Women, Incarcerated

by Sharona Coutts and Zoe Greenberg, RH Reality Check

Investigative Series Shows Systemic Abuses of Women in Prisons and Jails

Keeley Schenwar learned she was pregnant the same day she was arrested. That spring of 2013, she didn’t pee on a stick and study the results in the bathroom; there was no moment of elation. Instead, a nurse at the Cook County Jail in Chicago led Schenwar to a separate part of the facility, away from the other women. When Schen­war asked why, the nurse broke the news.

Schenwar, who was just 23 at the time, with warm brown eyes and glossy black hair, barely knew what to say. She had been struggling with a heroin addiction for more than five years. For the second time, she’d been caught stealing from a Walgreens – medicines, makeup, razors – anything she could sell to local corner stores to scramble together the $400 or $500 she needed to pay for her addiction.

She’d been in and out of county jails for years, but this time she was headed to state prison, and she was pregnant.

“I cried,” she told RH Reality Check. “I didn’t want to tell anyone I was in jail. I didn’t want to tell anyone I was pregnant.”

Over the course of her incarceration, Schenwar experienced two instances of human rights abuses linked to her pregnancy. She also joined the ranks of a growing group in the United States: women who are incarcerated.

While women make up a small share of all those detained in local, state and federal prisons and jails, their numbers are growing. The number of women in state and federal prisons jumped by 646 percent between 1980 and 2012 – from around 25,000 to more than 200,000 – one-and-a-half times the speed at which the incarceration for men increased during the same period. In 2012, more than 200,000 women were held in prisons or jails, according to The Sentencing Project, a D.C.-based nonprofit group that has tracked these issues for more than 25 years.

The surge in incarceration disproportionately affects women of color, according to The Sentencing Project. In 2010, Black women were incarcerated at nearly three times the rate of white women (133 versus 47 per 100,000), while Hispanic women were incarcerated at 1.6 times the rate of white women.

Experts told RH Reality Check that, because corrections systems were created with men in mind, the facilities, practices and policies remain ill-suited to the particular needs of women behind bars.

“There’s been a tremendous neglect of incarcerated women’s medical needs because, overall, they’re a small proportion of the incarcerated population: 9 percent of prisons, and 11 percent of jails,” said Dr. Carolyn Sufrin, assistant professor of gynecology and obstetrics at Johns Hopkins University.

In fact, federal, state and local officials charged with overseeing corrections facilities collect virtually no consistent data about how women are treated in a system made for men, RH Reality Check found in a five-month investigation.

The federal Bureau of Justice Statistics, when asked for a national count of corrections facilities that house women, could only provide RH Reality Check with data that was a decade old. It showed that in 2005, there were a total of 1,821 state, federal and privately run facilities, of which 187 facilities were authorized to hold only female prisoners, and 276 were authorized to house both males and females.

The dearth of information points to the invisibility of, and lack of concern for, incarcerated women, experts told RH Reality Check, and makes it difficult to determine how often abuses occur.

In our Women, Incarcerated series, we have detailed some of the major themes that emerged from our review of hundreds of lawsuits, public records requests and interviews with experts, public officials, and currently and formerly incarcerated women.

Our findings show the existence of deep, systemic problems in the way that the criminal justice system deals with women.

While some of the egregious abuses of incarcerated women are well known – shackling of pregnant women, and rampant sexual abuse in some facilities – RH Reality Check has identified a host of other problems that receive virtually no attention from mainstream media.

The problems include substandard conditions for pregnant prisoners; widespread failure to provide treatment or medical care for women with drug dependency, who comprise the overwhelming majority of women prisoners; frequent denial of care for women experiencing miscarriage; forced induction of birth; and, ultimately, the termination of women’s parental rights because of rigid federal and state laws ostensibly intended to protect children.

Like Schenwar, the majority of women behind bars are of reproductive age (the median age of incarcerated women in the United States is 34) and more than four-fifths suffer a serious substance abuse disorder, often related to prior trauma. The vast majority – 84 percent – are behind bars for non-violent crimes, usually related to their drug dependency or social marginalization, according to a 2012 report for the Bureau of Justice Assistance that surveyed nearly 500 prisoners in urban and rural jails in multiple states – one of the very few national studies of incarcerated women.

In other words, for women, incarceration frequently amounts to punishment for poverty, mental illness, addiction and abuse, experts said.

“We’ve seen a skyrocket in the prison population overall, and women have increased faster than men,” Amy Fettig, senior staff counsel at the ACLU’s National Prison Project, told RH Reality Check. “That’s a direct result of the fact that so many low-level offenders end up in prison or jail where previously they may have been diverted into the community, or had access to mental health care.”

Schenwar’s story is representative of many women’s experience in incarceration. In this first part of our Women, Incarcerated series, we focus on Schenwar’s prison time – which involved a high-risk pregnancy, forced induced labor and shackling – to illustrate the problems that thousands of women face behind bars.

Inadequate Food, Conditions for Pregnant Prisoners

As with many women who are incarcerated, Schenwar’s crimes were related to her drug dependency.

Her criminal record shows arrests for thefts, trespassing, a DUI and parole violations. Schenwar was living with her boyfriend at the time she was arrested, and he too was struggling with heroin.

After finding out that she was pregnant, Schenwar hoped to avoid going to prison. She reasoned that the judge would go light on her, due to her condition, and allow her to do community service. Instead, she was sentenced to a year at the Logan Correctional Center, a place where prisoners wear blue and white, but pregnant prisoners wear pink. Apart from that, the facility makes few accommodations for pregnant prisoners.

Even something as basic as food posed problems. In her four months of pregnancy during incarceration, Schenwar recalls being hungry “all the time.”

“When you’re pregnant, you want to eat,” Schenwar told RH Reality Check. “It wasn’t like I expected my craving foods to be delivered to my cell,” she said, but she needed more than the extra apple or egg and carton of milk that were provided to pregnant prisoners every day.

She also recalls that pregnant women, like all prisoners, had to walk through the open yard to access the mess hall, whether it was snowing or brutally hot.

The failure of corrections facilities to provide adequate food for pregnant prisoners emerged as a pattern across many states, our research found. Most recently, the Correctional Association of New York released a damning report, based on five years of interviews and legal research, revealing that New York’s state facilities were also failing to provide sufficient food and acceptable living conditions for pregnant prisoners. And Diana Claitor, executive director of the Texas Jail Project, told us that the lack of plentiful, healthy food is a frequent problem for pregnant prisoners in Texas as well.

Despite the inadequate food and conditions, Schenwar says she received good medical care while she was incarcerated. She recalls regular visits to an OB-GYN, and frequent ultrasounds. In fact, for many pregnant prisoners, incarceration affords them the first opportunity to receive prenatal care.

Schenwar is quick to explain that she wasn’t seeking sympathy. But she says that the guards reacted to her requests, and those of other pregnant prisoners, with demeaning comments.

“The officers judged us constantly,” she said. “If you would complain, they would say, ‘You put yourself here. You were doing drugs and pregnant. I don’t feel bad for you.’”

While at the prison, Schenwar maintained her use of methadone, as prescribed by her doctor. Abruptly ceasing opioid use is extremely dangerous during pregnancy, as it can lead to miscarriage. However, Schenwar’s methadone use created an unexpected complication: It disqualified her from transferring to the Decatur Facility, which has a nationally recognized prison nursery program that allows prisoners to stay with their babies for the first year of their lives. So Schenwar knew that she would be separated from her daughter as soon as she gave birth.

“You’re Not Going to ‘Fall Out’ in My Yard” – Forced Induction of Labor in Illinois Prisons

What most upset Schenwar was the prison’s decision to induce her labor when she did not want to be induced – an act that constitutes a human rights violation, experts told RH Reality Check.

At 5 a.m. in early September, Schenwar was on her way to the mess hall with the other prisoners.

“Schenwar, fall back,” she recalls one of the guards saying, as she walked behind the other prisoners heading to breakfast.

Two weeks earlier, the prison doctor had informed Schenwar that her delivery would be induced. Schenwar had tried to object, saying that her baby was not ready to be born, and that she wanted to wait until her labor started naturally. Inducing labor can be risky for mothers and their babies. Studies have shown induction to be associated with higher rates of cesarean sections, longer stays in the hospital and greater blood loss for women giving birth.

But, Schenwar says, the doctor made it clear that she did not have a choice, and when she still objected, she says the doctor called prison guards.

“I had three, maybe four, guards surrounding me saying, ‘I don’t know where you think you are. This is our prison.... You’re not going to fall out in my yard or in the mess hall and cause some kind of chaos,’” she said. “I was scared and I was having a baby and I was in prison. I went back to my cell and I cried, because I knew I would be alone.”

So, when guards told Schenwar to fall back, she thought she was in trouble. But instead guards told her it was time to give birth.

“They explained that because I was being induced that day, which I did not know, they said I could not eat,” she recalled in an interview with RH Reality Check.

When RH Reality Check first sought comment from the Illinois Department of Corrections in relation to Schenwar’s allegation of forced induction, Tom Shaer, who was then the director of communications, did not reply to our specific questions, but wrote in an email, “Inmate anecdotes are often either wholly inaccurate or grossly exaggerated. Not always, but often.”

This notion – that prisoners, and especially women prisoners, are liars – permeates the dozens of cases we reviewed where prisoners suffered miscarriages, still-births and even deaths. While there are undoubtedly instances of false allegations, time and again prisoners’ allegations have been borne out in litigation and federal investigations.

Shaer has since left the department, and his replacement, Nicole Wilson, told us in an email that induced births are an “option” for prisoners:

“Pregnant prisoners consult with their physician on nutrition and birthing options to make decisions that best meet each individuals’ needs. Offenders whose pregnancies are deemed high risk are encouraged to elect induction so they can be transferred to Bloomington where the hospital can meet their specific needs for a safe delivery.” [sic]

In a later email, Wilson changed her stance, saying instead that Schenwar’s methadone treatment meant she was deemed to be a high-risk patient, and that the “decision to induce would have been made by the OB/GYN and would have been made for the benefit of both mother and baby.”

Wilson said that Schenwar had not signed a “refusal of treatment,” which, Wilson said, was offered to prisoners who did not want their births induced.

However, RH Reality Check was able to speak with Kendra Smith, who was also pregnant while incarcerated at Logan. Smith recounted that guards also tried to force her to induce her delivery, but she resisted, involving the warden and the prison’s family services officer. Smith said she recalled similar pressure being put on a third pregnant prisoner incarcerated at Logan.

According to Gail Smith, founder of Chicago Legal Advocacy for Incarcerated Mothers (CLAIM), the Illinois Department of Corrections seems to have initiated a practice of requiring incarcerated women to have induced labor.

“Every woman that I have spoken with after release who has given birth inside in the past year has been induced,” Smith told RH Reality Check.

In a close examination of cases involving the shackling of incarcerated pregnant women, RH Reality Check found hints that induction may be a standard practice at corrections facilities in other states as well.

Farah Diaz-Tello, a staff attorney at National Advocates for Pregnant Women, told RH Reality Check that forced induced labor constitutes clear human rights violations of pregnant prisoners.

“Any forced induced labor is a human rights violation, even if the pregnant person isn’t incarcerated, because people have a fundamental human right to bodily integrity and to refuse unwanted medical intervention,” she said.

Diaz-Tello said that the stories from Illinois are consistent with what her organization has been hearing from other states. For instance, she said that she had worked with a Texas woman who was forced to undergo a cesarean section while incarcerated, because the doctor was only scheduled to be at the facility for one day.

“The fact that it is happening in prison, where people are even more deprived of power than in a medical institution – that makes it even worse,” Diaz-Tello said.

“All Female Inmates are an Escape Threat”

In addition to the forced induction, Schenwar described a lonely and traumatic labor, during which she was shackled to the hospital bed.

“There’s a guard on the couch reading magazines as your whole life is torn apart,” she said. “They don’t let any family come. After you have the baby, they shackle you to the bed at their discretion. You hold your baby and then they take her and you go back to prison.”

At the time, Illinois still had an official policy that allowed prisoners to be shackled as soon as they were “no longer pregnant,” said Wilson, the corrections department’s spokesperson. That policy was changed in November 2013 so that “inmates who’d recently delivered a child could also go unrestrained for a pre-determined period of time.”

Despite media attention to the issue, shackling of pregnant prisoners remains common, with the majority of states still permitting the barbaric practice. Even in states where shackling is theoretically banned, local activists and incarcerated women say legal loopholes mean that many pregnant prisoners still find themselves bound in metal chains during transportation to the hospital, and after birth.

For instance, the 2009 law that barred the use of restraints on pregnant prisoners in Texas contains an exception for women deemed to be a flight risk, but doesn’t define what exactly that means.

At a 2012 meeting of the Texas Commission on Jail Standards, a commissioner “spoke publicly about his belief that all female inmates are an escape threat and that therefore the exception to the bar on use of restraints would always apply,” according to a letter drafted to the commission’s chairwoman by then-state Sen. Wendy Davis. (RH Reality Check obtained a draft of the email).

In other words, even women in active labor and birth should be seen as escape threats.

Diana Claitor of the Texas Jails Project told RH Reality Check that better monitoring of each incident of shackling is required to ensure the law is being properly enforced.

The emotional impact of shackling, including post-partum depression, can be profound, Claitor said.

“You suddenly feel yourself in the position of being rolled around like a piece of garbage chained to a table, and the other women there [at the hospital] shrink away in horror that you’re some kind of crazed animal that has to be shackled.”

The experience of being pregnant in prison, forcibly induced and ultimately shackled during delivery certainly left Schenwar with a sense of shame.

Her journal from October of that year – a month after her daughter was born – shows the young woman’s regret at the situation she was in.

“You held my hand just a few hours after I gave birth, wrapped your fingers tightly around my thumb and I knew as you focused your eyes on mine without turning away that I’d love you in every way, each day for the rest of eternity,” Schenwar wrote. “I tried not to sleep, knowing we only had a short time together. Shackles tied my ankles to the hospital bed. You’re the daughter of a prisoner, twice convicted felon, all result of a heroin conviction.”

“I’ll spend the rest of my life making this up to you,” she wrote.

Schenwar was released from prison in 2014, and is now sober. She is successfully caring for her daughter, as well as working with other mothers who have recently been released from prison or jail.

“Just because you’ve been to prison three or five times, doesn’t mean you have to go back,” she said. “People get past it, and they have careers and they have lives and they have families.”

Deprived of Care, Incarcerated Women Suffer Miscarriages, Stillbirths, Ectopic Pregnancies

On the morning of September 11, 2011, Krystal Moore thought she was dying. Sharp pain stabbed at her stomach, so much so that she curled up into a fetal position on her bed. She didn’t know what was happening. Though she was pregnant, she was only six months along, not nearly ready to give birth.

She couldn’t simply call the family doctor. She was a prisoner, serving time at the Jerome Combs Detention Center in Kankakee, Illinois, for smoking marijuana while on probation. But in the early hours of that Sunday morning, her pain was escalating quickly.

“I woke up hurting,” she told RH Reality Check. “I tried to get in the shower, and I couldn’t.”

She asked to go the hospital. She had spoken to some other prisoners, and she began to think she was having contractions. The pressure on her stomach was getting worse.

A guard telephoned the jail nurse, Ivetta Charee Sangster, to tell her that Moore was having stomach pains. Sangster was on duty that Sunday, though she wasn’t actually at the detention center, which, like many jails, doesn’t have full-time medical staff available, despite housing a sick and vulnerable population. Even if Sangster had been there, she was only a licensed practical nurse, a role that generally involves providing only very basic medical care, like taking a patient’s blood pressure or changing a bandage. She would not have been able to give Moore the urgent care she required for what had become a serious infection of her womb.

Sangster sounded irritated on the phone, according to the transcript of the call that later appeared in a lawsuit filed by Moore.

“Krystal Moore, she’s – in my opinion, a lot of times she’s full of shit,” Sangster told the guard. “You can go eyeball her and call me back if you want. She’s probably full of shit. But you can let her know that she can see the doctor tomorrow if she’d like.”

Our attempts to contact Sangster were unsuccessful.

By 2:30 that afternoon – at least eight hours since she first alerted guards to her pain – Moore began bleeding while sitting on a toilet. Screaming out of pain and fear, she was finally taken to a local hospital, but not before being forced to walk down the stairs from her cell to the ambulance, according to a court opinion from December 2013.

Moore was fully dilated by the time she arrived at the hospital, where she says she was shackled to the hospital bed. Then, around 5:20 p.m., she gave birth to twins. Had she been taken to hospital earlier, there was a possibility that the babies could have survived, according to an expert who provided evidence for the lawsuit. Instead, one baby lived for only a day; the other survived for 16 days.

“I remember it clear as yesterday. I think about my twins every day and every night. How would they be?” Moore said.

Moore’s case settled last year for $620,000, according to her lawyer. But in a five-month investigation, RH Reality Check found that her story is not unique. After reviewing more than 200 legal cases, as well as the Human Rights Defense Center’s database of “Deaths in [Corrections Corporation of America] Custody,” RH Reality Check identified at least a dozen instances of women experiencing miscarriages, stillbirths and ectopic pregnancies in jails and prisons across the country, in circumstances that show a shocking lack of medical care from the professionals charged with providing it.

This number is most likely a dramatic under-representation of the problem. In addition to the shame and grief that many women feel at the loss of a pregnancy, incarcerated women often fear complaining about their miscarriages behind bars because they do not want to compromise ongoing cases or face retribution from jail or prison staff, according to community activists and researchers who work closely with incarcerated women.

To be sure, low-quality prenatal care is a symptom of the larger problem of poor medical care in corrections facilities in the United States, as has been documented in California, Arizona and Florida and through thousands of lawsuits against prisons and the private contractors that sometimes run them.

Prison health services were so bad in the 1960s and 1970s that in 1976 the U.S. Supreme Court ruled that failure to provide appropriate medical care to prisoners amounted to a violation of the U.S. Constitution’s prohibition on cruel and unusual punishment. As a result, incarcerated people are the only group in the United States with a constitutional right to medical care.

But with the swelling number of women behind bars, the failure to provide prenatal care is becoming a major concern.

The cases we examined were strikingly similar to Moore’s: pregnant women waiting weeks to see doctors, nurses instructing women to take antibiotics for labor pains and prisoners miscarrying in toilets or on cell floors. Sangster’s comments would have fit into any of the cases that we read. Again and again, we saw women prisoners in need of prenatal care ignored, silenced and disbelieved.

“I feel like that jail done killed my kids,” said Moore. “I’ve been feeling that since the day I gave birth.”

Prenatal Care is Crucial – and Missing – Behind Bars

At the end of 2012, there were more than 200,000 women in prisons and jails, comprising 9 percent of the nation’s incarcerated population. Based on current trends, the number of women behind bars is expected to grow.

The median age of women in state and federal prisons is 34, and the majority of incarcerated women are of reproductive age, according to a study by the Bureau of Justice Statistics. Many women in prison have high-risk pregnancies, complicated by problems including poor nutrition, domestic violence, mental illness and drug and alcohol abuse.

Poor prenatal care in corrections facilities is a grave concern, especially since those facilities have become one of the major providers of health care for marginalized communities, according to Brad Brockmann, executive director of the Center for Prisoner Health and Human Rights at the Miriam Hospital in Providence, Rhode Island, an affiliate of Brown University.

“For many of the individuals who come into the system, their first physical as adults is when they enter prison or jail, because prior to January 2014 Medicaid was not available to many, with only safety-net programs available in the community,” Brockmann said.

The quality of prenatal care provided by prisons or jails varies wildly between and within states, with most facilities providing very poor care, according to a 2010 review of state policies by the National Women’s Law Center and the Rebecca Project.

The survey graded all 50 states on their treatment of mothers behind bars. Thirty-eight states received a failing grade in the category of prenatal care. The researchers reported that 43 states do not require medical exams as part of prenatal care for women in confinement. Forty-eight states don’t offer pregnant women screening for HIV.

And this review only examined what states saidtheir policies were; there were no on-site inspections. “Paper reviews are of limited value in a corrections context,” said Amy Fettig, senior staff counsel for the ACLU’s National Prison Project.

The reality is, no one is looking closely at what is happening in practice on a national scale when it comes to the care of incarcerated pregnant people, experts told RH Reality Check.

For instance, there are no clear answers to some fundamental questions, such as how many women are pregnant during incarceration each year in the United States. A 2011 report by the American Congress of Obstetricians and Gynecologists put the number at 6 to 10 percent of incarcerated women, while a 2008 study by the Bureau of Justice Statistics estimated that between 4 and 5 percent of women admitted to state and federal prisons that year were pregnant.

There are also no comprehensive data for the number of pregnant women in jails, which typically house people prior to conviction or sentencing, or sometimes for immigration matters or for shorter sentences.

And there is simply no national picture of pregnancy outcomes – miscarriages, abortions, stillbirths and live births – for incarcerated women, experts told us. The most recent data we could find came from 1998, when the Government Accountability Office reported that there were about 1,400 births in prisons that year.

Only two states require collection of data on pregnancy outcomes for incarcerated women – Delaware and Oregon, according to the Rebecca Project report. Delaware did not respond to our request for records, but Oregon provided information recorded about the only state prison that houses women, Coffee Creek Correctional Facility, between July 2012 and November 2014.

That data said there were 51 pregnant prisoners during that time, but gave little insight into the type of care provided to these women, apart from the indication that some women were assessed to see whether their pregnancies were high-risk. Of these pregnancies, 37 resulted in births while incarcerated. Eleven women had c-sections, and three women’s labor was induced. There was one miscarriage and one abortion, and an additional four women returned a negative pregnancy test after earlier indicating that they were pregnant. At the time the data were provided, seven of the pregnant prisoners remained incarcerated, while at least two had been released prior to giving birth.

The data did not cover jails, which are governed separately by each of Oregon’s 36 different counties, according to Wendy Smith, a spokesperson with the state’s Health Services Administration.

Another data set comes from Texas, which tracks how many pregnant prisoners are booked into county jails – in April 2015, there were 382. A draft bill would require Texas jails to collect data on prenatal care, as well as the use of solitary confinement or restraints on pregnant prisoners.

It’s therefore reasonable to imagine that thousands of women around the country are experiencing a wide range of pregnancy outcomes while in jails and prisons, with no oversight mechanism to track the care they receive.

But most states do not collect data on incarcerated pregnant woman, and there is no national set of data about prenatal care or pregnancy outcomes for incarcerated people.

Experts say this lack of national and local data is no coincidence.

“It’s one of the many areas where the lack of data points to the invisibility of incarcerated people, and specifically incarcerated women,” Tamar Kraft-Stolar, director of the Correctional Association of New York’s Women in Prison Project, told RH Reality Check.

Despite the lack of comprehensive national data, our investigation found that, with few exceptions, prenatal care in prisons and jails across the country is shockingly inadequate.

In addition to insufficient food and inappropriate living conditions for pregnant people, our research underlines what health experts and women’s rights advocates have said for years: Prisons and jails are among the most dangerous places to be while pregnant.

“A Near-Death Sentence” for Writing Bad Checks

For Laila Batts, poor prenatal care behind bars came close to ending her life.

In early January 2007, Batts was detained for ten days at the Elmwood Complex Women’s Facility, in Santa Clara, California, after writing a bad check to pay some bills.

Batts was in her first trimester of pregnancy the day she entered jail, and that night she began to experience spotting and severe cramping. For the next ten days, Batts complained to nurses about her pain.

By Monday, January 8, Batts told jail staff that she wanted to go to the hospital, because her condition was getting worse. Her request went unfulfilled. On January 9, a nurse saw Batts bleeding on the floor of her cell and complaining that her symptoms were getting dramatically worse, but the nurse did not send for emergency help. When Batts finally saw a doctor the next day, January 10, the doctor noted that she was suffering from an abnormal pregnancy, was at risk of an ectopic pregnancy and required care, according to records produced in a lawsuit. But instead of providing that care, the doctor sent Batts back to her cell. Batts thought she was suffering a painful miscarriage.

“What started out as a request for modified community service in light of her pregnancy turned into a near-death sentence, bringing Ms. Batts within hours – perhaps minutes – of losing her life,” court filings said.

The day after she was released from jail, Batts woke in excruciating pain and was rushed by ambulance to the emergency room, where, she told RH Reality Check, surgeons removed her ectopic pregnancy, as well as a fallopian tube. Ectopic pregnancies are extremely dangerous, and require immediate attention to avoid potential death of the pregnant person.

Batts settled her case, but declined to say how much she was awarded.

What is unusual in her lawsuit is that the complaint focused on the physical and mental pain that she endured. The vast majority of cases we examined focused on the loss of the fetus, not on the suffering of the pregnant woman, because the law tends to focus more on permanent losses – the death of a “viable” fetus – than on temporary pain experienced by the woman. For this reason, we found more cases involving stillbirths (a loss of pregnancy after 20 weeks’ gestation) than miscarriages, which occur prior to 20 weeks.

And because many miscarriages are difficult, if not impossible, to prevent, it is extremely difficult for women who have suffered them while incarcerated to prove any fault on the part of the authorities. This makes mistreatment of miscarriage tough to detect, with even grassroots community advocates struggling to identify where it has occurred.

Diana Claitor, executive director of the Texas Jail Project, says she usually doesn’t hear about a miscarriage from the woman who suffered it.

“Mostly we get a grandmother calling,” Claitor told RH Reality Check. “The first call I got was an elderly Hispanic woman asking, ‘Is there any way we can get the body of our dead grandchild and put it in the family plot?’”

“Sanctity of Life in Texas Looks Like This”

Many of the cases of miscarriage or stillbirth we found occurred in states that have recently introduced laws that claim to protect fetuses, even at the expense of the woman bearing them.

For example, miscarriage in Texas is treated differently if it does not happen behind bars.

Last year, Dallas police swarmed a high school after a fetus was found in a toilet. They launched an investigation, reviewing video footage and interviewing teachers to find the “suspect.”

But two years earlier, no such attention was given to the case of Autumn Miller, who in the summer of 2012 miscarried into a toilet while serving a one-year sentence at the Dawson State Jail, also in Dallas.

Miller, who in pictures has light brown hair and a warm smile full of straight, white teeth, was already the mother of three children. She had entered the jail in February, after violating probation on a drug possession charge, not realizing she was pregnant.

Throughout May and June, Miller complained of cramps and fatigue, and requested a pregnancy test and Pap smear. She never received either from the jail.

On the night of June 14, Miller began bleeding, and experiencing pain so severe that she couldn’t walk, according to a lawsuit filed against the Corrections Corporation of America. Miller told guards she felt like she was having a baby.

Guards brought her to a medical unit where a nurse waited on a telescreen (like the jail in Kankakee, there was no full-time medical staff on-site). But Miller could barely explain what was happening before a guard turned off the screen, handed her a menstrual pad and locked her in a segregated cell.

Screaming, Miller gave birth into a toilet. She was then handcuffed, shackled and transported to the hospital separately from her newborn. Miller named the infant Gracie Robinson; she barely weighed a pound. Gracie died four days later.

“They had her locked in a cell down in the medical area, all by herself, when she was laboring, unbeknownst to her,” Miller’s lawyer, Paula Sweeney, told RH Reality Check. “Then they couldn’t find the key to get the door open when it became apparent what was going on. Then, as she’s laying there on the cot, with blood everywhere, in terror and agony, the male guards start taking pictures with their cell phones.”

Miller’s case was settled in January 2014, and the facility that housed her has since been shut down because of budget cuts as well as increased scrutiny about what was going on behind the prison walls.

“Texas runs around bragging about the sanctity of human life, until you get a chance to see it in real life,” Miller’s lawyer told us. “Sanctity of life in Texas looks like this.”

No Role for Prosecutors in Prenatal Care

Experts have a wide range of recommendations to improve pregnancy care in prisons and jails, including laws that require tracking and reporting pregnancy outcomes, the elimination of solitary confinement for pregnant prisoners and an increase in prisoners’ access to OB-GYNs.

In Texas, a coalition of groups, including the Texas Jail Project and the ACLU of Texas, is pushing for a bill that would mandate tracking of prenatal care and treatment of pregnant prisoners in the state’s approximately 250 county jails.

The bill has caused unease among some women’s advocates, however, because of fears that gathering data on pregnant prisoners could lead to more punitive action by the state.

“There is legitimate fear from legislators that are interested in doing this kind of tracking that those numbers will be used to punish pregnant women for drug use,” Mathew Simpson, policy strategist at the ACLU of Texas, told RH Reality Check. “When it comes down to it, if we don’t know the birth outcomes, we can’t make an assessment of where the gaps are.”

The broader picture, however, is that jails and prisons are generally the wrong place to house pregnant women, given that they frequently lack the appropriate staff or facilities, and are fundamentally geared toward punishment, not care.

“Judges and prosecutors think that it’s a good idea to empower jail guards – whose job is to punish criminals – to give prenatal care,” Lynn Paltrow, the executive director of National Advocates for Pregnant Women, told RH Reality Check. “There has to be a very clear consensus that there is no role for prosecutors to be involved in prenatal care.”

Punished for Addiction: Women Prisoners Dying from Lack of Treatment

Tracy Lee Veira had been in jail for seven days when she was finally allowed to have visitors. Popular in her hometown of Orange City, Florida, Veira had a web of friends eager to see her, as well as two young children who were restless for their mother.

For years Veira had skirted the law, possessing cocaine, violating probation. Once, Veira was pulled over by the local sheriff for driving without a license for the third time in a row. According to her mother, Donna Mullins, Veira threw her keys on the hood and said, “Please, take my keys! I have a problem with driving!”

Most recently Veira had been arrested for “doctor shopping”: requesting the same Oxycodone prescription from three different doctors.

But Veira was also trying to remake her life. In early September 2009, she had turned herself in to the Volusia County Jail for an outstanding warrant, wanting to put her trouble behind her, according to her mother.

When she entered the jail, Veira told officials she had been taking Oxycodone, a highly addictive opioid pain medication, every day, even as recently as that morning.

But the medical staff at the Volusia County Jail did virtually nothing with that information. They did not document what she said, did not speak to her former doctor or outside pharmacy, did not make any plans to continue her medication, and did not order any follow-up care, according to a lawsuit later filed by Veira’s estate against the correctional health-care company that manages most of Florida’s corrections facilities, Corizon Health.

After three days in jail, Veira was feeling nauseous and scared. She couldn’t keep anything down. She was transferred to a solitary confinement cell, closer to the guards who were ostensibly monitoring her deteriorating health.

For the next few days, Veira tried to get the guards to help her. By the seventh night, Veira was so ill that Patty Blair, a childhood friend who was also at the jail while Veira was there, could hear Veira’s cries.

“It was frightening to hear her beg them, because you could hear in her voice that she didn’t feel good,” Blair told RH Reality Check. Blair says the correctional officers told Veira to lie down, that she simply had a leg cramp and needed to rest.

In fact Veira was undergoing a dangerous detox.

On September 16, 2009, Veira was found dead in her cell. No one on the jail staff made any announcement; prisoners whispered stories from cell to cell about who had died and why, according to Blair and another woman we spoke to who was at the jail with Veira. An autopsy later determined that Veira’s digestive system shut down due to severe dehydration. During her week in jail, she had lost 20 pounds.

In an interview with RH Reality Check, Mullins recalled lifting Veira’s 7-year-old son onto her knee later that night. He was supposed to have visited Veira that day. Instead, Mullins told him that his mommy had gone to Heaven. “He just looked at me, and asked, ‘Why?’”

A Corizon spokesperson told RH Reality Checkthat the company was not able to comment specifically on Veira’s case because of ongoing litigation. The spokesperson added in an email, “It is our standard policy to document all available medical history, including current prescriptions, of our patients when they enter our care.”

A Volusia County Jail spokesperson had “no comment involving the matter.”

Veira is one of thousands of women who have struggled with drug addiction behind bars. And she is not the only one who has died from poor treatment. During a five-month review of more than 200 lawsuits, and interviews with lawyers and public health experts, RH Reality Check found that drug treatment for incarcerated women is inconsistent and inadequate – and in some incidents, like Veira’s, it is fatal.

Incarcerated women have extraordinarily high rates of drug dependency: A recent report from the Bureau of Justice Assistance of the U.S. Department of Justice found that 82 percent of the women they surveyed had a serious substance use disorder – a much higher rate than their male peers, who report a rate of 44 percent. It is no coincidence that incarcerated women also have high rates of mental illness and past trauma.

Like Veira, two-thirds of women in prison are incarcerated for non-violent crimes, often related to mental illness, poverty, abuse or addiction. In 2010, more than 25 percent of female prisoners in state and federal facilities were there for drug crimes.

The petty nature of the crimes in some of the cases we examined made the poor treatment of women’s drug dependencies even more striking. Christina Ackerman, for example, was arrested for stealing DVDs from a Blockbuster in 2003. She died from dehydration related to withdrawal after five days in a county jail in Pennsylvania. She was 21 and had a three-year-old daughter, according to a lawsuit filed on her behalf.

When correctional officers found Ackerman lying on the floor in her own vomit, they notified a nurse, who said, “What do you want me to do about it?”

Savannah Sparks met a similarly grim fate when she went to jail for shoplifting in 2012. She died from complications related to withdrawal after six days in a county jail in Kentucky, according to Prison Legal News. During Sparks’ incarceration, she vomited continuously, sweated profusely and was unable to eat or drink. But still, no one at the jail took her condition seriously.

Instead, the on-duty prison nurse told WDRB.com: “She had a bad detox. I mean, we have those all the time. It wasn’t something that made me feel like, you know, ‘Oh my god, I need to tell somebody else!’”

Medical and public health experts told RH Reality Check that corrections facilities urgently need to improve the way they address prisoners’ drug dependency.

“As a physician, I see drug addiction as a health-care issue,” Dr. Carolyn Sufrin, an OB-GYN at Johns Hopkins Hospital, told RH Reality Check. “Without appropriate drug treatment, people are being punished for their struggles with addiction.”

Best Practices for Drug Treatment Rarely Followed

If serious drug addiction is common for women prisoners, high-quality treatment is not. A report by the Bureau of Justice Statistics indicates that between 2000 and 2011, female jail prisoners were nearly twice as likely as males to die of drug or alcohol intoxication while in custody.

Detoxing from drugs and alcohol can be a dangerous process that requires physician oversight, experts told us. While coming off opiates can leave patients susceptible to death from associated dehydration or other conditions, abruptly stopping alcohol consumption can itself be fatal, due to the effects that such chemical changes can have on the brain.

Roughly one million arrestees per year may be at risk for untreated alcohol or opiate withdrawal, according to a 2004 study published in the American Journal of Public Health.

The National Commission on Correctional Health Care (NCCHC), which accredits prison health-care programs, publishes standards for how to treat opioid and alcohol withdrawal in correctional settings.

For opioid withdrawal, the NCCHC advises that all prisoners be carefully evaluated when they enter the jail; those that test positive for withdrawal risk should be treated with methadone or buprenorphine, both FDA-approved drugs for detoxification.

But many incarcerated people simply don’t receive that treatment.

“In a well-run prison or jail that’s providing adequate care, someone who’s detoxing would be potentially provided with some medication to ease the withdrawal symptoms, and he or she would be watched for suicide or accidental death. This requires personnel and entails costs,” Brad Brockmann, the executive director of the Center for Prisoner Health and Humans Rights at the Miriam Hospital in Providence, Rhode Island, told RH Reality Check. “The best practices, which are out there, are rarely followed.”

The quality of drug treatment can vary widely between federal prisons, state prisons and county jails.

The federal Bureau of Prisons (BOP) has a detailed drug treatment program, outlined in a 2012 report to Congress. The program includes drug abuse education at all 118 BOP facilities, as well as non-residential and residential drug abuse treatment programs at many facilities. In 2012, there were residential drug treatment programs at ten federal prisons for women (out of 27 total federal prisons for women). That year, 47,087 prisoners participated in non-residential, residential and community transition drug treatment programs in federal prisons.

There is strong evidence that offering drug treatment to prisoners has tangible benefits to society. In a three-year study published in 2000, the BOP found that female prisoners who participated in residential drug abuse treatment programs were 18 percent less likely to recidivate than similarly situated female prisoners who did not participate in treatment.

But for women in county jails – waiting to be sentenced or serving time for misdemeanors – drug treatment can be disorganized and insufficient.

Hope Wulliman, a former director of nursing at the Manatee County Jail in Florida, said prisoners going through withdrawal at her jail were sent to a separate medical unit for “basic treatment” that fell far short of what such patients required.

“They basically got comfort measures, like Imodium [used to treat diarrhea],” she told RH Reality Check. She said she had seen many people go through withdrawal at the jail, with “lots of different symptoms: hallucinating, jumping off the toilet, kicking at the air.”

Wulliman had never worked in corrections before she took the job in 2009.

“There wasn’t really a whole lot of training at all,” she told RH Reality Check. “Some of it was just common sense ... nursing is nursing.”

Like most of Florida’s prisons and jails, health care at Manatee County’s facility is provided by Corizon Health, a national company with a deeply troubled record when it comes to patient care.

Inga Jones, a nurse who worked at the Volusia County Jail from 2005 to 2010 – where Tracy Veira died – said in a court filing that poor drug treatment at the jail was common.

“Drug and alcohol withdrawal protocols were routinely not followed,” she said in court papers obtained by RH Reality Check. “We worked three days on and two days off, and many times I recall returning to duty to find a patient in full-blown detox.”

When asked about their policies or procedures for prisoners with drug dependency, a Corizon spokesperson said in an email, “We are always working to improve policies and procedures in the interest of our patients. We change protocols as needed and on an ongoing basis in accordance with annual NCCHC reviews.”

Florida’s problems with Corizon and its other private provider, Wexford Health Sources, have been so severe that the state has announced it is seeking to renegotiate the $1.4 billion in contracts it has between the companies.

“Their Substance Abuse Treatment Just Ended”

Even at the level of state prisons – which, in contrast to jails, usually house prisoners for longer periods and often for more serious crimes – drug treatment can be limited, and programs can end abruptly.

In Illinois, for example, the nonprofit Wells Center offers drug and alcohol treatment to a number of correctional facilities.

The center, which gets funding from state contracts, currently provides gender-specific and trauma-informed care modeled off cognitive behavioral therapy for about 180 women in Illinois.

The need is much greater than that. Bruce Carter, the executive director of the center, estimates that if he had enough funding, staff and space, he could easily have three times as many patients.

Women prisoners are especially eager for drug treatment, Carter told RH Reality Check.

“Women will oftentimes have an additional motivation of wanting to get better because they’re the primary caretakers of their kids.”

According to Carter’s numbers, the treatment works. Forty-eight percent of women who have not participated in the program recidivate within three years, while women who complete treatment are far less likely to go back to prison, with a recidivism rate of only 22 percent.

But three of the five programs that Wells offered to women prisoners in Illinois have closed in the past five years.

Carter says he received a call in 2012 saying that the drug treatment program at Decatur, a minimum-security prison for women, would be shut in a week. He had to ask to keep it open for 30 days, so he could give his staff notice.

“For those inmates who were scheduled to finish their treatment in 30 days, they were able to,” Carter told RH Reality Check. “For everyone else, their substance abuse treatment just ended.”

States Sending Pregnant Women to Jail for Drug Use

The broader political context of patchy, poor or nonexistent drug treatment for women prisoners is this: States are increasingly jailing pregnant women because of their drug use.

In Tennessee, legislators passed a pregnancy criminalization law in 2014, making it possible to prosecute women who use illegal drugs while pregnant. The bill allows women to be charged with aggravated assault, which carries a maximum penalty of 15 years in prison. As Imani Gandy has noted, the law will disproportionately affect Black women.

And as Jessica Mason Pieklo reported last year, South Carolina and Alabama have both made various criminal laws applicable to pregnant women, while Minnesota and South Dakota have altered their laws to include a special process for putting pregnant women in jail if they are deemed a risk to their fetuses. In March 2015, the North Carolina Senate introduced a bill that would make it a criminal offense for a woman to use drugs while pregnant.

In other words, these laws are sending women to jail for drug use, even though county jails and state prisons are often not equipped to handle serious drug addiction.

Allison Glass, state director of Healthy and Free Tennessee, says laws that send pregnant women to jail for drug use – but do not require improved drug treatment in jails – hurt women.

“The legislators’ concern really is not about helping women, or helping the fetuses that they say they care so much about,” she told RH Reality Check.

“It’s really about punishing women who are struggling with a health-care issue.”

A County is Compelled to Improve Drug Treatment for Pregnant Prisoners

In Montana, a lawsuit over the failure to provide drug treatment to a pregnant prisoner has resulted in county-wide reform.

The settlement of the case also reveals how difficult it is to make systemic change to incarcerated women’s drug treatment since it is fragmented by state and county lines.

Before entering the Lake County Jail in Polson, Montana, in March 2009, Bethany Cajúne was doing well. As part of a yearlong opiate addiction treatment program, she was attending weekly counseling sessions and taking Suboxone, a medication that prevents withdrawal. She was studying for her GED, taking care of her five children and working to be sober, according to a lawsuit filed by the American Civil Liberties Union (ACLU) on her behalf.

When she turned herself in to the county jail for outstanding traffic violations, she was about four months pregnant.

She arrived at the jail with her Suboxone in hand. Both her drug counselor and her doctor said she should stay on the prescription while in the jail.

There is a general medical consensus that it is dangerous for a woman to stop taking Suboxone while pregnant. Stopping the medication increases the risk of miscarriage or preterm labor; it also causes a pregnant woman to go through withdrawal, which threatens the health of her and her fetus.

But at Lake County Jail, the doctors and nurses would not give Cajúne her Suboxone. She asked repeatedly for the medication, and filed medical complaints. Her doctor called the facility multiple times, warning the sheriff and the jail’s doctor that Cajúne and her fetus were at risk.

Judy Beck, a spokesperson for the Montana Department of Corrections, told RH Reality Checkthat she could not speak to Lake County Jail’s policies, since the Montana DOC doesn’t have control over county jails.

But in an email, she said, “Suboxone is not on the MT DOC’s formulary list. There is a process for approving use of non-formulary medications. That process is the same for inmates whether they are pregnant or not.”

Without the medicine, Cajúne quickly went into withdrawal. Dehydrated and anxious, she started vomiting and having diarrhea. At one point she fainted in her cell. After nine days at the jail, Cajúne lost about ten pounds.

Instead of giving her Suboxone, guards put Cajúne in solitary confinement, referred her to a psychiatrist and told her to “tough it out.”

She was still pregnant, but scared that her untreated withdrawal would cause her to miscarry.

Finally a public defender intervened on her behalf, and she was released from the jail. Severely dehydrated, she went to the emergency room, where she was rehydrated and put back on her Suboxone.

The case was settled in 2011; part of the settlement involved a provision that other pregnant women at the county jail would be protected from similar treatment.

“A different case could have implications beyond the specific jail,” Andrew Beck, staff attorney at the ACLU Reproductive Freedom Project, told RH Reality Check. “The harm was caused by this jail, and the solution was to tell this jail to fix its policies.”

Even at the county level, though, the case made an impact, according to Beck.

“Because the jail agreed to this policy, and we haven’t heard of any other cases, we have every reason to think that this has made an important difference.”

 

This cover story is comprised of three of four articles in the “Women, Incarcerated” series published by RH Reality Check (http://rhrealitycheck.org) between March 30 and April 1, 2015, which are reprinted with permission. The fourth article will appear in a future issue of PLN.

 

Case Summaries

Meredith Manning – Tennessee, 2004: Twenty-three-year-old Manning began to miscarry in a Corrections Corporation of America facility. She bled for two days before she was taken to the hospital, where she gave birth to a baby that died shortly after. This case settled for $250,000.

Shela Williams – Texas, 2014: Williams was 18 weeks pregnant when she entered a Texas jail. She had a high-risk pregnancy but did not receive adequate obstetric care while incarcerated. When a doctor finally did examine Williams, he told her that her child “wasn’t going to make it.” She went to a nearby hospital, where she delivered her stillborn; she was not allowed to attend his funeral.

Bethany Cajúne – Montana, 2009: Although Cajúne was pregnant, and both her doctor and drug treatment counselor had prescribed her continued use of Suboxone (a medication that suppresses withdrawal symptoms) in jail, the doctors and nurses there would not give her the prescription. She went through immediate withdrawal, losing ten pounds in less than two weeks. She feared she would lose her baby. Finally, after nine days, a public defender intervened and she received the treatment. This case settled in 2011.

Gretchen Harbison – Indiana, 2010: Harbison could not feel her fetus move for three days. She was eventually transferred to a hospital, where she delivered a stillborn. Harbison alleges that the prison doctor failed to treat her pregnancy with any urgency, despite knowing that she had four complicated deliveries in her past.

Tiffany Pollitt – Pennsylvania, 2010: A prisoner hit Pollitt in the stomach; she repeatedly reported the incident, but no doctors or nurses took her seriously. She continued to say she was in serious pain. Corrections officers told Pollitt to “grow up,” asked her what she expected them to do and told her “better luck with next shift.” Then Pollitt bled all over the floor of her cell. Finally, she was transferred to a nearby hospital, where she delivered a stillborn baby.

DeShawn Balka – Georgia, 2012: Balka was about 24 weeks pregnant when she entered the jail. She experienced nausea, cramping, bleeding and vaginal discharge, which she reported to jail guards. No one examined her. Then she began experiencing extreme pain and cramping. She sat on the toilet in her cell and pressed the emergency call button; no one responded. Ultimately she gave birth into the toilet. Her baby was pronounced dead at the hospital a few hours later.

Countess Clemons – Tennessee, 2011: Eighteen-year-old Clemons started miscarrying in a jail in Tennessee. After leaving her in a cell for almost three hours, guards took Clemons to a hospital, where she delivered a baby who died soon after he was born. This case settled for $690,000 in 2014. The Corrections Corporation of America was also issued a sanction for destroying video evidence of the delay in treatment.

Nicole Guerrero – Texas, 2012: Guerrero began to experience pain, bleeding and cramping, and alerted medical staff. Guerrero was put in solitary confinement, where she went into labor by herself on the floor of her cell. The umbilical cord was wrapped around the baby’s neck, and the baby was later pronounced dead. Guerrero was made to stay in solitary confinement while the infant was taken away.

Latish Durden – Georgia, 2012: Durden had a high-risk pregnancy and had surgery on her cervix while at the jail. She required constant monitoring. She began experiencing cramping, bleeding and discharge, but she was not treated. Eventually she was taken to the hospital, where she delivered a stillborn baby.