An Analysis of Court Decisions,Statutes,and Administrative Regulations Related to Pregnant Inmates

Abstract

Pregnant inmates represent about 5% of females within the correctional population. Although this is a small portion of the entire inmate population, it is important to adequately address their needs to protect the health of the mother and the fetus. Many states have failed to properly address this issue. However, the states that appear to be the most comprehensive in terms of their treatment of pregnant inmates are California and Pennsylvania. Other states should model their statutes and administrative regulations after these states to effectively address the needs of pregnant inmates.

Keywords

Pregnant inmate women prison jail

Introduction

In the United States, there has been a significant increase in the number of women who are incarcerated in prisons and jails. A proportion of those who have entered prison and jail do so while pregnant. Estimates are that about 5% of women who are incarcerated in prisons nationwide enter prisons while they are pregnant (Levi, Kunakemakorn, Zohrabi, Afanasieff, & Edwards-Masuda, 2010). Because of the limited resources devoted to incarcerated pregnant women in prisons and jails, programs and resources tailored to this special population have been found to be inadequate in meeting their needs. Some examples of these inadequacies include the absence of special diets, lighter workloads, and medical resources for miscarriages, premature births, and deliveries (Wooldredge & Masters, 1993). Although the treatment of pregnant women outside of the criminal justice system has significantly advanced, this has not been the case with incarcerated pregnant women.

In addition to these inadequacies, many pregnant inmates are classified as high risk because of drug addiction, sexually transmitted diseases, or pelvic inflammatory disease (Parker, 2006). Although drug use during pregnancy is frequently cited by researchers as a critical problem, this has generally been overlooked, even though there has been a trend toward incarcerating pregnant, substance-abusing women to protect the health of the mother and the fetus. Given this trend, health officials in jails must be able to provide appropriate detoxification to pregnant drug addicts because the fetus may experience withdrawal symptoms (Parker, 2006). Many jails, however, have failed to provide appropriate care for pregnant inmates and their unborn children. Research indicates that drugs in prisons are readily available. This means that pregnant inmates are likely to continue using drugs for the duration of their pregnancy (Egley, Miller, Granados, & Ingram-Fogel, 1992). As a result of inadequate care, numerous negative outcomes include increased levels of fetal and neonatal death, intrauterine growth retardation, premature labor and delivery, and other conditions that necessitate admission to neonatal intensive care units (Siefert & Pimlott, 2001). Furthermore, such inmates may experience psychological distress as a result of the separation from their newborn child, which is also related to long-term problems experienced by the child (Wooldredge & Masters, 1993).

As of September 2013, 41 states and the District of Columbia have enacted pregnancy-specific statutes and/or administrative regulations (American Civil Liberties Union [ACLU], 2013). Some states have enacted statutes, while others have passed administrative regulations, and others have done both. This article seeks to analyze court cases as well as statutes and administrative regulations related to pregnant inmates to determine whether their specific needs are adequately addressed, as suggested by Tapia and Vaughn (2010). A model statute is then provided to guide policy makers when considering statutes and regulations that best meet the needs of pregnant inmates.

Pregnant Inmates in Prison

As the number of women in prisons has increased, so too has the number of women who are pregnant when entering prison. By 1998, about 5% of women who entered state prisons and 6% of women who entered jails nationwide were pregnant upon admission (Bureau of Justice Statistics, 1999). This increase has resulted in the need to address the issue of the medical issues of women in prison, particularly with regard to pregnancy and childbirth. This section will address some of the issues related to the health needs of pregnant inmates.

Problems faced by pregnant inmates

Various agencies have presented policy recommendations to reduce the likelihood of pregnant inmates experiencing physical and psychological problems. Such recommendations have included providing prenatal care in prisons, providing full-time nurses and midwives, allowing nursing infants to remain with mothers during their period of incarceration, and extending visiting hours for mothers with their children (Wooldredge & Masters, 1993). A study by Wooldredge and Masters (1993) analyzed the presence of various types of services for pregnant inmates in state prisons. Some of these services included prenatal care, networking with community agencies providing prenatal care, Lamaze classes, and special diets. None of the facilities reported having programs that allowed infants to remain with the mother. Eight wardens noted no problems. Some problems noted by wardens included inadequate resources for pregnancy complications, no maternity clothes, the use of belly chains during transport, and no separate visiting areas for mothers and children. This study was conducted 20 years ago but is the only study that has been conducted with this group of inmates.

Health care and prenatal needs of pregnant inmates

Women who enter correctional facilities are generally in poor health as a result of poverty, substance abuse, and the presence of physical and sexual abuse (Hotelling, 2008; Parker, 2006). As a result, many women who enter prison while pregnant are considered to have high-risk pregnancies. Having histories of drug addiction and sexually transmitted diseases are examples of criteria that are used to consider a pregnancy as high risk. These problems are exacerbated by the lack of gynecological examinations upon admission, the failure to ask appropriate screening conditions, and the lack of on-site physicians who specialize in obstetrics and gynecology (Arnold, 2004).

This is particularly problematic for drug-abusing pregnant women. The failure to provide an appropriate form of detoxification may harm both the mother and the fetus. Pregnant, drug-addicted inmates are forced to undergo withdrawal without consideration for the health of the fetus, even though the fetus can also experience withdrawal symptoms (Parker, 2006). Despite its seriousness, this problem has remained overlooked even though there has been a trend toward incarcerating substance-abusing pregnant women to protect the health of the fetus (Barry, Ginchild, & Lee, 1995). Continued drug use during pregnancy can have a number of adverse effects for the baby, including intrauterine growth retardation, reduced gestation, low birth weight, decreased head circumference, and premature delivery (Siefert & Pimlott, 2001).

Drug-abusing pregnant inmates present a number of psychologically based needs. The link between past and present instances of physical and sexual abuse and current substance use has been well documented in the research literature (i.e., Clark & Foy, 2000; Kaukinen & Demaris, 2005). Women who have been physically and sexually abused at some point are more likely to engage in substance use and abuse. Unless these issues are recognized and dealt with, it is unlikely that such women will be successful in achieving and continuing abstinence from substance use, especially if the abusive partner is the father of the baby (Siefert & Pimlott, 2001).

Although some argue that incarceration is harmful to women and their unborn child because of the level of stress, others maintain that incarceration may improve the health of pregnant inmates because they are receiving an adequate level of food and have limited access to drugs (Parker, 2006). One study indicated that pregnant inmates who experienced short-term incarceration were more likely to experience poor prenatal care, histories of drug abuse, and poor nutrition compared with the long-term incarceration group (Cordero, Hines, Shibley, & Landon, 1991). Another study comparing a group of incarcerated pregnant inmates with a control group indicated that a greater percentage of those who were incarcerated acknowledged the use of illicit drugs and tobacco, yet positive outcomes were still found among those who were incarcerated, despite increased drug use (Egley et al., 1992).

Effect on mothers and children

Incarceration is found to be harmful to the well-being of both mother and child because of the stress related to imprisonment (Parker, 2006). Early studies in this area assumed that the infant would be victimized at birth as a result of the circumstances under which the birth occurred (Johnson, 1969). One study analyzing three facilities in California found that all three sites were lacking in health care plans and case management systems related to prenatal care. In addition, inmates perceived the health care providers at these facilities as insensitive and unresponsive to their health care needs (McCall, Casteel, & Shaw, 1985).

The long-term effects of the mother’s incarceration on the child have not been extensively studied. The few studies that have directly analyzed these children have generally indicated negative results. One study found that most children who were identified as having severe behavioral and disciplinary problems had experienced parental crime, arrest, and incarceration, while some children had a parent who was incarcerated when the study was taking place (Johnston, 1995). The negative impact of a mother’s incarceration, in particular, may persist throughout one’s childhood. Furthermore, forcibly separating children from primary caregivers is devastating to children’s emotional needs, who are in a vulnerable and frightened state. This is further exacerbated by their separation from siblings (Kampfner, 1995). Recent research finds that individuals whose mothers had been imprisoned are significantly more likely to experience arrest, conviction, and incarceration as adults (Muftic, Bouffard, & Armstrong, 2016).

Shackling of pregnant inmates

Shackling is defined as the practice of placing chains on an inmate during pre-labor, labor, or post-labor. Examples of this practice include attaching arms or legs to the bed with chains, shackling legs together during childbirth, and attaching ankles together with chains during the process of inducing labor. Restraints are used on women regardless of their history of violent behavior or flight risk (Amnesty International USA, 2001). The majority of pregnant inmates who are shackled during labor are considered to be nonviolent and not considered to be a flight risk (Griggs, 2011). Although this practice is allowed in most states, it is considered to be unconstitutional and violates human rights guidelines (Sichel, 2008). It is argued that shackling violates the Eighth Amendment right against cruel and unusual punishment because it causes pain and deprives prisoners from receiving adequate medical care (Griggs, 2011). Most states continue to allow this practice during the third trimester of pregnancy, and many of these states allow shackling during labor (Doetzer, 2008). According to the ACLU, 18 states have either prohibited or placed restrictions on shackling pregnant inmates (ACLU, 2012). They discuss numerous problems related to shackling, including health risks to the mother and the fetus, as well as potential violations of constitutional law and international human rights treaties.

Although some states actively engage in shackling of pregnant inmates, Massachusetts has recently passed an anti-shackling law to prevent shackling and promote safe pregnancies. The Massachusetts bill disallows the use of restraints of any kind during any stage of the pregnancy or during delivery and instead uses vehicles with seatbelts to transport inmates to medical providers and court proceedings (Commonwealth of Massachusetts, 2014).

Viewpoints of the National Commission on Correctional Health Care (NCCHC) and American Correctional Association (ACA)

The NCCHC (2010) has addressed guidelines for shackling. It considers the differential application of restraints depending on the phase of labor and delivery. During the prepartum period, restraints should be used restrictively, and their recommended use varies depending on the part of the body being restrained; for example, abdominal, leg, or ankle restraints should not be used, while wrist restraints should be applied in a manner that would allow the inmate to protect herself and her baby in the event of a fall. During the partum period, it is recommended that the use of restraints be avoided unless there is a serious threat of harm to self or others. Similarly, restraints should be avoided during the postpartum period to allow for recovery from labor and delivery, as well as for optimal bonding between the mother and the baby.

Like the NCCHC, the ACA (2012) addressed the use of shackling during transport, delivery, and the postpartum period. They specify that female offenders who are suspected to be pregnant should be restrained in the least restrictive manner as possible. The use of waist restraints is prohibited at any point during pregnancy, while leg restraints should only be used under extreme circumstances during transport, but never during labor and delivery. Also, electronic restraints are not to be used at any point during pregnancy or labor and delivery.

Method

Cases were found by conducting a search on LexisNexis with the search term pregnant inmate to determine lower level federal and state-level cases that specifically addressed pregnant inmates in prison or jail as of September, 2013. A total of 16 cases were found that were relevant to pregnant inmates—14 at the federal level and two at the state level. Links for state statutes and administrative regulations were found through the portion of the ACLU website that discusses state standards for the health care of pregnant inmates (ACLU, 2013). These links are current as of September, 2013. These links addressed various issues related to pregnant inmates, which are grouped into different categories: shackling, prenatal care, counseling, childbirth/postpartum care, and other references, which was a catchall category that includes issues not addressed in the previous four sections.

Court Cases, State Statutes, and Administrative Regulations

Prison health care has been an issue for the past several decades, beginning with Estelle v. Gamble (1976). In this case, an inmate filed a complaint under 42 U.S.C. §1983 because of a back injury received while working in prison. He claimed that he was subjected to a violation of his Eighth Amendment right against cruel and unusual punishment because of the lack of diagnosis and inadequate treatment from prison officials for his injuries. On appeal, the U.S. Supreme Court held that deliberate indifference to serious medical needs by prison constitutes an Eighth Amendment violation. Although this case did not specifically focus on pregnant inmates, it did bring inmate health care to the attention of researchers and practitioners. This would later be extended to pregnant inmates, which is the focus of this section.

Analysis of State and Federal Court Cases

Although cases involving pregnant inmates have yet to reach the U.S. Supreme Court, such cases have been addressed by a handful of lower level federal and state courts, which are summarized in Table 1. Currently, no cases involving pregnant inmates have reached the U.S. Supreme Court. Instead, cases at the federal level have reached the U.S. District Court and the U.S. Court of Appeals.

Table 1.

Summary of State and Federal Court Cases Involving Pregnant Inmates.

	Which court?	Issue	How decided?	Reason for decision?
Federal cases
Archer v. Dutcher 733 F.2d 14 (1984)	U.S. Court of Appeals—2nd Circuit	Was a pregnant inmate denied her rights under the Eighth Amendment by prison officials as a result of their alleged indifference to her safety and medical needs?	The court reversed the dismissal of appellant’s civil rights action by grant of summary judgment in favor of appellee prison officials because there were factual problems to be considered	The role of the court is not to determine findings of fact
Boswell v. County of Sherburne 849 F.2d 1117 (1988)	U.S. Court of Appeals—8th Circuit	Are jailers and the county entitled to qualified immunity after discovering that a pretrial detainee was pregnant and disregarded her pleas for help?	The court affirmed the judgment from the district court, which had denied the motions from the county and individual jailers for summary judgment on the ground of qualified immunity	Jailers were aware that detainee was experiencing bleeding, discharge, and cramping; chief jailer and sheriff were seeking to release inmate as soon as possible to avoid medical costs
Brawley v. State of Washington 712 F. Supp.2d 1208 (2010)	U.S. Dist. Court—W. D. Wash.	Does shackling an inmate during labor and during the postpartum period constitute an Eighth Amendment violation?	The court denied defendants’ motion to dismiss for failure to exhaust, or laches, or on grounds of qualified immunity as to plaintiff’s Eighth Amendment claim	Defendants were not facing an emergency situation but still subjected the inmate to a substantial risk of physical harm, the unnecessary pain caused by shackling, and the restricted position of confinement and created discomfort and humiliation
Clifton v. Eubank 418 F. Supp.2d 1243 (2006)	U.S. Dist. Court—D. Colo.	Did deliberate indifference on the part of correctional officials to the inmate’s labor symptoms resulting in the death of the fetus constitute an Eighth Amendment violation?	Defendants’ motion for summary judgment is denied; plaintiff’s motion to recognize the constitutional rights of prison inmates is denied as moot	Because the damage inflicted by the alleged violation is terminal and irreversible, and because no relief is available to the inmate, who is no longer incarcerated, the Prison Litigation Reform Act (PLRA) should not operate to bar her claim
Coleman v. Rahija 114 F.3d 778 (1997)	U.S. Court of Appeals—8th Circuit	Did the nurse act with indifference to the pregnant inmate’s serious medical needs?	The punitive damages award is vacated and the order of the district court is affirmed in all other respects	A finding of deliberate indifference to a serious medical need, while establishing liability under §1983, does not necessitate a finding of callous indifference warranting punitive damages
Doe v. Gustavus 294 F. Supp.2d 1003 (2003)	U.S. Dist. Court—E. D. Wisc.	Are prison officials who acted deliberately indifferent to the medical needs of the pregnant inmate entitled to qualified immunity?	Defendants’ summary judgment motion was granted as to the nursing supervisor, but denied in all other respects	The expert would testify that any nurse would have known that the plaintiff was in labor. The jury could then find that, because the defendants are nurses, they must have known that the plaintiff was in labor. A jury could proceed to find that some, or all, of their actions constituted deliberate indifference.
Goebert v. Lee County 510 F.3d 1312 (2007)	U.S. Court of Appeals—11th Circuit	Did the defendants display a deliberate indifference to the pregnant inmate’s medical needs under the Eighth and Fourteenth Amendments?	The judgment of the district court was reversed as it concerned the physician, the facility commander, and the jail service provider, but was affirmed as it concerned the sheriff	The physician, facility commander, and jail service provider displayed a deliberate indifference to the inmate’s medical needs; the sheriff had no direct contact with the inmate
Hogan v. Wellstar Health Network 2013 U.S. Dist. LEXIS 35841 (2013)	U.S. District Court—N. D. Ga.	Did the defendants display a deliberate indifference to the pregnant inmate’s medical needs under §1983?	The court dismisses all §1983 claims against all defendants in this case	The doctrine of qualified immunity is not meant to be applied to privately employed guards.
Moulton v. Desue 2012 U.S. Dist. LEXIS 189103 (2012)	U.S. District Court—Middle D. Fla.	Did the defendants display a deliberate indifference to the pregnant inmate’s medical needs?	Because the law clearly established that conduct as alleged violated a pretrial detainee’s Fourteenth Amendment right to medical care, Hendrix, DeSue, Mixon, and Hollingsworth are not entitled to qualified immunity.	The deliberate decision to disbelieve the inmate’s and other inmates’ complaints and to withhold medical care could amount to more than grossly negligent deliberate indifference to the inmate’s constitutional right to medical care
Nelson v. Correctional Medical Services 583 F.3d 522 (2009)	U.S. Court of Appeals—8th Circuit	Are correctional officials entitled to qualified immunity after shackling an inmate with no flight risk during the final stages of labor?	Affirmed denial of summary judgment to the officer but reversed district court’s order with respect to the director	The officer did not perceive the inmate to be a flight risk based on the inmate’s actions; the director was not personally involved in the inmate’s care
Pool v. Sebastian County 418 F.3d 934 (2005)	U.S. Court of Appeals—8th Circuit	Are jail officials entitled to qualified immunity?	The judgment denying defendants’ summary judgment based on qualified immunity was affirmed	The inmate informed prison officials that she was pregnant, bleeding, passing blood clots, and in extreme pain from cramping, so much so that it affected her ability to perform routine daily functions such as eating and showering. These facts constituted a need for medical attention that would have been obvious to a layperson. Based on these facts, it cannot be said that appellants were not deliberately indifferent in responding to inmate’s miscarriage
Villegas v. Davidson County 789 F. Supp.2d 895 (2011)	U.S. Dist. Court—Middle D. Tenn.	Does shackling during final stages of labor and the denial of a breast pump following labor constitute a §1983 violation?	Summary judgment denied	The Supreme Court has held that shackling in prison can violate the Eighth Amendment; it was clear that the inmate needed a breast pump to relieve painful engorgement that she was experiencing
Webb v. Jessamine County Fiscal Court 802 F. Supp.2d 870 (2011)	U.S. Dist. Court—E. D. Ky.	Are the defendants entitled to qualified immunity after the inmate delayed seeking medical care for her labor symptoms?	Motion denied	Plaintiff has brought forth no evidence to demonstrate that defendants acted with an “intent to cause Webb emotional distress” as required by Kentucky
Women Prisoners of the District of Columbia Dept. of Corrections v. District of Columbia 93 F.3d 910 (1996)	U.S. Court of Appeals—D.C. Circuit	Are men and women entitled to equal access to educational programs and activities according to the Fifth, Eighth, and Fourteenth Amendments?	Judgment remanded to trial court	Certain provisions of the trial court’s order provided broader relief than was necessary to remedy Eighth Amendment violations. This also applies to obstetrical and gynecological care for women.
Zaborowski v. Dart 2011 U.S. Dist. LEXIS 146000 (2011)	U.S. Dist. Court—N. D. Ill.	Does the sheriff’s shackling policy violate inmates’ due process right to their liberty interest in bodily integrity?	The court denies the parties’ cross-motions for summary judgment as to the plaintiffs’ official capacity claim and state law negligence claim. The court grants Sheriff Dart’s motion for summary judgment as to the individual capacity claim.	Because genuine disputes of material facts exist in relation to the due process claim, the court denies the parties’ cross-motions for summary judgment; Sheriff Dart asserts he was unaware of the specific, day-to-day procedures the correctional officers used in restraining pregnant detainees.
State cases
Alford v. Osei-Kwasi 203 Ga.App. 716 (1992)	Court of Appeals of Georgia	Does the use of a taser on a pregnant inmate constitute an Eighth Amendment violation?	The court affirmed the trial court’s grant of summary judgment against the inmate and her minor son but reversed the trial court’s denial of the lieutenant’s motion for summary judgment	Only the unnecessary and wanton infliction of pain constitutes cruel and unusual punishment forbidden by the Eighth Amendment; the lieutenant took actions within the scope of his authorized duties, his position required the exercise of discretion, and Alford produced no evidence that these actions were willful, malicious, or corrupt.
Calloway v. City of New Orleans 524 So.2d 182 (1988)	Court of Appeal of Louisiana, 4th Circuit	Were the actions leading to the wrongful death of the inmate’s baby on behalf of prison officials considered negligent?	The court reduced the award of damages to $ 30,000 and affirmed the amended judgment holding defendants liable for the wrongful death of the prisoner’s child	Had the prison medical personnel timely transported the plaintiff, it is reasonable to conclude that proper medication would have prevented a premature delivery.

Issues

The issue in the majority of these cases involved either Eighth Amendment violations or the debate surrounding qualified immunity for correctional officials. Specifically, cases involving Eighth Amendment violations were related to various issues, including shackling, indifference to the inmate’s medical needs, and the use of a taser. Regarding qualified immunity, various officials claimed that they were entitled to this because their obligation was not clearly established at the time of the incident. In another case, an inmate was shackled despite being in the final stages of labor and being in severe pain throughout the process. In most of these cases, these lawsuits stemmed from death or serious injury to the baby, or emotional distress on the part of the mother, with the exception of the cases where prison officials were seeking qualified immunity.

Decisions and reasons for the decision

Overall, the decisions in these cases tended to be evenly decided in terms of whether or not they were in favor of the inmate. In cases where the inmate delayed seeking medical care or in cases where factual problems needed to be considered, for example, courts decided against the inmate. However, cases that involved shackling tended to be decided in the inmate’s favor. As it relates to decisions involving qualified immunity, this was granted to individuals who were not directly involved in the care of the inmate. However, this has been denied to correctional officers in private facilities, even those who were directly involved in the care of the inmate.

Analysis of State Statutes and Administrative Regulations

As of September, 2013, 41 states and the District of Columbia had enacted statutes or administrative regulations that relate to reproductive care or the care of pregnant women, including childbirth, in correctional facilities (ACLU, 2013). Links to these statutes and administrative regulations were obtained through the ACLU website. This section will identify and then analyze the 42 states and jurisdictions that have statutes or administrative regulations related to the care of pregnant inmates. A comparison of the statutes and administrative regulations as found on the ACLU website is provided in Table 2.

Table 2.

Analysis of State Statutes and Administrative Regulations Related to Pregnant Inmates.

State/jurisdiction	Statute, administrative regulation, or both	Shackling?	Prenatal care?	Counseling?	Childbirth/postpartum period?	Other references?
Alabama	AR	Leg irons will not be used at any time during transport Belly chains will not be used regardless of their level of custody	Medical exams given to all pregnant inmates All high-risk pregnancies screened for treatment All pregnant inmates will be provided obstetrical care consistent with community standards of care	NA	Leg irons will be used to secure the inmate to the bed by cuffing one leg to the bed after delivery; will only be used when the inmate has come from recovery and placed in a room	Once notified that an inmate is pregnant, the social worker will ensure the documentation for a sponsor who is identified by the inmate for the unborn child is completed
Alaska	S/AR	NA	Prenatal visits determined at the clinical discretion of the physician The prisoner shall receive proper prenatal care	Female prisoners shall be provided with counseling regarding family and pregnancy upon request.	Routine postpartum visits are scheduled after delivery, but the date and time of doctor’s visits or procedures will not be disclosed to the inmate in advance While the inmate is in the hospital, physical contact with newborn may be limited The childbirth will be arranged to take place at a hospital that is normally outside of the institution	NA
Arizona	AR	The Electronic Mobilization Belt shall not be used with a pregnant inmate Pregnant inmates shall not be restrained during delivery After the birth, prescribed custodial level restraints shall be reapplied Inmates shall be restrained in the least restrictive way possible	NA	NA	NA	NA
Arkansas	AR	NA	Providing comprehensive care services that are necessary to reach term or to interrupt pregnancy in accordance with applicable regulations, standards, and statutes	Providing appropriate and timely counseling in planning for the custody of unborn children and to ensure that procedures for the placement of the child is in his or her best interests	NA	NA
California	S/AR	Pregnant inmates shall not be placed in restraints by the wrists, ankles, or both during labor, including during transport, delivery, and while in recovery, unless deemed necessary for safety and security purposes	Every female inmate will be supplied with information regarding family planning	Pregnant inmates are referred to a social worker to discuss placement of the unborn child and options available after delivery	Institutions housing pregnant inmates shall develop local operating procedures to ensure a safe and healthy delivery A ducat shall be issued for the offender’s 6-week postpartum checkup Support persons may be present by request	Methadone treatment shall be provided to all pregnant offenders who have been on heroin or who are currently receiving treatment
Colorado	S/AR	The staff of a correctional facility or private contract prison, when restraining a female inmate, shall use the least restrictive restraints necessary to ensure safety of the staff of the correctional facility or private contract prison have actual knowledge or a reasonable belief that the inmate is pregnant Restraints may be used if medically necessary for safe childbirth, if there is a flight risk, or there is a risk of harm to self or others No leg shackles or waist restraints during labor and delivery, during the postpartum period, or during transport for childbirth	Interested females may be provided with information about appropriate methods of birth control Females have the responsibility to determine whether they wish to have an abortion	Supporting outside agencies may aid the offender in child placement planning The Department of Corrections will provide counseling and assistance to pregnant offenders in keeping with their expressed desires in planning for their unborn children	The childbirth should be arranged to occur at a hospital outside of the institution Physical contact with newborn may be restricted while the mother is hospitalized Those who wish to put their child up for adoption or opt for placement in foster care will be offered available options under state law	NA
Connecticut	AR	NA	Receipt of care in the form of appropriate diet, vitamins, and routine obstetrical clinical visits	Inmates may receive care in the form of counseling	NA
Delaware	AR	Restraints should not be used during labor and delivery; the application of restraints during other pre- and postpartum periods should be restricted as much as possible, and, when used, done so in consultation with medical staffUnder no circumstances shall leg or waist restraints be used during labor and delivery	Recommended medications, treatments, and follow-ups will be provided with the health of the fetus taken into consideration	Upon request, counseling will be provided for offended for those who wish to have abortions	Medical staff will arrange appropriate childbirth arrangements to take place at a local outside medical facilityChild placement is the offender’s responsibility prior to childbirth and no newborn will return to the correctional facility with the mother	Those who are in a methadone program will continue to receive methadone
District of Columbia	AR	The DOC shall place no restraints on any woman in labor, during delivery, or in recovery immediately after deliveryDuring third trimester of pregnancy, no restraints shall be used unless there is a history of assaultive behavior	Pregnant inmates shall be provided with confidential and comprehensive prenatal careNo DOC officials shall, in any manner, have an influence on whether or not an inmate has an abortion	If pregnancy is suspected, the inmate is transferred to an in-house clinic to receive pregnancy testing and counseling	NA	NA
Florida	S	NA	Prenatal care and medical care will be provided throughout the duration of the pregnancy	NA	Pregnant inmates are temporarily transferred to a hospital outside of the detention facility when giving birth	Receipt of supplemental food and clothing and excused from inappropriate work assignmentsAn inmate shall be transferred to a hospital if complications arise that are beyond the scope of the detention center’s medical facility
Hawaii	S	No restraints of any kind may be used during the third trimester, during postpartum recovery, or during any portion of the pregnancy if ordered by a physician, except in extraordinary circumstancesNo leg irons or waist chainsAny restraints used shall be the least restrictive availableIf the professional treating the patient requests that restraints not be used, the corrections officer must immediately remove all restraints	NA	NA	No correctional personnel shall be present in the room during labor or childbirth, unless specifically requested by medical personnel	NA
Idaho	S/AR	A correctional institution shall not use restraints of any kind on a prisoner known to be pregnant during labor and deliveryNo leg or waist restraints during deliveryCan be used to prevent injury to self or others or if there is a risk of escape	Family planning will be offered as part of the comprehensive health care and is available upon requestAbortions may be requested in consultation with a health care providerWomen who choose to continue their pregnancy shall receive obstetric care once the pregnancy is confirmed	Counselors and case managers will assist the woman in making a decision regarding the placement of her baby during her incarcerationWomen shall be provided information on community family planning resources to assure continuity of care in the community	At the onset of labor, the offender should be transferred to the local hospital for evaluationThe offender must make arrangements for the care of the infantRelevant health care records shall be transferred to the future health care provider or housing facility	NA
Illinois	S/AR	No handcuffs, shackles, or restraints of any kind may be used during the transport to the hospital for delivery of the babyUnder no circumstances are leg irons/shackles or waist shackles allowed to be used during labor	The decision to continue or terminate a pregnancy is made by the woman in consultation with her physicianThose considering abortion shall be provided with information related to the risks of the procedure and available alternativesOffenders shall be granted a furlough for the purpose of obtaining an abortion	NA	NA	NA
Indiana	S	NA	Necessary prenatal care and treatment shall be provided with acceptable medical practice and standards	NA	Necessary postnatal care and treatment shall be provided with acceptable medical practice and standardsWhen possible, arrangements should be made for the birth to occur in a hospital outside of the correctional facility	If a child is born in a correctional facility, this may not be mentioned on the birth certificate
Kansas	AR	NA	Pregnancy testing, routine prenatal care, and high-risk prenatal careHealth care staff should provide advice on proper levels of activity, safety precautions, and nutritional guidance and counseling	Pregnancy counseling is provided to inmates to determine their desire in planning for their unborn children	Postpartum follow-up is provided	Management of chemical addiction
Louisiana	S	An electronic restraint belt shall never be usedNo handcuffs behind the backNo leg ironsNo face-down placementNo restraints during labor unless medical staff orders therapeutic restraints for those who are a danger to self or othersNo restraints shall be used during pregnancy-related medical distress, or during transport	NA	NA	NA	The prison operator authorizing the use of restraints on a pregnant prisoner pursuant to this part shall, within 10 days of the use of restraints, make a written record of the use of restraints, which includes the type of restraint used, the circumstances that necessitated the use of restraints, and the length of time that restraints were used
Maine	S	NA	NA	NA	NA	Inmates may be exempt from the payment of medical and dental services if they are pregnant
Maryland	S	NA	A complete history, physical exam, and laboratory test shall be provided when requested by the inmatePrenatal care shall be provided with acceptable health standards, including regular appointments, medications, and patient education	NA	A reasonable time before the anticipated birth, the inmate may be transferred from the correctional facility to another facilityThe inmate shall be returned to the correctional facility as soon as possible depending on the inmate’s level of health	If an inmate is about to give birth in a correctional facility, the governor may exercise executive clemency regarding the sentence
Massachusetts	S/AR	NA	Inmates shall be provided with routine prenatal care, high-risk prenatal care, including those who are chemically addicted	Upon determination of pregnancy, the Health Services Administrator or designee shall notify the appropriate facility social worker to arrange access to counseling.Inmates who request an abortion will be provided with counseling services	NA	Pregnant inmates are immediately available for parole with a physician’s certification stating that the best interests of the child are contingent upon the mother’s parole
Michigan	S	NA	Pregnant inmates shall be provided information on prenatal care	NA	NA	NA
Minnesota	AR	Pregnant inmates must not be restrained during transport except for security reasons (flight risk, danger to self or others)	The decision to have an abortion lies solely with the offenderBoth therapeutic and elective abortions are provided	Following the abortion, referrals will be made as determined by the practitioner, which may include psychological services	NA	NA
Montana	AR	Each facility administrator will ensure that facility transport procedures emphasize public safety and address secure and medically approved restraint use for pregnant offendersFacilities that house female offenders will establish restraint procedures for the transport of pregnant offenders based on mutually approved security and medical considerations	NA	NA	NA	NA
Nebraska	AR	NA	NA	Comprehensive counseling for those who have expressed desires to plan for their unborn children	NA	NA
Nevada	AR	NA	Available prenatal and intrapartum care	Family planning counseling	Birthing in an appropriate settingAvailable postpartum care	NA
New Hampshire	S/AR	Pregnant inmates classified as C-1 or C-2 will not be restrained; those classified as C-3 through C-5 will be restrained during the second and third trimesters by front handcuffs only; no belly chains or leg irons will be used during transportationDuring labor, inmates will not be restrained at all	Pregnancy testing and prenatal care shall be provided to each applicable inmate under the direction and supervision of physicians, nurse practitioners, and other fully qualified health officials; prenatal period begins with the 1st day of last menstrual period	Assistance will be provided to the pregnant inmate in keeping her expressed desires for her unborn child through comprehensive counseling and assistance through social services	The pregnant inmate shall submit information for two family members whom she wishes to be present with her in the delivery roomDuring labor, delivery, and recovery, the officer assigned to be with the inmate should be a female when possible	Inmates who are found to be addicted to alcohol or drugs will be assessed for detoxification treatment
New Jersey	S	NA	Pregnant inmates shall be provided with prenatal care and nutritional supplements and diets as prescribed by physicianThe correctional facility shall provide suitable maternity clothes, reasonable housing assignments, and appropriate exercise and reduced work schedules	Counseling and assistance shall be provided to the pregnant inmate for assisting in planning for her unborn child and in making decisions such as whether to keep the child or give it up for adoptionReligious and social counseling is provided	The father of the child, if not incarcerated, may be present in the delivery roomWhen the pregnant inmate chooses to carry the baby, arrangements shall be made in advance at an appropriate medical facilityAppropriate postpartum care shall be provided	NA
New Mexico	S/AR	Facilities shall use the least restrictive restraints necessary when the inmate is in the second and third trimesters of pregnancyNo restraints are to be used during labor unless there is reason to believe that the inmate is a danger to herself or others or if there is a substantial flight risk, then the least restrictive restraints are used	Provisions of pregnancy management are available, including pregnancy testing, a routine and high-risk prenatal care, and appropriate nutrition	Comprehensive counseling and assistance are available for pregnant inmates	Postpartum follow-up is providedBirth certificates/registries do not list the correctional facility as the place of birthWhen nursing infants are allowed to remain with mothers, provisions are made for a nursery where the infant is to be placed when not in the care of the mother	The management of chemically addicted offenders is enforcedPregnant inmates with a history of opiate use will be referred to the appropriate physician for assessment and treatment
New York	S	No restraints of any kind shall be used during transport to or from the hospital, institution, or clinic where the woman receives care, during labor, or after birthIf there is a risk of injury to self or others, the woman may be cuffed by one wrist	Comprehensive prenatal care shall be provided by qualified specialists, which includes regular examinations, advice on appropriate levels of activity and safety precautions, nutritional guidance, and HIV education	When giving birth, the woman shall be provided with comfortable accommodations elsewhere under such supervision and safeguards to prevent her escape from custody	Facilities and services for the rooming-in housing and care of infants shall be adequate to meet the needs of the inmate populationA child may be returned with its mother unless she is physically unfit to care for the child	NA
North Carolina	AR	NA	NA	Social work services include counseling, assistance in making the best possible placement plan for the child, parenting classes, maternal health education, and other support groups	All deliveries take place at an outside hospital; correctional staff is assigned to stay with the inmate during her stay in the hospital	If specialized care is required, then services in the community are referredEnsuring that the proper foods are received to meet dietary needs
North Dakota	AR	No restraints shall be used during labor, delivery, or in recovery immediately after delivery, and during the third trimester until laborDuring pregnancy, no restraints to be used during transport unless there is history of assaultive behavior or displays injurious behavior to self, fetus, or has escaped; in these cases, only front cuffs shall be used	NA	NA	NA	NA
Ohio	S/AR	NA	Pregnant prisoners shall receive prenatal care as determined necessary by the jail physician	The parenting coordinator/case manager discusses options for the pregnancy and physical custody of the child after birth	Prison nursery programs in institutions for women may be established to allow inmates and their babies to reside together	NA
Oklahoma	AR	NA	Prenatal care consists of those services necessary for the health of the pregnant woman and her fetus and includes offender education, ongoing risk assessment, and the development of an individualized offender management plan	Counseling and education is related to exercise, diet, and sterilization options during the first trimester, and signs of labor, danger signs, and common discomforts during the third trimester	All offenders should be delivered at the OU medical center’s department of obstetrics and gynecologyUpon discharge from the medical center, the offender will return to the facilityThe offender will be seen at 2 weeks, and 6 weeks postpartum	NA
Oregon	AR	Normal restraint procedures shall be modified for pregnant inmates; standard restraint procedure for pregnant inmates shall utilize handcuffs or flex-cuffs secured in front of the bodyThe inmate will not be restrained during labor, delivery, and recovery	The pregnant inmate shall receive obstetrical care as soon as the pregnancy is confirmedPrenatal vitamins will be ordered	Reproductive health care services, including family planning, pregnancy counseling, and abortion services, shall be provided in a non-judgmental fashion regardless of sex, race, religion, age, or marital statusGroup and/or individual counseling will be offered	At the onset of labor or the rupture of membranes, the inmate will be transferred to the local hospital	NA
Pennsylvania	S/AR	NA	If an inmate is pregnant, the medical department shall provide scheduled obstetrical examinations, prenatal vitamins, and any medication as prescribed by the physicianSpecialists in obstetrics provide prenatal careEach facility is responsible for prenatal careLab tests are to be done on every prenatal inmate	Postpartum education classes and counseling programs shall be made available to the inmate; separation issues and postpartum expectations and abnormalities shall be the focus of this programming	At the first signs of labor, the inmate shall be transported to the infirmaryThe obstetrical specialists also conduct postpartum follow-upVisitors are allowed in the birthing room if they are on the inmate’s approved visitors list	Pregnant inmates are required to have a TB test
Rhode Island	S/AR	During the second or third trimesters of pregnancy, only restraints deemed medically appropriate may be usedIf restraints are used, they should be applied in the least restrictive manner necessaryNo handcuffs, shackles, or restraints to be used during transport to a medical facility unless there is risk of harm to self, staff, or others, or if there is a substantial flight risk	NA	NA	Under no circumstances can leg or waist restraints be used during labor and deliveryWaist restraints not to be used under any circumstances during postpartum recoveryHandcuffs and leg restraints only used when there is risk of physical harm to self, staff, or others, or if they are a substantial flight risk	If health care professional treating the offender requests that restraints not be used, any correctional officer accompanying the detainee must immediately remove all restraints
Tennessee	S/AR	NA	An inmate initiating health services to confirm pregnancy is charged for the initial visit; subsequent events are non-chargeable	NA	NA	Furloughs can be granted for up to 6 months
Texas	S/AR	Restraints may not be used to control inmate at any time during labor, delivery, and recovery, unless there is a danger to self or others, or a flight riskIf restraints are used, they are to be used in the least restrictive way possible	Pregnant offenders will receive comprehensive health care in addition to appropriate sick call services, diet counseling, vitamins, routine specialty clinic appointments with obstetrical services, and all lab testing as deemed necessary	Pregnant offenders shall be provided with comprehensive counseling and assistance in keeping with their expressed desires in planning for their unborn children	NA	The department shall establish a screening program to identify female inmates who are between ages 18 and 44 years, sentenced to a term of confinement <2 years, and at risk for pregnancy with alcohol-related complications
Utah	S	NA	When a youth offender is pregnant, adequate prenatal care shall be provided	NA	There shall be placement in an accredited hospital prior to deliveryAs soon as her condition after delivery will permit, she shall be returned to the secure facility	If the division has concerns related to the offender’s ability to raise her child, the division shall petition the juvenile court to hold a custody hearing
Vermont	S/AR	Inmates shall not be routinely restrained after first trimester of pregnancyMechanical restraints of any kind shall not be used after she has been declared to be in active labor; the inmate shall remain unrestrained after delivery while in recovery at the hospital	NA	NA	NA	Reasonable and appropriate measures consistent with public safety are made to transport in a manner which prevents physical and psychological trauma, respects privacy, and represents the least restrictive means necessary
Virginia	S	NA	Pregnant inmates shall be provided with obstetrical and medical social services	NA	NA	Substance abuse services shall develop policies and procedures for the timely and appropriate treatment of pregnant women with substance abuse
Washington	S/AR	NA	Services provided include diagnosis of pregnancy, prenatal care, care for complications, physician services, hospital services, and pregnancy termination	NA	Services provided include delivery and postpartum care	NA
			These services will be provided in the most appropriate setting, such as the institution’s clinic or a community facilityOffenders known to be pregnant will be provided with HIV testing, unless they refuse to give consent
West Virginia		Pregnant inmates will not be restrained after reaching the second trimester of pregnancy, provided, that if the inmate poses a threat of escape, or to the safety of herself, the public, staff, or the fetus, the inmate may be restrained in a manner reasonably necessaryThe director or designee shall consult with an appropriate health care professional to assure that the manner of restraint will not pose an unreasonable risk of harm to the inmate or the fetus	NA	NA	NA	NA

Note. S = statute; AR = administrative regulation; S/AR = both statute and administrative regulation; DOC=Department of Corrections and TB does = tuberculosis.

Very few of these statutes or regulations specifically address standards set forth by the NCCHC and the American Public Health Assocation (APHA) (ACLU, 2013). The NCCHC provides specific indicators of compliance for pregnancy care in general, including prenatal medical examinations and testing, advice for inmates regarding suitable levels of activity and safety precautions, nutritional guidance and counseling, maintaining lists of specialized obstetrical services, written agreements with local facilities for childbirth, keeping a record of pregnancies and their outcomes, and having written policies and defined procedures that address compliance with this standard. Additional recommendations include providing pregnant inmates with counseling that is suitable with her intentions, depending on whether she wishes to keep the baby, place the baby up for adoption, or have an abortion. The standards provided by the APHA demonstrate some overlap with those of the NCCHC, but some additional important recommendations are provided. Some of these additional recommendations include special housing and diets, proper identification and referral of high-risk pregnancies, treatment to prevent the transmission of HIV to the fetus for women who are HIV positive, prohibiting shackling during labor and delivery, and ongoing access to newborns following delivery.

Shackling

Some states have recently enacted statutes and regulations regarding the shackling of pregnant inmates to reduce the likelihood of enforcement in prisons and jails. Twenty-one states have imposed regulations on their use during the various stages of pregnancy as well as during labor and delivery. When considering the use of shackles during the stages of pregnancy, nine of these states set limitations on their use during the second and third trimesters of pregnancy. For example, New Mexico only allows the least restrictive restraints possible to be used during the second and third trimesters of pregnancy. Most of these statutes and regulations provide an exception to the use of restraints if the inmate has a history of violent behavior. In addition, many of these states either place restrictions on or do not allow the use of restraints during transport. During labor and delivery, many of these states are much more relaxed in terms of the use of restraints, in many cases, disallowing their use.

Prenatal care

The analysis indicated that 31 states addressed some form of prenatal care for pregnant inmates. This ranges from prenatal care for juveniles, in the case of Utah, to the supply of prenatal vitamins to inmates, in the case of several other states. In most cases, however, states simply specify that prenatal care is available for pregnant inmates. Nine states address the possibility of abortion for pregnant inmates.

Counseling

Over half of the states (23 states) addressed the availability of some form of counseling for pregnant inmates; in most cases, this was provided to assist the pregnant offender in planning for her unborn child and assisting in the placement of the child after birth. A couple of states, including Oregon, provide counseling to inmates throughout all stages of pregnancy, including those who choose to have an abortion. Providing counseling to pregnant inmates allows them to express their feelings related to their babies as well as determine what the best possible placement might be for the baby based on the circumstances of the mother.

Childbirth/postpartum period

In terms of care for the pregnant inmate during childbirth and the postpartum period, only 13 states addressed making transfers to outside hospitals for labor and delivery. This is an important consideration, as most prison infirmaries are not equipped to meet the needs of childbirth. In addition, many of these states restrict the mother’s contact with their newborn child. This can be problematic as it relates to bonding between the mother and the baby, especially if the mother intends to keep the baby after her release from prison, or unless she is physically or mentally unable to care for the baby. Ohio differs from the majority of states in that it allows for prison nurseries to be establishes so that inmates and their babies can reside together. Some states (13 states) address some form of postpartum care for mothers; this ranged from simply stating that postpartum care was available to transfer as soon as possible after delivery to a secure facility.

Other references

Only a handful of states (seven) addressed the availability of chemical dependence treatment for pregnant inmates. This is concerning, considering that many pregnant inmates are likely to be addicted to alcohol or drugs. More states should address these issues in the mother so that this will be less likely to have harmful impacts on the baby. A couple of states provide clemency or furloughs for pregnant inmates, which is included in this column.

The majority of states only provided basic information regarding prenatal, intranatal, and postnatal care by only stating that these forms of care were available for pregnant inmates. These states failed to follow the guidelines provided by the NCCHC and the APHA by only referencing a small portion of the recommendations.

Toward a Model Statute

Based on this analysis, the states that appear to be the most comprehensive in addressing the care of pregnant inmates are California, New Hampshire, New Mexico, and Pennsylvania. They address a variety of medical issues related to pregnant inmates, including the care of the pregnant inmate, as well as the baby following birth while the mother is incarcerated. Collectively, these states provide restrictions on shackling pregnant inmates, particularly during the second and third trimesters, as well as during labor. In addition, these states provide for prenatal care for pregnant inmates with regard to family planning and pregnancy testing. These states also consider the best option for the placement of the baby by providing counseling and social services to the pregnant inmate. As it relates to inmates with a history of alcohol or drug use, these states seek to address these issues by recommending treatment. The remaining states should follow the trend of these states as it relates to the treatment of pregnant inmates, because these states appear to provide a variety of options for such inmates. A recommended model statute is summarized in Table 3.

Table 3.

Recommended Model Statute.

Shackling	Prenatal care	Counseling	Childbirth	Postpartum period	Alcohol/drugs
Least restrictive restraints to be used during the second and third trimesters of pregnancyNo restraints to be used during labor	Information shall be provided regarding family planningPregnancy testing and prenatal care shall be provided to inmates by health professionals specializing in obstetrics; this includes routine exams, lab tests, and prescribed medications	Comprehensive counseling shall be made available for the pregnant inmate, including the use of social services; this includes discussing the placement of the unborn child, separation issues, and postpartum expectations	During labor, delivery, and recovery, the officer assigned to be with the inmate should be a female when possibleSupport individuals may be present by request, pending prior approvalOperating procedures shall be developed to ensure a healthy and safe delivery	Obstetrical specialists shall conduct postpartum follow-up visits	Pregnant inmates with a history of drug or alcohol abuse will be referred for assessment and treatment, if necessary

Discussion

Although some state statutes and administrative regulations address some of the specific health related needs of pregnant inmates, other states have either failed to do so adequately or not at all. The medical needs of females in the correctional setting need to be properly addressed so that both mother and baby stay healthy in the long run. Many females who enter prisons and jails are in poor health and are at high risk because of substance addiction, sexually transmitted diseases, and being of lower socioeconomic status, which most likely results in fewer visits to physicians. Not only is the health of the fetus at risk because of these conditions, but because not all jails or prisons routinely provide obstetrical and gynecological services to female inmates, such inmates are at risk for having undetected diseases, such as ovarian cancer, breast cancer, and abnormal pap smears (Arnold, 2004).

From this analysis, it appears that many of these state statutes and administrative regulations are inadequate for meeting the needs of pregnant inmates both during the pregnancy as well as during the postpartum period, according to the guidelines provided by the NCCHC and the American Public Health Assocation (APHA). Two states that appear to be the most comprehensive in their coverage of pregnant inmates are California and Pennsylvania. The issue of the use of restraints on pregnant inmates has recently been controversial. Some states have recently passed laws that prohibit the shackling of pregnant inmates during labor. In some instances, policies have attempted to justify the use of shackling by stating that inmates may be a danger to themselves or others, or that they pose a substantial flight risk. Remaining states that have not passed policies prohibiting shackling should follow the example of states that have successfully passed such policies.

To best address the needs of inmates during pregnancy and during the postpartum period, states should consider the best option for the baby. If the mother is physically or mentally unfit to care for the infant, adoption should be considered. For mothers with substance abuse issues, these problems should be addressed as soon as the problem becomes apparent to reduce health risks to the mother and the baby. Also, more states should consider limitations on the use of restraints during the second and third trimesters of pregnancy, as well as during labor and delivery. Any falls resulting from the limited range of motion resulting from the restraints could be detrimental to the baby.

Issues revolving around pregnant inmates continue to be addressed as a problem across prisons and jails, yet little research has been conducted on this group of inmates. Although fewer women are incarcerated in comparison with men, and only a small portion of these women are pregnant, more research is needed to determine the best methods of addressing the medical needs of this population. This article examines the plight of pregnant prison inmates with the hope that the needs of this generally powerless and dispossessed segment of American polity can be better addressed and improved in consonance with the “evolving standards of a decent and maturing society.”

Although only a relatively small number of female inmates enter prison while pregnant, there is a need for rules to determine how these inmates should be treated. These rules are designed for the good of the inmate as well as that of the baby who, after all, is a future member of the free society. Some courts have protested the rights of both the inmate and the baby under the rubric of the prohibition against the cruel and unusual punishment clause of the U.S. Constitution. Legislatures have also enacted laws in the interest of just treatment and humanitarianism.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author Biographies

Leah McCoy Grubb, PhD, is a recent graduateof the College of Criminal Justice, Sam Houston State University. She is currently employed with the Texas Department of Criminal Justice. Her research interests focus on women in the criminal justice system, legal issues, and sexual offending.

Rolando V. del Carmen, PhD, is distinguished professor of criminal justice (law) in the College of Criminal Justice, Sam Houston State University. He obtained BA and LLB degrees from Silliman University in the Philippines, an MCL from Southern Methodist University, an LLM from the University of California–Berkeley, and a JSD from the University of Illinois in Champaign–Urbana. He has authored numerous books and articles on law and criminal justice.

References

American Civil Liberties Union. (2012). The shackling of pregnant women and girls in U.S. prisons, jails, and youth detention centers. Retrieved from http://www.aclu.org/files/assets/anti-shackling_briefing_paper_stand_alone.pdf

American Civil Liberties Union. (2013). State standards for pregnancy-related health care and abortion for women in prison. Retrieved from http://www.aclu.org/state-standards-pregnancy-related-health-care-and-abortion-women-prison-map#3

American Correctional Association. (2012). Public correctional policy on use of restraints with pregnant offenders. Retrieved from http://edpdlaw.com/ACA%20Policies.pdf

Amnesty International USA. (2001). Women in custody. Retrieved from http://www.amnestyusa.org/pdf/custodyissues.pdf

Arnold

K. D.

(2004). The right to live: A constitutional argument for mandatory preventative health care for female prisoners. William & Mary Journal of Women and the Law, 10, 343-366.

Barry

E. M.

Ginchild

Lee

(1995). Legal issues for prisoners with children. In Gabel

Johnston

(Eds.), Children of incarcerated parents (pp. 147-166). New York, NY: Lexington Books.

Bureau of Justice Statistics. (1999). Women offenders. Washington, DC: U.S. Department of Justice.

Clark

A. H.

Foy

D. W.

(2000). Trauma exposure and alcohol use in battered women. Violence Against Women, 6, 37-48.

Commonwealth of Massachusetts. (2014). H.B. 1433, 188th Sess. (Mass. 2014) (presented by Kay Khan, sponsor). Retrieved from https://malegislature.gov/Bills/188/House/H1433

10.

Cordero

Hines

Shibley

K. A.

Landon

M. B.

(1991). Duration of incarceration and perinatal outcome. Obstetrics & Gynecology, 78, 641-645.

11.

Doetzer

(2008). Hard labor: The legal implications of shackling female inmates during pregnancy and childbirth. William & Mary Journal of Women and the Law, 14, 363-392.

12.

Egley

C. C.

Miller

D. E.

Granados

J. L.

Ingram-Fogel

(1992). Outcome of pregnancy during imprisonment. Journal of Reproductive Medicine, 37, 131-134.

13.

Estelle v. Gamble, 429 U.S. 97 (1976).

14.

Griggs

C. L.

(2011). Birthing barbarism: The unconstitutionality of shackling pregnant prisoners. Journal of Gender, Social Policy & the Law, 20, 247-271.

15.

Hotelling

B. A.

(2008). Perinatal needs of pregnant, incarcerated women. The Journal of Perinatal Education, 17(2), 37-44.

16.

Johnson

E. H.

(1969). Childbirth to women under sentence: Characteristics and outcome. Carbondale, IL: Center for the Study of Crime, Delinquency, and Corrections.

17.

Johnston

(1995). Effects of parental incarceration. In Gabel

Johnston

(Eds.), Children of incarcerated parents (pp. 147-166). New York, NY: Lexington Books.

18.

Kampfner

C. J.

(1995). Post-traumatic stress reactions in children of imprisoned mothers. In Gabel

Johnston

(Eds.), Children of incarcerated parents (pp. 147-166). New York, NY: Lexington Books.

19.

Kaukinen

Demaris

(2005). Age at first sexual assault and current substance use and depression. Journal of Interpersonal Violence, 10, 1244-1270.

20.

Levi

Kunakemakorn

Zohrabi

Afanasieff

Edwards-Masuda

(2010). Creating the “bad mother”: How the U.S. approach to pregnancy in prisons violates the right to be a mother. UCLA Women’s Law Journal, 18, 1-77.

21.

McCall

Casteel

Shaw

N. S.

(1985). Pregnancy in prison: A needs assessment of perinatal outcome in three California penal institutions. Washington, DC: Office of Justice Programs.

22.

Muftic

L. R.

Bouffard

L. A.

Armstrong

G. S.

(2016). Impact of maternal incarceration on the criminal justice involvement of adult offspring. Journal of Research in Crime & Delinquency, 53, 93-111.

23.

National Commission on Correctional Health Care. (2010). Restraint of pregnant inmates. Retrieved from http://www.ncchc.org/restraint-of-pregnant-inmates

24.

Parker

(2006). Pregnant women inmates: Evaluating their rights and identifying opportunities for improvements in their treatment. Journal of Law and Health, 19, 259-295.

25.

Sichel

D. L.

(2008). Giving birth in shackles: A constitutional and human rights violation. Journal of Gender, Social Policy & the Law, 16, 223-255.

26.

Siefert

Pimlott

(2001). Improving pregnancy outcome during imprisonment: A model residential care program. Social Work, 46, 125-134.

27.

Tapia

N. D.

Vaughn

M. S.

(2010). Legal issues regarding medical care for pregnant inmates. The Prison Journal, 90, 417-446.

28.

Wooldredge

J. D.

Masters

(1993). Confronting problems faced by pregnant inmates in state prisons. Crime & Delinquency, 39, 195-203.