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How do prisons treat their pregnant inmates?

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As a record number of women enter prison, many states are failing to provide adequate medical care to pregnant inmates and even shackling some women during delivery, according to a new report by the Rebecca Project for Human Rights and the National Women's Law Center.

California did better than most states – receiving an overall B grade on the report card, placing it among the top five states. In the three categories the report examined [PDF] – prenatal care, shackling polices and family-based treatment as an alternative to incarceration – California was given a C, B and A, respectively. Only one state, Pennsylvania, received an overall A-minus.

Since the introduction of mandatory sentencing to the federal drug laws in the mid-1980s, the number of women in prison nationwide has risen by 400 percent, according to the report. In California, the number of incarcerated women in California rose from 1,232 in 1979 to 10,812 in 2009, according to the California Department of Corrections and Rehabilitation.

Barry Krisberg, a fellow at the UC Berkeley Center for Criminal Justice and former president of the National Council on Crime and Delinquency, said about this new report: “What these people did is look at what's going on at the state level, and really the unfinished story is at the county level.”

So how is California really doing in practice?

The report gave California a C for its policies on prenatal care, commending its medical examinations, prenatal nutrition counseling and availability of HIV testing. It deducted points for the state's lack of screening and treatment of high-risk pregnancies, planning for deliveries, and reporting on pregnancies and their outcomes. 

A 2006 investigation [PDF] of the health care delivery system for women imprisoned in California by the National Council on Crime and Delinquency noted that:

Stakeholders also report horrible prenatal care. Some pregnant women, of whom many are considered high risk, do not see obstetricians nor do they receive sonograms. Concerns such as high blood pressure, lack of fetal heartbeat and vaginal bleeding are are often ignored.

Ronald Babcock, captain of the Women and Children's Service Unit at the state Department of Rehabilitation and Corrections, said prenatal care at the facilities is excellent.

“They get some of the best health care they've ever had in their life. They're given the information about pregnancy, they get pregnancy coaching classes, and are continuously monitored. We don't take any risks.”

Shackling during labor and delivery

The report gave California a B for its policies on shackling. California passed a statute in 2005 prohibiting the use of restraints during labor and delivery. However, the report notes that the Department of Corrections does not require each incident involving restraints to be reported.

And in March 2010, Legal Services for Prisoners with Children found that less than a third of California's 58 counties are in compliance with the 2005 law.

Babcock, the department of corrections captain, said women are rarely shackled in state facilities. “Hurting herself, an unborn child or another person – that would be the only way we would shackle. It's common sense. A lot of pregnant women don't have good balance."

On Sept. 27, Gov. Arnold Schwarzenegger vetoed AB 1900, which would have ordered county jails and prisons to stop shackling pregnant women during transportation.

“This bill had so much support – Democrats and Republicans, law enforcement, medical groups – that the only real reason I could think of that this bill was vetoed ... was a bureaucracy getting in the way of pregnant women in California,” said Alicia Walter, a consultant who worked with ACLU-Northern California to pass the bill.

Carolyn Sufrin, an obstetrician-gynecologist at UCSF and the San Francisco County Jail, wrote in a recent op-ed in the San Francisco Chronicle that the current law, which prohibits the shackling of pregnant women only during labor, "puts correctional officers in a difficult position, making judgment calls about the beginning of labor without adequate information." She added:

The result can be doctors and correctional officers negotiating over the removal of shackles, and it takes time and attention away from the laboring mother and her baby.

Lt. Mark McCorkle of the Los Angeles County Sheriff's Department said their policies are already in line with the failed AB 1900 legislation.

Karen Shain, policy
 director of Legal Services for Prisoners with Children and a sponsor of the bill, said while "it's true that California is probably in a better situation than other states," advocates were hoping the state "could actually go a little further."

Family-based treatment

California received an A for its family-based treatment alternatives to incarceration. There are currently five facilities in California (San Diego, Sante Fe Springs, Fresno, Bakersfield and Pomona) that enable incarcerated women to continue living with their children while serving time. The contract for the Oakland location for the Community Prisoner Mother Program recently expired and was not renewed due to the budget crisis.

Michael Sumner, research manager at UC Berkeley's Thelton E. Henderson Center for Social Justice, said California generally does family-based treatment programs well. The only issue, he said, is that there aren't enough.

"I think the number of spots they have is 100, 140 tops. If you look at the entire pool of incarcerated mothers, it's a very small percentage" who are able to participate, he said.

Babcock, with the department of corrections, noted that such programs are voluntary for jailed mothers. "For the women who are interested," he said, "we are meeting the request level."



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