When Jail Is the Only Way to Get Prenatal Care

(Dave Nakayama/Flickr/Creative Commons)

My worst day in jail is better than my best day on the streets.” Every time Kima, a young mother I cared for while she was incarcerated and pregnant at the San Francisco jail, said this to me, my heart sank. She made this declaration—too many times for me to count—not because jail was comfortable or relaxing, but because her life outside of jail was so tumultuous, so precarious, that jail in comparison was a temporary salve.

As an OB-GYN and researcher who provides and studies women’s health care behind bars, I have gotten to know many pregnant women like Kima. Kima has a vibrant, spunky personality. She is a spoken-word artist whose beautiful poetry has brought me and others to tears. Kima also grew up in an unstable home, and her school was ill-equipped to help, so she dropped out as a teen. With no employment opportunities and poor social supports, she wound up homeless. She was sexually assaulted. She started using drugs to ease her pain, and eventually selling drugs to make ends meet; jail was next. Kima had been in and out of jail dozens of times for petty charges, and was arrested in her third trimester of pregnancy after shoplifting a bar of Dove soap. As usual, she could not afford bail, and she stayed in jail until two weeks after she gave birth to her baby girl. Jail was the only place where Kima got prenatal care. Why is that the case?

While the last few years have seen increasing calls for criminal justice system reform, one group has received minimal attention: women. Yet they have been the fastest-growing segment of the incarcerated population for decades. In 1980, there were a little over 12,000 women behind bars; in 2015, that number was over 210,000. Most of these incarcerated women are like Kima—young mothers, arrested for nonviolent charges. The majority of them suffer from mental illness and histories of abuse. Many, also like Kima, have limited access to health care and no stable housing. Pregnant incarcerated women have been abandoned by a safety net in disarray and policies that have relied on incarceration as a way to handle social and medical problems. And so jail has become the place where they can access medical care and other services.   

This is not to say that jail was cozy for Kima—it wasn’t—and we should not make jail harsher than it already is. Rather, it is to say that her life outside of jail was dangerous and demoralizing, so for Kima, jail was comparably better. This is our collective failure. 

Jail is a place intended to detain, confine, and punish. It is not intended to be the place for pregnant women to nurture their pregnancies or bond with their newborns. It shouldn’t be, but for many women, this is what it has become.

Even as many pregnant women rely on prenatal care in jails and prisons, what happens to them is astoundingly variable. At some places, like the San Francisco jail where I worked, women receive comprehensive prenatal care. That means regular clinic appointments, vitamins, ultrasounds, and access to emergency care. But at many places, women receive poor quality, barebones prenatal care. Others are shackled during labor, or give birth in their jail cells. And with a few exceptions, women are quickly separated from their newborns.  

The problem for Kima and for thousands of other pregnant incarcerated women is that it’s only getting worse.

In 2015, for the first time in four decades, there was a decline, albeit modest, in the number of women behind bars. Thanks to the Affordable Care Act, millions more women have gotten health-care coverage; some have even enrolled through programs in jails. But in 2017, Attorney General Jeff Sessions is breathing new life into the failed “war on drugs,” while promising to get more “tough on crime.” The House and Senate health-care bills plan deep cuts to Medicaid, causing an estimated 22 million people to lose their coverage. My patients in jail will be disproportionately affected by such cuts, and will enter jail sicker as a result.    

At a time when we need smarter policies that invest in people’s lives instead of in prisons, we are getting exactly the opposite. If we want people’s “best days” to be with their families, living healthy lives outside of jail, then we need to stop relying on jails to solve our country’s problems.

This article was posted in conjunction with the Scholars Strategy Network.

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