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Shackled and In Labor

Shackled Posters

Twenty-nine U.S. states allow pregnant incarcerated women to be shackled, even during labor and delivery. This barbaric practice has been condemned by many medical and international humanitarian organizations, including the American Medical Association, Amnesty International, and the United Nations Committee Against Torture. But it wasn’t until 2000 that even one state—Illinois—enacted legislation restricting the use of restraints.

Prisoners’ access to adequate health care, including reproductive health care, is a constitutionally protected right, according to the American Civil Liberties Union. However, the reality in U.S. correctional institutions is quite different. A new report investigating facilities across New York State found egregious problems in the care that incarcerated women receive. Reproductive Injustice: The State of Reproductive Health Care for Women in New York State Prisons by the Women in Prison Project of the Correctional Association, a criminal justice advocacy organization, provides details of this profoundly substandard care. Findings include pregnant women still being shackled during labor—despite a 2009 law banning this practice in New York State—routine separation of women from their newborns, and even lack of sufficient sanitary products.

“These conditions are not uncommon across the U.S. and in some places are even worse than in New York,” said Tamar Kraft-Stolar, director of the Women in Prison Project and author of the report. “This report sheds light on the deplorable standards of care in our prison system and reveals how incarcerated women are denied even a basic level of humanity and dignity. There’s a level of tolerance for the mistreatment of women in prison and for our misuse and overuse of prison because of who we incarcerate. It’s really racism and gender oppression that allows these practices to exist.” In fact, black women are three times more likely than white women to be incarcerated, and Latinas are 69 percent more likely.

The in-depth five-year study found virtually no oversight of reproductive health care; deplorable conditions for pregnant women, including lack of heat and ventilation in their housing areas and insufficient amounts of healthy food; denial of family support during labor; and instances of pregnant women being kept in solitary confinement, including a woman with an ectopic pregnancy, a condition that can be life-threatening. Researchers conducted more than 1,100 interviews with incarcerated women, security staff, doctors, and correctional officers; toured 20 facilities throughout New York State; reviewed medical charts; and compiled data from about 1,550 mail-in surveys from incarcerated women.

The U.S incarcerates more women per capita than any other country. But correctional facilities and policies have not adapted to the increase in women.

“The prison system is geared towards men, which is how shackling started in the first place,” explained Amy Fettig, senior staff counsel of the National Prison Project at the American Civil Liberties Union. “Men are always shackled when they are transported out of a correctional facility to receive medical care, and that policy has been applied across the board without considering the unique needs of women.”

Aside from the physical pain that shackling can cause, it is also emotionally brutal.

“I was handcuffed in the ambulance and gave birth 19 minutes after I got to the hospital. There was no one in the room except the officer, and they wouldn’t let me call my mother,” said Tina Tinen of her experience giving birth while incarcerated in a New York State facility in 2011, two years after the law barring the use of shackles was passed. “I was allowed to hold my son for a few minutes and then he was taken away. I didn’t see him for another seven hours. I was only allowed to see him once a day and I had to be in shackles. It made me feel like an animal to have to hold my son like that. Where was I going to go? I had just given birth. My child was being punished too.”

Maria Caraballo was transported to a hospital from a New York State facility in handcuffs and ankle restraints, also after the anti-shackling legislation had passed. “They handcuffed one hand to the bed. The doctor asked the officers to remove it, but they refused,” she explained. “I was handcuffed to the metal part of the hospital bed. The line is really short, so you can’t move because it twists around and cuts your wrist. You can’t lift your body up and push, like a regular person, and you don’t have anyone there to support you, help you, lift you up. I had it on the whole time I was giving birth, even when my daughter was coming out. They kept me handcuffed while I held her, and only took them off when I went to the prison ward. I was shackled for eight hours.”

In 2008, the Federal Bureau of Prisons barred the use of restraints in federal prisons with exceptions for extreme situations. By the middle of 2013, 17 states had adopted similar legislation. Maryland, Massachusetts and Minnesota passed anti-shackling bills last year, and the District of Columbia passed one in January.

But enactment of anti-shackling legislation has been an arduous process in many states, filled with setbacks. Friends of Iowa Women Prisoners (FIWP), an advocacy organization, reported that there have been bills before the state legislature there for years. Last year, “it passed the Iowa Senate with a wide majority,” said Terry Walker, an advocate from FIWP. “This is not a partisan issue, so we were hopeful about passage in the House. Unfortunately, the bill was not even assigned to committee in the House and failed to even be considered. In 2013, the bill even had the support of the Board of Corrections [which governs the Department of Corrections].” Advocates are working on getting the bill re-introduced this year.

In Massachusetts, a broad coalition of advocates including feminists, civil rights advocates, and criminal justice activists spent over a decade trying to pass an anti-shackling bill.

“It was a big effort—13 years in the making,” explained Megan Amundson, executive director of NARAL Pro-Choice Massachusetts. “The bill was first filed in 2001, and this past legislative session was the only time it actually saw any movement in the legislature. We had a coalition that worked specifically on this bill, a communications strategy, a grassroots organizing strategy, and a political strategy all working together to build enough momentum to get the bill passed.”

Formerly incarcerated women not only constituted a major part of the effort, but also raised public awareness about their experiences, explained Andrea James of Families for Justice as Healing (FJAH), a national organization that advocates for incarcerated women and works for alternative sentencing. “Most people don’t realize what we go through,” said James, who founded FJAH in 2010 while serving a sentence at the federal correctional institution in Danbury, Connecticut. “Not being able to breast-feed, being separated from your baby are part of being a mother in prison. These issues are often championed by people who aren’t directly impacted. The campaign around the anti-shackling bill was a chance for formerly incarcerated women to have their voices heard. It also built strong coalitions that are still in place. It opened the blinders on people who didn’t realize what was really going on within the Department of Corrections and provided a platform to expose some of their really bad practices.”

Advocates hope that anti-shackling bills will have positive ripple effects. “Shackling legislation is significant on many levels,” said Gavi Wolfe, legislative counsel at the ACLU of Massachusetts. “For women who are not shackled, it can mean better health outcomes, and certainly less cruelty and barbaric treatment. Women’s experiences giving birth matter. It’s also important to make a public policy statement that this is not okay. We shouldn’t have to make this kind of statement of principle in legislation because it’s so obviously unacceptable treatment, but apparently we do.”

“Anti-shackling legislation can potentially save lives,” said Veronica Lorson Fowler, of the ACLU of Iowa. “The Department of Corrections has been less than transparent about whether shackling has happened. Administrators said it wasn’t happening, and then we found media reports and photos that documented it.”

But even when states, like New York, pass anti-shackling bills, advocates have found that they lack teeth for across-the-board implementation, and women are still often restrained at some point during the birthing process.

“The challenge is to get legislation enforced,” said Deborah Golden, director of the DC Prisoners’ Project at the Washington Lawyers’ Committee for Civil Rights and Urban Affairs. “The big issue is how it’s implemented on the ground, getting the information out to providers and making sure that correctional officers know what they are supposed to do. There are thousands of agencies that detain people—juvenile facilities, police lock-ups, and so on.”

To that end, Prisoners’ Legal Services of Massachusetts and the Prison Birth Project have just received funding from the National Institute for Reproductive Health to monitor implementation of the Massachusetts law.

According to Mothers Behind Bars, a 2010 study by The Rebecca Project for Human Rights and the National Women’s Law Center, incarcerated women “often have undiagnosed or untreated chronic conditions such as depression, diabetes, hypertension and asthma.” Many have been victims of violence as children, abused by a partner, or both, and have not received treatment. The experience of being incarcerated can open up emotional wounds.

“Prison could be used to augment public health, but instead it often exacerbates poor health conditions,” said Fettig. “Women in prison already have difficult health care needs.”

Advocates are also pushing for more alternatives to incarceration programs for women who have been charged with a nonviolent crime, particularly mothers. A majority of incarcerated women have school-age children and are their primary or sole caretaker. Children with an incarcerated mother are more likely to suffer from a range of emotional issues as well to spend time in foster care. “Everything falls apart in a family when you imprison mothers,” said Fettig.

JusticeHome, an alternative to incarceration community-based program in New York City, graduated its first class of participants last year. Not one woman has been re-arrested. “When you address the circumstances of a woman’s life while maintaining the connections that mean the most—her home, her children, her job or school,” said Georgia Lerner, executive director of the Women’s Prison Association, “you give her a real chance to make positive and lasting changes.”




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