Incarcerated and pregnant: Motherhood behind bars

GETTY IMAGES

Pregnant women must deal with hurdles while incarcerated, including limited bonding opportunities with their newborns.

Part of a series produced in partnership with Pulitzer Center.

Kristie Puckett found out she was pregnant about a week before she was arrested in 2008. At the time, she was suffering from a substance use disorder.

“I was a young mother when my victimhood and substance use disorder were criminalized,” she said. “I didn't receive treatment, I received incarceration.”

While being held in Mecklenburg County Jail, she received no prenatal care, which is why it wasn’t until she was in labor that she learned she was having twins, who were born premature.

Due to a lack of adequate healthcare, Puckett wasn’t entirely sure how far along she was, or the health of her pregnancy.

“It wasn’t a refusal; it just didn’t happen. Nobody said, ‘no you can’t have any care,’ there was just no care,” she explained.

Puckett took a guilty plea to ensure that her children were born free, which was a priority for her as a Black woman.

“It’s important when we talk about pregnant people, but especially about Black pregnant people, we’re going to be talking about the core of all Black people’s fight for citizenship; and then there’s a second part of that: if we are granted citizenship, are we capable of handling it? Can we rule and govern ourselves in a way that is productive? Black mamas, Black women, have always been seen as deviant in this country.”

Puckett said she knows mothers are allowed only two days of recovery in the hospital with their newborns. Moms can get an extra two days if they opt for the more invasive, more expensive c-section. Puckett said mothers will  take risks if it means they can spend more time with their newborn.

“We don’t see incarcerated people as people, or as people who are deserving,” Puckett said. “The dehumanization – we don’t refer to people by their names but as numbers. It’s easy to overlook their very real needs, because now they become more of a commodity or property, as opposed to a person.”

Puckett said her experience is the standard, because there is no standard of care. Today, she lobbies with the law, policy and strategy center at Forward Justice, which is part of North Carolina Second Chance Alliance. She also said that there are people who receive care that they don’t need, like being routinely sterilized.

The number of women behind bars has been steadily outpacing the growth of the male population nationwide. 64.6 women per 100,000  are incarcerated in the United States, according to a 2020 article in the Journal of the American Academy of Psychiatry and the Law. Earlier this year, the Prison Policy Initiative reported that approximately 190,600 women and girls are incarcerated in the U.S., and that between 2009 and 2015, more women were added to state prison populations than men.

The National Institute of Corrections reported that as of 2020, the number of prisoners under the jurisdiction of North Carolina correction authorities was 29,461 located in 55 state prisons and held in custody of private prisons or local jails. In 2024, the Prison Policy Initiative’s profile for North Carolina reports that the state has an incarceration rate of 559 people per 100,000 people.

In its fiscal year 2021–22 report, the NC Department of Adult Corrections reported that there were 18,957 admissions to North Carolina prisons of which 15% were female. There were 47,607 total admissions to probation, post-release and parole programs; of which 23% were female. Females comprised 8% of the prison population. A 2019 article in the American Journal of Public Health reported that approximately 4% of women admitted to state prisons were pregnant between 2016 and 2017.

Erin McClain, MA, MPH is assistant director of Collaborative for Maternal and Infant Health at the UNC Chapel Hill School of Medicine. Starting in 2017, The North Carolina Perinatal Health and Incarceration Working Group, which included nonprofits and county and state health departments, collaborated to research the impact of the state’s criminal justice system on perinatal health.

McClain said that there are about 1,400-1,500 pregnant women incarcerated in North Carolina every year and one prison specifically for housing pregnant women: North Carolina Correctional Institute for Women.

“There used to be the assumption that all pregnant people in jails were sent to NCCIW,” McClain said. “We know that’s not the case.”

McClain explained that, due to lack of staffing and funding, resources are often not available to transport women and pregnant people to NCCIW, which is in Raleigh, especially from counties far away. Last year, the North Carolina Sentencing and Policy Advisory Commission published that the state’s jails are exceeding population projections.

North Carolina’s prisons were reported to be struggling to provide adequate healthcare for inmates suffering from substance abuse disorders, according to an April article from Carolina Journal. Law enforcement agencies are also struggling to recruit and retain personnel.

The NC Perinatal Health and Incarceration Working Group has been instrumental in crafting the 2021 Dignity for Women Who Are Incarcerated Act, which standardized policies across state prisons and county jails to ensure proper prenatal care of pregnant people.

“There's a level of medical care there that is more advanced than what the county jails can provide,” said Eddie Caldwell, executive vice president and general counsel of the North Carolina Sheriff’s Association of NCCIW.

Inmates can seek a safekeeping order from a judge to be transferred to NCCIW; safekeeping orders are generally granted to inmates who are considered “especially dangerous” or “especially sick.”

“As far as jails go, it is extremely rare for a pregnant woman to be in jail, and if they are, it is generally not for an extended period of time,” Caldwell said. He explained that only convicted women, or those with safekeeping orders and medical conditions, are housed at NCCIW. Women awaiting trial stay in jails.

A 2021 memo by NCDPS states that prenatal care consists of routine medical exams, nutrition guidance, counseling, substance abuse management and safety precautions. Most importantly, it prohibits shackling mothers while giving birth. The memo also standardizes that “all offenders of reproductive age” be administered a pregnancy test upon admission to any correctional facility and confirmed pregnancies will be transferred to NCCIW. At the time of its passing, North Carolina joined over 30 other states that have legislated against shackling laboring people.

“I don't think they run tests on men or women, for any particular medical condition, when they come into jail,” Caldwell said. “They ask them a bunch of questions and if the inmate identifies some medical conditions that they're dealing with, then they'll make sure that they get appropriate care staff.”  

Accessing data on the amount of incarcerated pregnant people in North Carolina, or the United States in general, is difficult. North Carolina does not currently have a standardized reporting system for data on pregnant individuals who are under carceral control in the state. Some counties consider that data protected by HIPAA. In 2017, a reported 81 babies were born to incarcerated women in North Carolina’s prisons and jails, with an additional 50 pregnant women incarcerated in prisons and jails according to the NC Department of Public Safety.

McClain said that children have been born to mothers alone in their cells in the past, and the supplemental nutrition pregnant people have received in county jails amounted to an extra carton of milk at mealtimes.

“We have had really unfortunate situations that we are still hearing about where the detention officer did not want to remove handcuffs from somebody who was undergoing labor, even though they were numb from the chest down,” McClain said. “Part of what was able to get the law over the finish line in the legislature is, unfortunately, we had a patient who, the officers did not remove the shackles, and the baby ended up dying.”

An advocate from the North Carolina American Civil Liberties Union informed The Post that it found many of the state’s county jails are not in compliance with the Dignity Act after compiling data from public records requests.

Some jails either don't have policies specific to pregnant people or have policies around pregnant people that contradict the policies of the Dignity Act. For example, some counties have written exceptions for shackling laboring people into their own policies although the Dignity Act completely prohibits it.

“I don't have any specific information, because I have not cross-examined or interrogated jail staff in any of the 100 or 90-some jails, but from talking to the sheriffs, I think they've all been trained on it and I have not heard one complaint, since law was enacted, alleging that anybody is not complying with the law,” Caldwell said. “So that tells me that compliance with the law is pretty universal throughout the state.”

Counties subcontract medical and health services to medical care companies, Caldwell explained. For example, Mecklenburg County contracts with Vital Core Health Strategies. Sheriffs are responsible for crafting healthcare plans for their jails, which includes allocating funds. Those plans are approved by county commissioners and health departments.

“The level of care that the pregnant female inmate receives is the amount of care that physician says is appropriate,” Caldwell said. “If you wanted to know what a doctor in a jail does when they are told that a female inmate is pregnant, you would have to talk to the company to see what they say. I suspect what they tell you is the same thing that a local doctor would tell you.”

Usually, children are placed with a relative while the birth mother remains under state control. Separation of infants from their birth mothers has negative health outcomes for babies and their mothers.

Breastfeeding is proven to be healthier for newborns by significantly reducing the risk of Sudden Unexplained Infant Death Syndrome, according to the National Institute of Child Health and Human Development.

The Centers for Disease Control and Prevention also reports that breastfeeding is mutually beneficial for the mother and the baby by strengthening the immune system, reducing the likelihood of respiratory disease, lowering blood pressure, and stimulating production of oxytocin, a hormone that can cause the uterus to contract and reduce bleeding.

Incarcerated mothers are often unable to access supplies or clean places to pump and store their breastmilk. Love Anderson, COO of Breastfeed Durham and chair of the North Carolina Breastfeeding Coalition, says there is currently no statewide practice that prioritizes lactation support for incarcerated mothers.

Separation of mothers and infants results in higher rates of mental illness, interactions with the criminal justice system for children of the incarcerated, and increased recidivism.

A 2021 article from the Journal of Midwifery and Women’s Health reported that there is a heavy association between post-partum separation of mothers and their infants and increased suicidal ideation amongst mothers.

The 2020 article from the Journal of the American Academy of Psychiatry and the Law also mentions that children whose mothers are incarcerated suffer from sleep disorders,  depression, anger, and anxiety, and are 2.5 times more likely to be incarcerated than compared with children of incarcerated fathers, and three times more likely than children whose mothers have never been incarcerated.

McClain said that it’s difficult to find a balance between allocating more funding to prisons and jails, even if it means it makes them more humane; in the same vein, Puckett said that more work should be done to stop criminalizing and locking people into a cycle of poverty to avoid these dynamics from happening in the first place.

“We keep addressing social political and economic issues with incarceration,” Puckett said. “As long as we continue to do that, we will never really see the return on the investment that we are looking for.

“If we want people who have experienced really traumatic events to display resilience and grit and turn those experiences and transform their trauma into lived expertise, then we have to put places and spaces in places that allow them to do that. Prison just compounds people who are already in a lot of pain.”

This article corrects the number of pregnant women incarcerated in North Carolina annually.

Comments