Being Pregnant in Prison Is a Nightmare That Won’t Be Ended by One Bill Alone

Crystal Muñoz was four months pregnant when federal agents knocked on her door. They assured the Texas mother that she wasn’t in any trouble; they just wanted to know about a map she had drawn for some people two years earlier. Little did she know that talking with them would lead to a 20-year prison sentence — and delivering her baby with her wrist and ankle cuffed to a hospital bed.

Federal agents arrested Muñoz for conspiracy to distribute marijuana. The courts allowed her to stay at home with her husband and months-old daughter until the end of her trial. When a jury convicted her in October 2007, she was sent to the Ector County Detention Center to await sentencing. By then, she was in her last trimester.

“It was horrible to be in there at all,” Muñoz told Truthout, “but to be pregnant [in that jail] was super-awful.”

She recalled being handcuffed and shackled — with cuffs around her wrists and ankles — when she was brought to an outside hospital for prenatal visits. Depending on the officer, she might also have a metal chain wrapped around her waist.

Each day brought the same meal — beans, cornbread and bologna, even though lunch meats can cause listeria in pregnant people and result in serious illness for fetuses. Muñoz requested extra fruits and vegetables to no avail. The jail did not supply prenatal vitamins. Her husband attempted to navigate the jail bureaucracy to bring her a bottle, but despite his efforts, the vitamins never reached her.

The American College of Obstetricians and Gynecologists states that pregnant people should drink eight to twelve cups of water each day, but Muñoz recalled that meals were the only times that the jail provided drinking water. Otherwise, women would have to drink water from the bathroom sink, the same sink where people brushed their teeth, washed their hands and washed their panties. “And it’s right by the toilet,” Muñoz added.

Not wanting to risk bacteria, Muñoz hid empty potato chip and snack bags, filled them with ice, then drank the contents.

The day after Christmas, Muñoz went into labor. She was brought to the hospital, where officers secured her left wrist and left ankle to the bed posts. Although the attending doctor ordered the officers to remove the restraints, they did so slowly — first freeing Munoz’s ankle and, when she began birthing her baby, her wrist.

“I was super-healthy, so she came out super-healthy,” Muñoz said, recalling that her baby was the same size as her first daughter. But if she had had a more difficult pregnancy, or preexisting health conditions, her pregnancy and birth might have been much worse.

Now, federal lawmakers are seeking to improve pregnancy care in the federal prison system.

In October, Senators Amy Klobuchar (D-Minnesota) and Susan Collins (R-Maine) introduced the Protecting the Health and Wellness of Babies and Pregnant Women in Custody Act. Rep. Karen Bass (D-California) introduced a similar House bill in March.

The legislation bans restraints during pregnancy, a prohibition already enacted by the 2018 First Step Act. It also prohibits placing pregnant people in solitary confinement during their third trimester.

The bill also directs the Bureau of Prisons, which oversees all federal prisons, to provide regular access to water and bathrooms, nutritionally adequate diets, prenatal vitamins as well as information about parental rights and lactation. These protections would only apply to pregnant people in federal jails and prisons.

Data Show Thousands of Pregnant People in Prisons, But Mostly in State Prisons

Carolyn Sufrin is a medical anthropologist, OB-GYN and an assistant professor at Johns Hopkins University School of Medicine. She is also the founder of the organization Advocacy and Research on Reproductive Wellness of Incarcerated People (AARWIP), which researches reproductive health care behind bars. During a 12-month period between 2016 and 2017, ARRWIP found that approximately 4 percent of people entering state and federal prisons and 3 percent of people entering jails were pregnant.

“The vast majority of pregnant people who are incarcerated are not in the federal system,” Sufrin told Truthout. During ARRWIP’s 12-month data collection, there were 172 pregnant people in federal women’s prisons, comprising 0.3 percent of the federal women’s prison population. Since then, those numbers have not increased significantly.

In addition to prohibiting shackling during pregnancy, the 2018 First Step Act instituted data collection on pregnancy and pregnancy outcomes in federal prisons. In 2019, federal authorities reported that 180 pregnant people had been incarcerated in federal facilities that year. Ninety-four gave birth while incarcerated. Federal authorities reported one instance of handcuffing a pregnant person, allegedly for disruptive behavior.

The following year, as COVID-19 began spreading across the country, 91 pregnant people were incarcerated in federal facilities. Thirty-nine were released before giving birth; of the 52 who remained, 50 had live births, one had a stillbirth and there was one maternal death. There were no reports of restraints of pregnant people.

Many states do not collect or report pregnancies or pregnancy outcomes in their prisons or jails. The new federal bill would alleviate that black hole by directing the Bureau of Justice Statistics, which collects and publishes data about incarcerated people in the United States, to include information about pregnancy, pregnancy-related care and the use of solitary confinement during pregnancy.

Legislation Is Not Always Enough to Ensure Humane Treatment

The bill comes too late to help Muñoz, who was granted clemency by then-President Donald Trump and reunited with her now-teenage daughters in February 2020.

But even for future people who are pregnant behind bars, legislation doesn’t necessarily ensure that prison or jail officials will follow the new measures. In 2009, formerly incarcerated mothers and their allies succeeded in passing legislation in New York to end shackling during labor, delivery and postpartum recovery. But despite the law, as late as 2014, prison officials continued to clap pregnant people in handcuffs, leg irons and belly chains when transporting them to outside medical visits — and even restrained them in the hospital hours after they had given birth.

In 2018, Maryland passed a law requiring jails and prisons not only to have written policies to address pregnancy and child placement, but to provide incarcerated people with these policies. In 2019, the state also passed a law prohibiting jails and prisons from placing pregnant people in solitary confinement.

Kimberly Haven, the executive director of Reproductive Justice Inside, helped draft both bills and has been monitoring implementation. She noted that in July 2021, two years after the prohibition of solitary confinement for pregnant people, Jazmin Valentine was placed in solitary after being arrested on an alleged probation violation. She gave birth alone in her jail cell after jail staff and nurses ignored her pleas for help, telling her over the course of six hours that she was merely withdrawing from drugs, not in labor.

“The reason we wrote this bill was just for this reason,” Haven told Truthout. “We came to them [Maryland’s jails and prisons], offered our trainings and training materials, and we were rebuffed.”

While the federal bill allows for the use of restraints or solitary confinement under extreme circumstances, it requires federal jails and prisons to review their use every few hours and report any such use.

But, noted Sufrin, “those [reporting requirements] are after the fact. There are no mandatory sets of health care standards or system of oversight or accountability to entice jails and prisons to follow the standards.”

Ultimately, said Sufrin, the solution to inadequate and terrible pregnancy and postpartum care “is not to incarcerate pregnant people in the first place and to invest in access to adequate pregnancy and postpartum care in the community.” But, she added, “that’s going to take a long time. We need some mandatory standards and systems of oversight and accountability.”