Roosevelt Institute | Cornell University

Birth in Chains: Maternal Harm Behind Bars

By Elena MessingerPublished April 28, 2019

inmate, pregnant, handcuffs
In many American state prisons, inmates are required to wear restraints when traveling outside their correctional facility. For pregnant women, this commonplace practice can have near catastrophic effects.

Last year, the New York Police Department faced backlash when a woman was forced to wear handcuffs while giving birth. Despite strong objections from the hospital staff, she was placed in restraints for the duration of her delivery. In December, she filed a lawsuit seeking damages for her traumatizing, and illegal, experience.

The New York State legislature has somewhat condemned the use of restraints on pregnant women. In 2015, it strengthened prohibitions against shackling women in labor and a post-partum period of eight weeks. Compared to other states with anti-shackling legislation, New York’s protections are narrow. While ten states limit shackling for a woman’s entire pregnancy, New York regulation begins with labor. Disparities also exist regarding physician authority to remove constraints and whether these rules apply to juveniles. That being said, the very existence of New York’s regulatory legislation is anomalous. Only twenty-two states check the shackling of pregnant inmates at all.

Recently, the issue of shackling was addressed on a federal level. The First Step Act, enacted in December of 2018, largely ended the imposition of restraints on pregnant women in federal correctional facilities. Yet, most women are not locked up in federal prisons. The front lines of female incarceration are state facilities and local jails.

These legislative chasms are unacceptable. State legislators need to terminate the practice of shackling pregnant women — action is required on a regional scale. The impact of this widespread restraint use is destructive and unnecessary. 

There are perilous health risks associated with experiencing pregnancy in chains. Restraints, which prevent pregnant women from breaking falls, can cause abdominal trauma and hypertensive conditions. They also interfere with a healthcare provider’s ability to monitor pregnancy and perform emergency lifesaving measures. Especially during labor, a mother’s mobility is critical in limiting discomfort and the need for medical intervention.

Such treatment can incur significant emotional trauma as well. A report from the American Psychological Association noted, “these risks are taken with a population that has a higher-than-average rate of mental health problems, including post-traumatic stress disorder, depression and substance abuse.” Restraints have the propensity to both produce new psychological conditions and worsen existing ones. In recognition of its detriments, the American College of Obstetricians and Gynecologists (ACOG) and the American Public Health Association have formally denounced this use of shackling.

Police often justify such dangerous measures by labelling pregnant women possible “flight risks.” The idea persists that incarcerated women will attempt escape while visiting the doctor or during labor. However, this precaution is superfluous. It is improbable that during the taxing experience of delivery, a woman will successfully flee her armed officers. It is similarly incorrect to assume incarcerated women pose a violent threat to civilians they encounter; the vast majority of women are arrested for nonviolent offenses. The shackling of pregnant inmates ultimately causes more physical harm than it prevents.

Every year, thousands of women are affected by unfair state shackling policies. Despite the decentralized nature of female imprisonment, researches have discerned clear, persistent trends. Notably, in recent decades, the number of women in prisons and jails has increased with an unparalleled vigor. According to The Sentencing Project, “between 1980 and 2016, the number of incarcerated women increased by more than 700%, rising from a total of 26,738 in 1980 to 213,722 in 2016.” Women, and specifically women of color, are the fastest growing population in correctional facilities. Approximately 12,000 pregnant women are incarcerated annually. At least sixteen-percent of these women give birth while in custody.

At present, twenty-eight states are complicit in a practice that actively harms women. Women are forced to give birth in chains. Women forgo their own health in the name of “public safety.” And, women spend years reconciling mental trauma formed in hours of delivery. Shackling pregnant women, especially during birth, is dangerous and unethical. There should be overwhelming support for measures that address this state legislative neglect.