Georgia remains hostile to women’s health care

Most incarcerated women are primary caregivers whose children are thrust into a world of uncertainty. For those able to maintain custody of their children, the substantial barriers to reentering communities created by thousands of collateral consequences drive a cycle of poverty and marginalization. For pregnant incarcerated women, few are informed of their induction date because of a hypothetical security threat. For similar reasons, family and other support persons are not permitted in the room during the delivery. In fact, the family is usually only notified of the birth when called on for guardianship. National physician organizations endorse continual access to newborns for mothers after delivery. This period has proven critical to bonding, breastfeeding and the health of both parties. In practice, most women receive little to no time with their newborn. The separation from their child, whether after an hour or a few days, is uniquely cruel and utterly devastating. Many of these children are funneled into foster care, where 1 in 5 later enter the criminal legal system themselves. In sum, incarceration drives adverse childhood experiences leading to worse health outcomes and intergenerational criminal legal involvement.

A new paradigm of justice for women

The first step forward involves data collection. A patchwork of county, city, state and federal systems make any carceral data collection difficult, and federal incentives along with oversight and sanctions for noncompliance are likely required to see significant change. However, it is not enough to simply count the number of confined pregnant women. External medical oversight is critical to improving the conditions for those incarcerated today. This would enhance both transparency and accountability, ensuring long neglected needs such as treatment for substance use disorders are managed according to guidelines. These improvements collectively represent harm reduction, as carceral environments undermine much of what makes medical care meaningful to patients. Health care is predicated on healing, safety and autonomy — values fundamentally opposed by incarceration.

Ultimately, jails and prisons are not and will never be appropriate environments for pregnant people. Some jurisdictions, including Colorado and Minnesota, have sought alternative sentencing. These programs allow for the diversion of incarcerated pregnant persons into community settings for the duration of their pregnancies and varying lengths of time postpartum. These programs ultimately fall short as mothers typically must return to carceral facilities and family separation endures.

We have the capacity to envision more than a dystopian future of women prisons and jail cells rebranded as mother baby units. There are limitless possibilities that would better support reproductive justice and public safety. Our goal cannot be a slightly better cage. If we take seriously that most social determinants of health are also determinants of crime, we can demand investments based around prevention of harm. We must not lose sight of the fact that nearly all women in the carceral system have first been victimized themselves — both interpersonally and structurally. Maintaining social structures that perpetuate marginalization and criminalization distracts from real solutions and far superior investments.

Carceral spaces undermine the health of individuals, families and communities. Likewise, data proves incarceration is often counterproductive to public safety. These facts make clear that the status quo and subsequent devastation brought by the caging of mothers is indefensible. The compounding of trauma and separation of families is an ongoing, widespread assault to the larger goals of reproductive justice. What should now be clear to all is that fighting for reproductive justice is likewise a project of health justice and racial justice. By rejecting carceral spaces for pregnant women, perhaps the door can be opened to redefining justice for all.

Megan Wasson is a student at Emory University School of Medicine student and future obstetrician and gynecologist. Mark Spencer is an assistant professor of medicine at Emory University and executive director of Stop Criminalization Of Our Patients (SCOOP).