Many women are pregnant when they enter jailand prison. In 1997–1998, more than 2200 pregnantStates rights and protections that many other govern-

ments around the world have agreed to recognize. women were imprisoned, and more than 1300 babieswere born in prisons (7). In at least 40 states, babiesare taken from their imprisoned mothers almost imme-Profile of Incarcerated Womendiately after birth or at the time the mother is dis-charged from hospital (7). The exceptional states areIn 1997, about 138,000 women were in jails and pris-California (6 community facilities where mothers andons in the United States (3,4), more than three timesinfants can remain from birth until the end of incarcera-as many as those women incarcerated in 1985. Fortion); Illinois (residential program for 15 qualified in-over a decade, the rate at which women are beingmates for up to 24 mo); New York, Nebraska, andincarcerated has been increasing far faster than that ofSouth Dakota (where a woman may keep her baby formen. Women are in prisons and jails primarily forup to 12 mo, 18 mo, and 30 days, respectively).nonviolent crimes and have far less violent criminal

The federal Bureau of Prisons program, Mothershistories than incarcerated men. The main type ofand Infants Together, allows low-risk pregnant womencrime for which women have been incarcerated into be placed in the community-based program beforerecent years is violation of laws prohibiting the posses-delivery. The mother can remain for 3 months withsion or sale of specified drugs. Compared with theirthe baby after delivery.number in the general population, black and Hispanic

Many women’s prisons are located far from wom-women form a disproportionately large segment ofen’s homes, making it difficult for them to maintainincarcerated women. The rate of imprisonment ofcontact with their families. For some, this loss of con-black women is more than eight times that of whitetact may mean termination of their parental rights. Thewomen; the rate of imprisonment of Hispanic womenimpact of incarceration on families as a whole and onis nearly four times that of white womenthe individual family members, particularly parentsAbout 78,000 women, who have generally beenwho are primary caretakers and their children, is atsentenced to imprisonment for more than a year, arethe very least disruptive and commonly traumatic (8).in federal and state government prisons. They make

In 1993 the U.S. House of Representatives pub-up 6.4 percent of the prison population of the Unitedlished findings of research on the harm of separationStates. County and city jails hold around 60,000and the benefits of maintaining family ties (9). It notedwomen, who are mainly awaiting trial or have beenthat many infants who are born shortly before or whilesentenced to relatively short terms of imprisonment.their mothers are incarcerated are quickly separatedThey constitute about 10 percent of the jail population.from their mothers, preventing the parent-child bond-The number of women incarcerated in prisons and jailsing that is crucial to developing a sense of securityin the United States is approximately 10 times moreand trust in children (9).than the number of women incarcerated in western

Federal legislation specifying that nearly $20 mil-European countries, whose combined female popula-lion could be spent on the establishment of projectstion is about the same size as that of the United States.in the period 1996–2000 to promote the maintenanceof family ties between incarcerated parents and theirMothers Behind Barschildren was passed in 1994. Since the law was en-acted, the U.S. Congress has failed to appropriate anyMore than 80,000 women in prisons and jails are moth-money to implement the legislation.ers, and they have approximately 200,000 children

under age 18 years. In 1990 the Eighth United NationsUse of Restraints on Pregnant InmatesCongress made the following recommendation (5):

The use of imprisonment for certain categories of offenders, Jails and prisons around the United States commonlysuch as pregnant women or mothers with infants or small

use restraints on incarcerated women when the womenchildren, should be restricted and a special effort made toare being transported to and kept in hospital, regardlessavoid the extended use of imprisonment as a sanction for

these categories. of whether they have a history of violence (only aminority have). Some authorities in the United States

All states have laws permitting the termination of pa- use chains or leg irons, restraints that are expresslyprohibited by international standards, as described byrental rights of parents who are incarcerated. Fewer


I was given an epidural, and I carefully moved into aRule 33 of the United Nations Standard Minimumsitting position while dealing with the leg iron. While theRules for the Treatment of Prisoners, which specifiesneedle was still in my back, I felt a strong contraction and

that ‘‘chains or irons shall not be used as restraints.’’ I knew that the baby was coming. When I told the nurse,Amnesty International has received reports of cases she told me not to push and said that the baby wasn’t coming

yet. I asked for the doctor and worked the leg chain aroundwhere a doctor was not present to request the removalso that I could lay down again.of restraints in circumstances where approval would

The doctor came and said that yes, this baby is cominggenerally have been given, or a guard with a key wasright now, and started to prepare the bed for delivery. Because

not immediately available. I was shackled to the bed, they couldn’t remove the lowerpart of the bed for the delivery, and they couldn’t put my

Illinois feet in the stirrups. My feet were still shackled together, andI couldn’t get my legs apart. The doctor called for the officer,but the officer had gone down the hall. No one else couldWarnice Robinson, imprisoned in Illinois for shoplift-unlock the shackles, and my baby was coming but I couldn’ting, described her experience giving birth as a prisoneropen my legs.

(10): Finally the officer came and unlocked the shackles frommy ankles. My baby was born then. I stayed in the deliveryGiving birth while incarcerated was one of the most horri-room with my baby for a little while, but then the officerfying experiences of my life. While enduring intense laborput the leg shackles and handcuffs back on me and I waspains, I was handcuffed while being taken to the hospital,taken out of the delivery room.even though I was in a secured vehicle with a metal grating

I was in the hospital for about three days, with one handbetween the driver’s and passenger’s compartments and withand one foot shackled to the bed. There was a heavy blueno interior door handles on the passenger doors. With thebox connecting the cuff with the bed, which left me no roomhandcuffs on, I could not even hold my stomach to get someto move. My handcuffs were removed when I was eatingcomfort from the pain. . . At the hospital I was shackledor holding my baby, but the leg irons were always on. Myto a metal bed post by my right ankle throughout 7 hoursleg was disconnected from the bed only when I used theof labor, although a correctional officer was in the roombathroom. Otherwise I was handcuffed and shackled, withwith me at all times. The shackles were not removed until 30one hand and one foot shackled to the hospital bed. Sinceminutes prior to my delivery. . . . Imagine being shackled toI went back to the jail, every visit with my baby has beena metal bedpost, excruciating pains going through my body,through the glass. I have not been permitted to hold myand not being able to adjust myself to even try to feel anybaby since my release from the hospital.type of comfort, trying to move and with each turn having

hard, cold metal restraining my movements. Not only wasthis painful, it was traumatizing, and very stressful for myself In March 1998 the Illinois Department of Correc-and also for my child. . . . Even animals would not be tions informed Amnesty International that all pregnantshackled during labor, a household dog or a cow on a

prisoners were restrained when being transported tofarm. . . . The birth of a child is supposed to be a joyoushospital and kept in restraints while in hospital, evenexperience, and I was robbed of the joy of my daughter’s

birth . . . Is it really necessary to handcuff and shackle when in labor, unless a doctor asked for them to bemothers who are in labor? With all the other security mea- removed and a correctional officer approved. Duringsures that were in place, and with my minimum security 1998, legislators drafted proposed laws to prohibit thestatus, did they really have to put me and my infant through

use of restraints on pregnant women when they werethat torture?being transported and in hospital, and on women inhospital after giving birth. In January 1999 the IllinoisAmnesty International received the following state-Department of Corrections informed Amnesty Interna-ment from Maria Jones (not her real name), a recenttional that it was preparing a new policy to stop theinmate of Cook County jail in Illinois. Ms. Jones wasuse of restraints on pregnant women while being trans-charged with violating drug laws and stated that sheported and in hospital. The policy will apply only tohad never tried to escape or been charged with a violentprisons. It will therefore not apply to Cook Countyoffence or been classified as dangerous. Nevertheless,jail, a report of which was described earlier.she was always placed in handcuffs and leg shackles

when she was taken from the jail to hospital for prenatalNew Yorkcare and to give birth, as she described:

I told the nurse that my water broke, and the officer tookAmnesty international received reports that six womenoff the handcuffs so that I could put on the hospital gown.were restrained while in hospital waiting to give birthI was placed on a monitoring machine with the leg shackles

still on. I was taken into the labor room and my leg was in New York City in 1998, despite the fact that noneshackled to the hospital bed. The officer was stationed just had a history of violence or had attempted to escapeoutside the door. I was in labor for almost 12 hours. I asked from custody. The policy of the New York City Depart-the officer to disconnect the leg iron from the bed when I

ment of Corrections prohibits the use of restraints onneeded to use the bathroom, but the officer made me usepregnant inmates admitted to hospital for delivery ‘‘un-the bedpan instead. I was not permitted to move around to

help the labor along. less the inmate attempts to escape at the hospital or


the inmate engages in violent behavior at the hospital Prison officials took them through a ward wherewomen are held when they are seriously ill or in laborwhich presents a danger of injury’’ (11). According

to the reports, one of the women gave birth while and for a short period after giving birth. The ward islocked. Inside the ward are four armed guards. Yet thehandcuffed to her bed in the labor room, unattended,

screaming for assistance. Another was put into hand- leg of every woman is chained to her bed. A womanshowed the delegates her shackle. She could lie oncuffs while labor was being induced. The report about

one mother’s experience continued: her side but she could not roll over. Prison officialsexplained that the shackle is removed only if a doctor

They took the handcuffs off when the baby was about to beinforms them that it is interfering with medical treat-born. After the baby was born she was shackled in thement or is injurious to a woman’s health.recovery room. She was shackled while she held the baby.

Had to walk with shackles when she went to the baby. Sheasked the officer to hold the baby while she went to pick Michigansomething up. The officer said it was against the rules. Shehad to maneuver with the shackles and the baby to pick up

Women who gave birth while in prison in Michiganthe item. In the room she had a civilian roommate and thetold Amnesty International in October 1998 that theyroommate had visitors and she had to cover the shackles,

she said she felt so ashamed. . . . She said she was trauma- were transported to the hospital secured by belly chainstized and humiliated by the shackles. She was shackled when and handcuffs, and were kept in restraints at the hospi-she saw her baby in the hospital nursery (a long distance tal even though they were constantly supervised byfrom the room). Passing visitors were staring and making

prison guards. One woman reported that she was hand-remarks. She was shackled when she took a shower; onlycuffed to the hospital bed until she was close to deliv-one time when she was not.ery, and that the cuffs were removed at the request ofa doctor. A second woman reported that, at the hospital,Ohioher legs were chained together until shortly before shegave birth. She told Amnesty International that theIn Ohio the state correctional authority informed Am-

nesty International that pregnant inmates are scheduled restraints were removed at the request of a doctorand only after the guard had obtained approval byto deliver their babies at the Ohio State University

Hospital and ‘‘are treated as any patient would be telephone from a superior officer. Both women re-ported that they were cuffed to their beds shortly aftertreated regarding procedures during labor and child-

birth. The exception is one arm or leg is secured to giving birth. In November 1998, Detroit City Councilpassed a resolution calling on state governor to banthe bed during labor unless the doctor requests the

restraints be removed. During delivery, there are no the use of restraints on pregnant women before andduring labor. The head of the Michigan Departmentrestraints on the inmate’’ (emphasis added) (12).of Corrections has stated that he was not aware of

Massachusetts cases where prisoners who were shackled while givingbirth (15). Amnesty International is seeking a detailed

In Massachusetts the policy of the correctional author- account of the department’s policy.ity provides that during their second and third trimester,pregnant inmates are to be transported to hospital only Concerns About Use of Restraints forin handcuffs. The policy prohibits the use of restraints Women in Laboron inmates in hospital who are in active labor unlessthey are disruptive (13). The use of restraints on women who are pregnant and

women who are ill is part of a pattern of the use ofKentucky restraints in prisons and jails and by police agencies

that Amnesty International considers constitutes cruel,In contrast, the policy of the Kentucky correctional inhuman, and degrading treatment in contravention ofauthority is that pregnant inmates may not be restrained international standards. The use of restraints on womenfrom the time they enter labor and the delivery area who are about to give birth endangers the woman anduntil they leave the recovery room. However, after her child, according to physician Dr. Patricia Garcialeaving the recovery area, ‘‘one leg may be restrained’’ (16):(14).

Women in labor need to be mobile so that they can assumevarious positions as needed and so they can quickly beCaliforniamoved to an operating room. Having the woman in shacklescompromises the ability to manipulate her legs into the

On November 18, 1998, Amnesty International dele- proper position for necessary treatment. The mother andbaby’s health could be compromised if there were complica-gates visited Madera County Hospital in California.


tions during delivery, such as hemorrhage or decrease in of restraints should be monitored to ensure strict com-fetal heart tones. If there were a need for a C-section, the pliance with policies.mother needs to be moved to an operating room immediatelyand a delay of even five minutes could result in permanent • • •brain damage for the baby. The use of restraints creates ahazardous situation for the mother and the baby, compro-mises the mother’s ability postpartum to care for her baby Human rights groups and health professional bodiesand keeps her from being able to breastfeed. consider that inadequate health care is one of the most

pressing concerns in United States prisons and jails.Amnesty International welcomes the fact that a grow- Ellen Barry, a noted attorney, who has representeding number of corrections departments acknowledge many women prisoners in legal action on healththat special attention is required for pregnant prisoners. care matters, observed, ‘‘medical conditions forIn a recent national survey, 20 of the 52 state, city, women in United States prisons and jails are appall-and federal corrections departments that responded re- ingly bad. . . .’’ (19). Amnesty International calls onported that they have specific policies or procedures federal, state, and local governments and authorities tofor the physical control and transportation of pregnant take urgent action to ensure that the laws, regulations,inmates (17). In 38 systems, medical personnel are policies, and practices for which they are responsibleinvolved in evaluating individual cases prior to the rigorously conform to international standards and re-restraint of pregnant women. However, policies for spect the human rights of women deprived of theirpregnant women that Amnesty International has seen liberty.still permit the routine use of restraints without consid-eration of their necessity. References

In October 1998, Amnesty International wrote tothe U.S. Attorney General, Janet Reno, requesting an

1. Amnesty International. ‘‘Not Part of My Sentence’’: Violationsinquiry into the use of restraints on pregnant women of the Human Rights of Women in Custody. New York: Author,prisoners. The letter was referred for response to the 1999. Order from Amnesty International USA, 322 Eighth

Avenue, New York, NY 10001; www.amnestyusa.org; costsection of the U.S. Department of Justice that is respon-$11.95 plus $3.00 postage.sible for enforcing federal criminal civil rights laws.

2. Amnesty International. United States of America: Rights forThe chief officer of the section informed AmnestyAll. AI Index: AMR 51/35/98, ch 7.

International that the section was unable to authorize 3. Galliard D, Beck A. Prison & Jail Inmates at Midyear 1997.an investigation because the information concerning Bureau of Justice Statistics Bulletin. Washington, DC: U.S.

Department of Justice, 1997.shackling ‘‘does not disclose a prosecutable violation4. Mumola C, Beck A. Prisoners in 1996. Bureau of Justiceof federal criminal civil rights statutes’’ (emphasis

Statistics Bulletin. Washington, DC: U.S. Department of Jus-added) (18). Amnesty International acknowledges thattice, 1997.

the routine use of shackles on pregnant women does 5. Report of the 8th UN Congress on the prevention of Crimenot violate criminal laws. It considers that an inquiry is and Treatment of Offenders. UN Doc. A/Conf.144/28, rev1

(91.IV.2), Res 1(a), 5(c), 1990.warranted because the practice violates internationally6. Pollock J. Parenting Programs in Women’s Prisons. Unpub-recognized human rights standards that the United

lished study. Open Society Institute, Center on Crime, Com-States should respect.munities and Culture, New York, 1999.

7. Inmate Health Care, Part II. Corrections Compendium 1998;Recommendations on the Use of Restraints 23(1).

8. Gabel K, Johnston D, eds. Children of Incarcerated Parents.New York: Lexington Books, 1995.Amnesty International recommends that jails and pris-

9. Title XLI—Family Unity Demonstration Project, forming partons adopt policies on the use of restraints that are in of the Violent Crime Control and law Enforcement Act ofaccord with international standards. Restraints should 1993, HR 3355.

10. Robinson W. Address in Washington, DC, Oct 6, 1998, atbe used only when they are required as a precautionthe launch of Amnesty International report, United States ofagainst escape or to prevent an inmate from injuringAmerica—Rights for all. AI Index:AMR 51/35/98.herself or other people or damaging property. In every

11. City of New York Department of Corrections. Directive 4202,case, due regard must be given to an inmate’s history June 19, 1989.and physical condition. Restraints must never be used 12. Jones L. Letter to Amnesty International from Human Services

Administrator, Ohio Department of Rehabilitation and Correc-as punishment. Policies on the use of restraints shouldtion, Mar 26, 1998.prohibit their use on pregnant women when they are

13. Saltzman W. Letter to Amnesty International from Seniorbeing transported and when they are in hospitalLitigation Attorney, Massachusetts Department of Correction

awaiting delivery, on women who have just given birth, with departmental policy, June 11, 1998.and on seriously sick inmates when they are being 14. Million G. Memorandum from Deputy Warden/Security, Feb

1, 1996.transported to and when they are in hospital. The use


15. McGinnis KL. Letter to Amnesty International from the Direc- 18. Mott J. Letter to Amnesty International from Acting SectionChief, Criminal Section, Civil Rights Division, U.S. Depart-tor, Michigan Department of Corrections, Nov 1, 1998.

16. Garcia P. Statement made to Amnesty International by Chi- ment of Justice, Oct 22, 1998.19. Barry E. Women prisoners and health care. In: Moss K, ed.cago Legal Aid to Incarcerated Mothers, Chicago, Dec, 1998.

17. U.S. Department of Justice National Institute of Corrections Man-made Medicine. Durham, NC: Duke University Press,1996:250.Information Center.Current Issues in theOperation ofWomen’s

Prisons. Colorado: National Institute of Corrections, 1998.

pregnant and imprisoned in the united states

Documents