AILSA CHANG, HOST:
A study published today counts the number of pregnant women in prison in one year - 1,396. It seems like a simple thing to do, but numbers like this haven't been gathered in decades.
CAROLYN SUFRIN: We need to know these numbers because when we don't know the numbers, that means that no one's looking, and anything can happen to these women.
CHANG: That's one of the authors, Dr. Carolyn Sufrin of Johns Hopkins School of Medicine.
SUFRIN: They can be shackled during childbirth. They can be placed in solitary confinement. They can have their complaints of contractions, bleeding, labor complaints ignored and deliver babies in their jail cells or prison cells.
CHANG: Delivering in cells is a worst-case scenario, but it does happen. As for shackling during birth, I spoke to Sufrin a few months ago on this program about that. It's something she has seen firsthand. She worked as an OB-GYN in a jail for six years, where she cared for incarcerated pregnant women. So for her, this work is very personal.
SUFRIN: Pregnant incarcerated people are one of the most marginalized and forgotten groups in our country, and the way that I think about it is that this is a reflection of the notion that women who don't count don't get counted.
SUFRIN: And women who don't get counted don't count.
CHANG: I mean, you note this really startling statistic that there are now seven times more incarcerated women in prison than there were in 1980, and yet prison facilities and the medical care offered to these women have not seemed to catch up to that reality.
SUFRIN: Right. And it's highly variable the kind of medical care that any incarcerated person but especially a pregnant incarcerated person would receive. Despite a constitutional mandate that prisons and all institutions of incarceration provide health care to people inside, there is no set of mandatory standards. There is no mandatory oversight that these institutions must follow. And so you get a wide range of some places that are actually providing relatively good pregnancy care and others that are providing harmful, neglectful or absent pregnancy care.
CHANG: So let's get into what your report covers. It's in the American Journal of Public Health.
SUFRIN: So from 2016 to 2017, we had 22 state prison systems across the country representing a geographically diverse range of states as well as the Federal Bureau of Prisons reporting to our study database every month for an entire year. And each month, they would report a variety of outcomes - how many pregnant people were admitted, how many births there were, miscarriages, abortions, stillbirths, maternal deaths. And that's how we collected the data.
CHANG: And I noticed that Florida, California and New York were not included in this report, and they have some of the largest prison populations in the country.
SUFRIN: That's right. Those three states along with Texas and Ohio had the largest populations of female prisoners in the country. Texas and Ohio were in our study. New York, Florida and California declined to participate. Participation was voluntary. But despite this, our data represent 57 percent of females in prison in the U.S.
CHANG: Oh, so more than half.
SUFRIN: More than half.
CHANG: You know, something that your study doesn't get into is that there are ripple effects from these births that are happening in prison. There are babies separated sometimes immediately from their mothers and never see their mothers again.
SUFRIN: That's right. We know that children who are separated from their mothers because they're in custody - they are more likely to end up in the foster care system even from birth, and everything is stacked against them...
CHANG: Yeah, yeah.
SUFRIN: ...Already and their opportunities for emotional stability and support, stable housing, education. And they're also more likely to be incarcerated themselves in the future. So the impact of these pregnancies on the next generation, on families, on communities, particularly communities of color, is profound.
CHANG: That's Dr. Carolyn Sufrin of Johns Hopkins School of Medicine. She's the author of "Jailcare: Finding The Safety Net For Women Behind Bars." Thanks so much for coming in today.
SUFRIN: Thanks so much for having me, Ailsa.