The Urgent Need to Address Reproductive Rights and Justice Within the Carceral System
A Crisis of Human Rights for Pregnant Women in Prison
Across the United States, countless pregnant individuals are subjected to inhumane treatment within correctional facilities, with existing policies often failing to protect their basic rights. Despite growing awareness, the systemic neglect and abuse persist, revealing a dire need for comprehensive reform.
Personal Narratives Highlight Systemic Failures
In December 2024, I connected via Zoom with Pamela Winn, a passionate advocate whose voice has become a beacon for incarcerated women’s reproductive rights. Her story is a stark reminder of the brutal realities faced by pregnant women behind bars. Winn’s experience of serving a 78-month federal sentence in Georgia, while pregnant, exemplifies the dehumanization endemic to the system.
At just six weeks pregnant, Winn was shackled around her ankles, wrists, and abdomen-a restraint that caused her to fall while being transported for a court hearing. It was only after enduring multiple medical requests over several weeks that guards permitted her to see a healthcare professional. Conditions within the facility-unsanitary environments, poor ventilation, contaminated water, expired food, and verbal abuse-left her with no choice but to accept these violations as part of her punishment.
The Trauma of Medical Neglect and Forced Birth
Winn’s suffering intensified when she experienced severe cramps and bleeding, crying out for hours without response until emergency services were finally called. She recalls, “They shackled me when they found out I was pregnant, and continued to do so even during my miscarriage. I was chained to a bed, with male officers refusing to look away. It was humiliating and dehumanizing.” Her fetus was reportedly discarded in the trash by guards, and upon her return to prison, Winn was placed in solitary confinement-a punishment that underscores the systemic disregard for her dignity and health.
Her story is not isolated. For many incarcerated women, these traumatic experiences are commonplace, yet their voices are often silenced or ignored. Winn’s advocacy has contributed to legislative efforts such as the First Step Act, aimed at reducing federal sentences, and the Dignity for Incarcerated Women Act, which bans shackling and solitary confinement for pregnant and postpartum individuals. Still, Winn reflects, “It feels like we’ve made progress, but in reality, nothing has truly changed.”
Recent Investigations and the Silence of Mainstream Media
In early 2023, the Senate Subcommittee on Human Rights, led by Georgia Senator Jon Ossoff, launched an investigation into the treatment of pregnant women in detention. The findings revealed over 200 documented violations, including non-consensual obstetric procedures, forced childbirth in cell conditions, shackling during labor, and even hearing about infant deaths via phone calls. Despite these alarming revelations, coverage in national media outlets remains limited, highlighting how the dominant narrative often marginalizes women’s experiences in the carceral system.
The Overlooked Reality of Women’s Incarceration
The discourse surrounding mass incarceration tends to focus on male populations, neglecting the unique challenges faced by women and pregnant individuals. This oversight hampers our understanding of how the prison system perpetuates trauma, especially for those subjected to gender-based violence. Critical questions remain: Are the constitutional rights established under Roe v. Wade extended to incarcerated women? Does the guarantee of healthcare under Estelle v. Gamble translate into quality care within prisons? Are policies in place to ensure routine reproductive health services, including screenings, prenatal care, and abortion access?
Disproportionate Incarceration and Its Impact on Women
Although women constitute less than 10% of the prison population, their incarceration rate has surged by 585% since 1980, outpacing that of men. Nearly half of these women are held in jails-county or municipal facilities where most are either awaiting trial or have not been convicted. Additionally, over half are mothers to minor children, and approximately 4% are pregnant at the time of incarceration.
Reproductive Justice and the Carceral State
The concept of reproductive justice, coined in 1994 by women of color activists, encompasses the right to have children, not have children, and parent children in safe environments. The prison system systematically violates these principles by restricting access to contraception and abortion, forcibly removing children from their mothers, and denying essential prenatal and postpartum care. These practices echo historical abuses rooted in slavery, where enslaved women’s reproductive capacities were exploited to sustain the institution.
Gaps in Healthcare and Policy Failures
Prison healthcare systems often lack clear policies tailored to women’s needs. For example, many facilities do not provide routine gynecological care, STI screenings, or pregnancy support. Reports indicate that women frequently feel neglected or mistreated by healthcare providers, many of whom lack specialized training. The trauma of sexual assault-both outside and inside detention-further complicates their healthcare experiences.
States vary widely in their policies. In New York, over half of jails have prenatal care policies, yet none address labor and delivery. Such gaps can lead to adverse maternal and infant health outcomes, as exemplified by Tiana Hill, a pregnant woman detained in Georgia, who recounted giving birth prematurely in her cell and losing her baby shortly after.
The Racial and Racialized Dimensions of Shackling and Maternal Health
Shackling pregnant women remains a contentious issue, with over 37 states enacting some restrictions. Nonetheless, the practice persists, often disproportionately affecting women of color. Racial disparities in maternal health are stark; Black women in the U.S. are three to four times more likely to die from pregnancy-related causes than white women. Shackling and inadequate healthcare exacerbate these disparities, reflecting a long history of racialized violence and neglect.
Inadequate Sexual and Reproductive Healthcare in Detention
Despite the HIV epidemic’s history within correctional facilities, testing and treatment remain insufficient. Only 16 states conduct comprehensive HIV screening in prisons, and access to preventive measures like PrEP and PEP is limited. The lack of reproductive health services perpetuates cycles of disease and neglect, especially for marginalized populations.
Historical Roots of Reproductive Oppression in the U.S.
The systemic suppression of Black women’s reproductive rights has deep roots in slavery and racialized policies. Laws like partus sequitur ventrem-which dictated that the status of the child followed that of the mother-ensured the continuation of slavery through reproductive control. Enslaved women were often forcibly impregnated, and their pregnancies exploited for economic gain. Medical experimentation and sterilization without consent, especially during Jim Crow, further targeted Black women, embedding reproductive coercion into the fabric of racial oppression.
The War on Drugs and Its Racialized Impact
The punitive policies of the 1980s and 1990s, notably the War on Drugs, disproportionately affected women of color. Sentencing for drug offenses soared, with Black and Hispanic women experiencing increases of over 800% and 300%, respectively. Media narratives vilified Black mothers, branding them as neglectful or dangerous, fueling racial stereotypes and harsher sentencing.
The Intersection of Poverty, Sex Work, and Criminalization
Economic hardship and the criminalization of sex work trap many women in cycles of incarceration. Laws targeting sex workers often criminalize victims of trafficking or abuse, further marginalizing vulnerable populations. These overlapping oppressions-racism, sexism, and economic inequality-compound the injustices faced by women of color in the criminal justice system.
Reproductive Rights as a Human Rights Issue
The mistreatment of pregnant women and mothers in detention exemplifies how the carceral system undermines fundamental human rights. From forced sterilizations to denial of prenatal care, these practices violate international standards and moral principles. The criminal justice system’s approach often prioritizes punishment over care, perpetuating cycles of trauma and marginalization.
The Role of Surveillance and Data Gaps
The increasing use of surveillance technologies-such as GPS ankle monitors and audio tracking-extends control over incarcerated and formerly incarcerated women, infringing on privacy and autonomy. Moreover, data collection on healthcare quality and outcomes remains inconsistent, hampering efforts to implement meaningful reforms. Without accurate data, policy solutions risk being ineffective or misdirected.
Legislative Efforts and the Path Forward
Recent bills like the Births in Custody Reporting Act aim to improve data collection on pregnancy and birth outcomes in detention facilities. While promising, these measures often lack enforcement mechanisms or fail to include the voices of those most affected. True progress requires a shift from reform within the existing system to abolitionist approaches that challenge the very foundations of carceral control.
Abolitionist Frameworks and a Vision for Justice
Reimagining justice involves recognizing that incarceration is not the solution to social problems. Abolitionist perspectives advocate for community-based alternatives that prioritize care, safety, and dignity. Instead of merely making prisons “better,” the goal should be to eliminate unnecessary incarceration altogether, especially for pregnant women and marginalized communities.
Building a Collective Future Rooted in Care and Dignity
Moving beyond punitive models, abolition calls for investments in social services, healthcare, housing, and education-resources that foster genuine safety and well-being. Recognizing the humanity of incarcerated women and their right to reproductive autonomy is essential in this transformative process. As advocates and policymakers, our responsibility is to listen, learn, and act to dismantle systems of oppression and build equitable communities where everyone’s dignity is upheld.
About the Author
Ira Memaj, MPH, is a public health educator and researcher specializing in health policy and sexual and reproductive health rights based in New York City.
