Introduction
Women are the fastest-growing portion of the prison population. While there are more men in prisons than women, women have been incarcerated at much faster rates. Since 1978 women's state prison populations grew 834%, which is more than double the rate of men's prison population. Specifically in Georgia, women's state prison populations have increased by 715%, compared to around a 370% increase for men's prison population.
Most women in prison are in their reproductive years, the age group that especially needs access to quality reproductive healthcare and pregnancy care. However, only 'half (54%) of pregnant women in prison reported receiving some form of prenatal care while incarcerated."
According to the US Bureau of Justice Statistics, 4 to 5% of women are pregnant when they enter a prison or jail facility. In some states, imprisoned women can become pregnant during private ("conjugal") visits with their husbands. Georgia does not allow conjugal visits, so imprisoned women in our state could become pregnant if allowed to attend work release programs, home visits, or other activities outside the prison. Also, women may become pregnant if raped by prison employees, but these traumatic incidences are not officially tracked or publicized.
As mass incarceration increases, the number of pregnant women incarcerated also rises. While the overall percentage of pregnant women in US prisons has remained pretty stable (between 6% to 10%), over 10,000 more pregnant women were imprisoned in 2019 than in the early 2000s.
Women of color are the most vulnerable to the rise in mass incarceration because they are disproportionally incarcerated. In 2017, the rate of imprisonment for Black women was twice the rate of white women imprisonment. Women of color and low-income women are also more likely to experience unintended pregnancies and therefore, need access to prenatal and/or abortion care.
Given the large scale and racial disparities of this issue, it is crucial that states and correctional facilities implement policies to protect the health of pregnant women in prisons.
Current laws and policies
Yet, medical prison policies are often hidden from public view. Legislators are not actively involved in crafting medical prison policy, and until recently (in 2019) Georgia had no laws specifically protecting the health of pregnant inmates. The Department of Corrections (DOC) develops medical policies behind closed doors, leaves medical decisions to prison administrators, or contracts medical services to external private companies (who are motivated by profit and not held accountable to the public). The section below explores the written laws regarding pregnant women's healthcare and medical services that are currently in place.
On the federal level, the 8th Amendment grants prisoners the right to medical care "for serious medical needs." However, there has been much debate in the courts on if pregnancy qualifies as a serious medical need. "Pregnancy alone," without complications, is not considered a serious medical need. Only once an imprisoned women's water breaks do the courts recognize their condition as a serious medical need that requires attention. This means prisons do not have to provide essential health services like prenatal check-ups, HIV testing, or high-risk pregnancies screenings. In addition, several cases determined that the 8th amendment does not extend to abortion care, deeming abortion not a serious medical need, but rather an "elective procedure," similar to a nose job or plastic surgery. These rulings ignore the advice of medical experts who state that accessible pregnancy and abortion care are part of "the standard care for women's health."
On the local level, Georgia does not have any written laws requiring prison facilities to provide specific medical treatment, access to abortions, or routine doctor visits for pregnant women. The Georgia Department of Corrections only has one publicly available policy that addresses pregnant women's healthcare - and it's only one line long. The Georgia DOC states "All female offenders will have access to reproductive and gynecological services."
Within the past year, the Georgia state legislature passed The Georgia Dignity Act, HB 345 in October 2019. This state law reverses decades of the inhumane and often dangerous shackling of pregnant women. The bill was spearhead by Pamela Winn, who lost her child due to the harmful conditions of her prison. Winn was pregnant when she entered prison but one day after being shackled and deprived of water, she fell - which caused her to begin miscarrying. She miscarried all night, woke up in a pile of blood, and did not receive any medical attention until 2 am after her fellow inmates continuously screamed for the guards. At the hospital, she was immediately shackled to a hospital bed, where she was examined by two unfamiliar male officers and watched helplessly as they threw away her baby in a trash can.
In response to Winn's story and countless others like hers, the 345 house bill adopts the following measures to provide basic safety and dignity to pregnant women in prisons:
- Pregnant women in 2nd & third trimester are not required to squat or cough during a strip search
- Pregnant women are not required to undergo vaginal examine by non-licensed professionals
- Prohibits shackling pregnant women in the second and third trimester and 6 weeks postpartum unless a threat to harm oneself or others or a flight risk (if restrained must fill out and report documents about the circumstances)
- Prohibits solitary confinement for pregnant women and immediate postpartum women
- Women temporarily in country jail and pending transfer to state penal institution will be transferred as quickly as possible
Inadequate care
Going Forward
Georgia has started to address the health of pregnant women in prison, but we have a long way to go to ensure pregnant women in prison receive access to quality pregnancy services, abortion care, and overall healthcare. Protecting women from basic cruelty measures, such as shackling, is only the first step to guaranteeing the dignity and safety of women in prisons. The Georgia legislature and the DOC needs to implement new regulations to fill the current gap in care for pregnant women in prisons, and these rules must be transparent and open to public oversight.
Georgia should introduce written policies for pregnancy health care in prisons that meets NCCHC, ACOG, APHA guidelines. These guidelines include routine prenatal medical examinations visits by licensed professionals, screening and treatment for high-risk pregnancies, HIV testing and treatment, and access to family planning services, abortion services, and postpartum contraception methods.
Expanding on The Georgia Dignity Act, Georgia DOC should implement specific policies that hold prisons accountable and ensure the law takes real effect. Specifically, policies could: require medical staff input considered when applying restraints, require reports of each use of restraints and have reports reviewed by an independent body, and administer consequences for individuals and/or institutions when the use of restraints was unjustified.
