Taken from the May/June 2014 issue of the Women's Health Activist Newsletter.

Before the recent TV series, “Orange is the New Black,” it’s likely that many of us had never looked at our criminal justice system with a personal lens — let alone a compassionate one. Although the show is less than perfect, it may provide the first level of exposure to the issues for people whose lives have not been personally touched by incarceration.

In 2012, the U.S. had just under 7 million individuals in prison, jail, probation or parole; an estimated 100,000 individuals in juvenile detention centers; and 478,000 people held in immigration detention.ⁱ For context, if we took everyone (children included) who lives in San Francisco, Washington D.C., Seattle, Houston, Chicago, and Miami, and put them in cages, we would still fall short of this total number, by over 50,000.

As you contemplate the idea of those cities as ghost towns, also think about the fact that more and more of the nation’s incarcerated population are women. The rate of incarceration for women is now increasing at nearly double the rate of men.ⁱⁱ

Incarceration has unique and shattering effects on women, their families, and their communities. Reproductive justice demands a focus on the needs of those who have faced the greatest harms, and an end to systems that foster these harms. Dr. Martin Luther King once said: “True compassion is more than flinging a coin to a beggar; it comes to see that an edifice which produces beggars needs restructuring.” For women’s rights advocates, our criminal justice system is one edifice that absolutely needs to be restructured.

Histories of Abuse

Our criminal justice system fails horribly at recognizing the forces that drive our nation’s increase in prisoners: poverty, substance abuse and trauma. A majority of women are in prison due to drug crimes and property crimes related to drug use.ⁱⁱⁱ

Incarcerated women are called junkies, crackheads, drunks, and are seen as unfit parents. Rarely is it possible for them to share their stories about the conditions — of poverty, stigma, abuse, and addiction — that lead them to acts of crime and despair. Nor are there many opportunities for them to share courageous stories of overcoming conditions that are unimaginable to many of us. But, by listening to these women’s stories and looking deeper into available social science research, it is clear that our nation is punishing survivors of trauma.

Women’s paths to incarceration are complex and often rooted in histories of multiple abuses —childhood sexual abuse and other forms of sexual, physical, and intimate partner violence.^iv A women’s drug use is often triggered by violence, either past or current.^v Struggling with mental health problems without sufficient support systems and effective mental health treatment is also linked to coping through addiction.^vi

Incarcerated women need access to services to address mental health, addiction, and intimate partner violence — but, instead, they are placed in a system that presents even greater barriers to needed care. Of the incarcerated women with substance abuse histories who need treatment, only 20 percent in state prisons, and 12 percent in Federal prisons, receive it.^vii  Worse, the programs that do exist are usually bare-bones and fail to address underlying social problems — including sexual and physical violence, poverty, and sexism — that deeply affect many women’s history with drugs.vⁱⁱⁱ

Further troubling, our laws and policies do not fall evenly across racial/ethnic lines, due to racism at every level of criminal justice system.^ix In 2010, African American women were incarcerated at nearly three times the rate of White women, and Latina women were incarcerated at a rate 1.6 times that of White women.^x This isn’t because these women of color are more likely to be criminals or to use drugs at a higher rate than White women. Rather, people of color are far more likely to be stopped, searched, arrested, prosecuted, convicted, and incarcerated for drug law violations than White women are.^xi

Young women of color who are survivors of abuse are also more likely to become involved in the criminal justice system than White girls — and even more likely to be if they are gender nonconforming.^xii These women also have lower chances of being treated as survivors and victims and to be referred to child welfare or mental health systems.^xiii

Instead of being treated for trauma, depression, addiction, and other injuries of violence, these women are displaced into the criminal justice system.^xiv A system that does not address the underlying trauma and abuse that likely contributed to women’s involvement with drugs and imprisonment may actually exacerbate them.

Abuses During Incarceration

Incarceration places women at risk of widespread sexual and physical violence at the hands of correctional officers.^xv Many women are unable to escape or control daily contact with their abuser. Abusers are rarely reprimanded; out of all complaints made in 2004, only one-third of accused staff were referred for prosecution; of those referrals, half were discharged, and one-tenth were disciplined but not discharged.^xvi

Abuses also include denial of needed health care. Many incarcerated women are in poor health and have chronic and/or communicable medical problems including HIV, Hepatitis C, and other sexually transmitted infections (STIs).^xvii But, their physical and mental health is routinely put at risk by ill-conceived security policies as well as delays in accessing both emergency and routine health care.^xviii

Incarcerated women receive minimal reproductive health care and what they do receive is often not provided in accordance with professional ethics standards. Six percent of incarcerated women are pregnant at any given time, but do not have access to prenatal care or birthing options, such as midwives or birthing centers. Prison food does not provide adequate nutrition to support a healthy pregnancy and these women have little, if any, access to prenatal vitamins.

As a result, the health of those who carry their baby to term and the fetus’s health are at risk. We know of incarcerated women in Washington State who were denied their 24-hour bonding period after birth as well as the chance to breastfeed their babies. Women who undergo cesarean section deliveries are often denied painkillers after a c-section. Even with the passage of laws that end the practice of shackling pregnant women prisoners during labor (the use of handcuffs, leg irons and waist chains) in 18 states, corrections departments in at least 23 states allow restraints to be used on women during labor; some allow women to be restrained during transportation and postpartum.^xix (See one woman’s personal story, below.)

For those who want to prevent or end a pregnancy, options are similarly limited and abuses are common. Some women are denied desired abortions, while others are subjected to non-consensual terminations. In addition, many women are denied access to contraceptives during incarceration and upon release. Even women who have established health histories that indicate a medical need for contraception apart from pregnancy prevention, such as oral contraceptives for treatment of menstrual disorders, are denied those medications. Instead, prisons exert coercive control over the bodies of incarcerated women, subjecting them to irreversible reproductive harms like non-consensual sterilization. Last year, an independent investigative report revealed California prisons had done tubal ligations on 148 women between 2006-2010 without following the approval process established by state law to protect them from coercion.^xx

A Need to Focus on Incarcerated Women’s Health

The abuse women experience in prison has devastating consequences for those who are survivors, have high rates of depression, and/or who are working on overcoming substance abuse and addiction. We must follow Dr. King’s advice and let our compassion act.

The Affordable Care Act provides opportunities to ensure that women have access to needed reproductive health, effective mental health services, and addiction treatment. But, when it comes to incarcerated women, many additional policy changes are needed. For example, many states terminate Medicaid coverage for incarcerated women, forcing them to re-apply for Medicaid benefits upon their release. This results in long delays in getting vital treatment and services. This problem can be mitigated by providing enrollment services upon release and “suspending” Medicaid access instead of terminating it, so that women do not need to re-enroll.

Women who are struggling with substance abuse and addiction need and deserve a public health response, rather than criminalization and the increased rates of incarceration and associated abuses that follow. And health advocates must bring a new focus and higher priority to the concerns of those women who are subjected to incarceration. By addressing the needs of these most marginalized women in our society, we will enhance liberty for all women’s reproductive lives. Learn more about how you can get involved at:http://nationinside.org/campaign/birthing-behind-bars.

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“D.S.” is a Doula and Birthing Justice Advocate who works in Seattle, WA.

Lillian Hewko, J.D. is the NWHN Reproductive Justice Fellow (LSRJ) and Co-Founder of the Incarcerated Mothers Advocacy Project in Seattle, WA.

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