The United States (US) incarcerates more people than any other nation, with 1.8 million individuals currently held in US prisons and jails. Structural racism is the foundation of the US criminal legal system: Black and Indigenous communities bear the brunt of the crisis of American mass incarceration.

In the past thirty years, women’s incarceration rates climbed significantly faster than men’s. A shocking 25% of women incarcerated globally are in the US. Most are between the ages of 15 and 49, with an estimated 50,000 pregnant individuals admitted to prisons and jails each year.

Although healthcare behind bars is a constitutional right, the standard of care in most facilities is low. Many healthcare needs go unmet, including for reproductive healthcare and obstetric care. Most states also separate individuals from their infants 24 to 48 hours after birth. These gaps in healthcare and unnecessarily punitive practices contribute to negative physical and mental health outcomes for parents and infants.

It is estimated that 21 states have implemented enhanced perinatal support programs in carceral settings. These holistic additions to standard reproductive care for pregnant and postpartum individuals feature one or more of the following: group prenatal and postpartum education; one-on-one labor, birth, and separation support; and lactation programming.

Offering enhanced perinatal support services and person-centered birth workers in carceral settings is an explicit application of the Reproductive Justice (RJ) framework which empowers and advocates for birthing individuals. Developed by SisterSong Women of Color Reproductive Justice Collective, RJ holds that all individuals are entitled to “safe and dignified” reproductive healthcare and experiences. Communities of color, specifically, have historically been denied equitable access. Mass incarceration and the conditions of healthcare behind bars are inherently incompatible with Reproductive Justice.

Eight states participate in Enhanced Perinatal Programs for People in Prison (E4P). They include Alabama (Alabama Prison Birth Project), Arkansas (Growing Together), Connecticut (Empowered Beginnings), Georgia (Georgia Prison Motherhood Project), Michigan (Michigan Prison Doula Initiative), Minnesota (Minnesota Prison Doula Project), Oregon (Oregon Prison Birth Project), and Virginia (Virginia Prison Birth Project).

The United States carceral system uses a gender binary in its language and facility categorization. In this project, we use gendered language only when referencing prior research and DOC statistics. We recognize a broad spectrum of individuals with the capacity for pregnancy and use inclusive language such as “pregnant people” and “birthing individuals.” We also recognize that most past research on pregnancy within carceral settings centered cis-gender women and fails to capture the lived experiences of transgender and gender diverse individuals. We aim to broaden the research lens to honor and understand these nuances. We further commit to using person-first language such as “incarcerated individuals,” recognizing that incarceration is a condition – an external imposition of authority and oppression – not a defining characteristic of the individual.

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