was born than those who weren’t put in restraints.
“Shackling does seem to impede infant-mother bonding,”
Dallaire also is examining health-care practices in general
for pregnant women in jails. In the first national study to look
at this population, currently under review, she and colleagues
found that most jails fail to follow national guidelines for
incarcerated pregnant women promulgated by groups including
ACOG. For example:
• Fewer than half of the 53 jails surveyed reported giving
pregnancy tests to all women who enter the facility, and less
than half provided fluid supplements or healthy food options
for pregnant women.
• Nearly half of the jails reported that pregnant inmates
addicted to opioids when they entered the facility went through
withdrawal with no medical assistance.
• More than 17 percent of the jails required that women be
handcuffed or shackled during and after delivery, and more
than half of them restrained women immediately after delivery.
Those findings square with a national survey of 19 state
prisons conducted by Ginette G. Ferszt, PhD, and Jennifer
Clarke, MD, and reported in the May 2012 issue of the
Journal of Health Care for the Poor and Underserved. The
team found that many state prisons fail to meet nutritional
recommendations for healthy pregnancies, that many pregnant
inmates don’t get adequate rest, and that psychosocial support
and education are minimal at best. Restraints were used “as a
matter of procedure in many facilities, even during labor and
delivery,” the study also notes.
Advocacy, policy and education
APA and psychologists are using this and related information to
educate policymakers and others with an eye toward reform. In
Minnesota, for example, Shlafer played a key role in urging the
state to adopt a comprehensive bill that not only limits the use
of restraints for pregnant women in custody, but provides them
with mandatory birth support and pregnancy testing. Passed
unanimously by the state House and Senate in 2014, the bill also
created a legislative advisory committee of representatives from
corrections, public health and human services now headed by
Shlafer. The group meets regularly to talk about how to balance
the women’s needs and safety concerns and determine ways to
implement the new policies.
On the federal level, APA has crafted a fact sheet and joint
policy statement with ACOG, the American Jail Association,
the National Commission on Correctional Health Care and
several other organizations calling on the federal government
to provide for data collection, training and technical assistance
and leadership on the issue of incarcerated pregnant women
and shackling. The statement also asks for federal policies that
would require standardized pregnancy care and evidence-and trauma-informed physical and mental health services for
incarcerated pregnant women.
The APA team also worked with Reps. Katherine Marlea
Clark (D-Mass.) and Karen Bass (D-Calif.) and House Judiciary Committee staff to usher related language into a prison
reform bill, H.R. 759, passed by the House Judiciary Committee Feb. 11. To keep up the momentum, APA also worked to
ensure that similar Senate legislation included provisions on
restraints, and participants in APA’s annual Leadership Institute for Women in Psychology visited Capitol Hill in March to
discuss the issue further.
Besides educating policymakers, a major issue to emerge from
this work is the need to educate and train corrections workers
and providers. As a step in that direction, Shlafer’s committee
wrote a pregnancy resource guide that is being distributed to
all correctional facilities in Minnesota. She and colleagues also
are providing trainings for jail nurses, correctional health-care
providers, jail administrators and others.
While these efforts are in the beginning stages, Shlafer and
others are seeing hopeful signs. On its own volition, for example,
the Minnesota Department of Corrections created its own
pregnant offender committee. Based on data from Shlafer’s
committee, the state now allows post-term women throughout
the state to pump and maintain their breast-milk supply so they
can continue breastfeeding when they return home.
“To me that’s a huge win, and not one that our committee
set out to see happen,” says Shlafer. “But it’s a place where we’ve
seen awareness and education and information help leverage
the system to change.” n
Research has found that more than 17 percent of
jails required women to be handcuffed or shackled
during and after delivery, and more than half of them
restrained women immediately after delivery.