How can we treat pregnant inmates humanely when we don't even keep track of them?

Thank you for supporting our journalism. This article is available exclusively for our subscribers, who help fund our work at The Baltimore Sun.

The harrowing stories of the experiences of pregnant women in prison have come from across the country in recent years. Women having little access to doctors and prenatal care, delivering in cells or giving birth while shackled. Lawyers have filed lawsuits on behalf of women in the most egregious cases.

But until now nobody in the justice system had good statistics on how many pregnant women were locked up in state and federal prisons, let alone the standard of care they were receiving. It was like the needs of these women were invisible — a tragic and unacceptable fact as the United States faces intense criticism for having some of the worst infant and maternal death rates in the world.


That thankfully changed recently with research released by Johns Hopkins Medicine that presented the first systematic look at pregnant women in prison and what happens to their babies.

The researchers from the medical system’s Pregnancy in Prison Statistics project found that from 2016 to 2017 1,400 pregnant women were admitted to federal prisons and in the 22 states that were studied. More than 90 percent of those pregnancies ended up in healthy deliveries, and no moms died from complications.


The researchers also collected other important health data on the mothers, including whether they had a substance use disorder or mental illness, that they will share later.

The data didn’t delve into whether these women are getting adequate care in prison, but the information gathered is an important starting point in improving maternity care for incarcerated women. You can’t begin to solve a problem if you don’t even know what the scope of that problem is. Lead researcher Dr. Carolyn Sufrin, an assistant professor in gynecology and obstetrics at the Johns Hopkins University School of Medicine, also said the information could be used to set up national guidelines for caring for pregnant women or even to come up with incarceration alternatives for these women.

It is puzzling that pregnancy concerns have been overlooked, given that most of the women in prison are of reproductive age. The ranks of women entering the prison system swelled during the tough-on-drugs crime era, but the prison policies haven’t kept up. The pregnancy data is part of a larger movement to treat women in prison more humanely, which has included making basic needs such as sanitary napkins easily available to female prisoners.

More than 110,000 women were in federal and state prisons in the United States at the end of 2016, and 75 percent were of reproductive age, or 18 to 44 years old, according to the Bureau of Justice Statistics. The Hopkins researchers found that the last time the bureau collected data on pregnancy was in 2004, and it relied on self reporting from prisoners. We’re talking a deplorable 15 years ago. At that time about 3 percent of women in federal prisons and 4 percent of women in state prisons reported they were pregnant at intake.

The Hopkins research data covered one year from 22 state prison systems (including Maryland’s), the Federal Bureau of Prisons, six jails and three juvenile justice systems. These prisons account for 58 percent of all the incarcerated women in the United States.

Also significant to note is that 28 state prisons didn’t participate, including three large systems — California, Florida and New York. States gave various reasons for opting out, including not having the resources. The prison officials who run these systems need to make it a priority and find the resources given that this is data these systems should be keeping on their own anyway.

We encourage the researchers to take their work further and look at how prison polices correlate with pregnancy outcomes. Are there certain policies or practices that would result in one system having more c-sections or miscarriages than another? The Hopkins data found more c-sections in the prison population than the general population. Is this an indication that prison officials are choosing the delivery option most convenient to the system, since c-sections can be planned, rather than giving mom a choice? The researchers say they will interview women in follow-up studies about their experiences.

Maryland’s correctional system has made improvements in recent years in how it cares for its pregnant inmates, who are taken mostly to the University of Maryland Medical Center. Health care company Corizon provides maternal care, and the state is also implementing a doula program and baby bonding program where inmates can visit weekly with their children in a nursery until they are three years old. State law prohibits the shackling of inmates during pregnancy.


The treatment of pregnant women should be part of a more passionate criminal justice reform that focuses on preparing people for when they re-enter society. Many women are in for non-violent crimes or personal issues, such as substance abuse, mental illness or crimes related to poverty that point more to a person who has life issues rather than someone with a criminal mindset. As Dr. Sufrin has said in her extensive research on incarcerated woman, jail has “become a safety net for women on the margins of society.” Within that sad reality, we need to do everything possible to make sure women don’t leave prison more broken than when they entered.