As Congress prepares to adjourn for the holidays, one piece of legislation that's still on the table is a bipartisan criminal justice bill known as the First Step Act.
It aims to improve federal prison conditions and reduce some prison sentences, a sticking point for some lawmakers. But the bill also contains a less controversial provision: a ban on shackling pregnant women.
Incarcerated people outside prison walls are considered potential flight risks. That label applies even to pregnant women when they leave prisons for medical care or to give birth.
These women are often restrained with handcuffs, ankle chains or shackles. Roughly two dozen states ban the practice of restraining incarcerated pregnant women during childbirth, but the First Step Act would apply to federal facilities.
The American Civil Liberties Union says shackling incarcerated pregnant women is "dangerous" and "inhumane." The American College of Obstetricians and Gynecologists says it puts the health of the mother and baby at risk.
Carolyn Sufrin, a medical anthropologist and OB-GYN at Johns Hopkins School of Medicine, works with incarcerated pregnant women. She says that the U.S. correctional system was designed with men in mind.
"When you have something as gender-specific as pregnancy, it reminds you of how flawed the system is and how ill-prepared it is to take care of pregnant people and the reproductive health needs of women in general," Sufrin says. "They're, if at all, an afterthought."
NPR's Ailsa Chang spoke with Sufrin about the practice of shackling incarcerated women. The interview has been edited for length and clarity.
On why incarcerated pregnant women are shackled
The rationale behind shackling is not something that I understand. When taken off-site all incarcerated persons are presumed to be dangerous and a potential flight risk. A pregnant person needs to be taken off-site for medical attention and for childbirth.
So when she's in a public space, the presumption is that she must be a flight risk and a public safety risk. Because of this default assumption, she needs to be restrained.
On delivering the baby of a shackled woman
When I was a first-year OB-GYN resident in training in Pennsylvania, I delivered the baby of a woman who was shackled to the bed. It made me more nervous and afraid and overwhelmed and also sort of confused me about my own role and my own complicity in this violence of shackling a pregnant woman in labor.
I had no idea that this was even possible and I didn't know if I was authorized to ask the guard to unshackle her. I just kept worrying about what I would do if there was an emergency. Luckily, the birth itself went fine.
This was a deeply troubling moment for me, of course much more so for the woman herself, but it's a pretty harrowing experience to have to practice medicine with someone who is in chains.
On the medical risks of shackling pregnant women
In labor, emergencies arise unexpectedly. We might need to do an emergency C-section if there are signs of distress or the baby's shoulder could get stuck in the birth canal. When one of these emergencies arises, as a health care professional, we need to focus on our patient, not on asking a guard to unshackle her.
And there are dangers throughout pregnancy, not just in labor and childbirth. If a pregnant woman falls, she could have a dangerous condition where the placenta separates and she could hemorrhage. Shackles can increase her risk of falling and also prevent her from being able to break a fall.
But on top of these medical risks, it's just common sense. The chances that a woman in the middle of labor, or even not in labor, can outrun someone and be a flight risk are just ludicrous.
I just gave birth six months ago and I can tell you that the thought of running off and escaping and outrunning anybody else is just ludicrous to me.
On the variability of medical care for incarcerated pregnant women
There are no mandatory standards that every prison and jail across the country has to follow when it comes to health services delivery. That means that every prison and jail has its own rules that it follows for pregnant people and the care they receive, including the use or nonuse of restraints.
But the issue really extends even much further than the use of restraints. It has to do with the entire health care for a pregnant person. There's tremendous variability and you can have some places that provide excellent, comprehensive prenatal care and other places where it's abysmal and even dangerous.
On why there's still work to do to ensure proper care for incarcerated pregnant women
This bill would only pertain to women incarcerated in federal facilities and under the jurisdiction of the U.S. Marshals Service, so it would not pertain to people incarcerated in state prisons, which is where the majority of women are incarcerated. It would also not pertain to women housed in local jails. And on top of that, it only addresses the issue of shackling pregnant women. That is an important step to take, but it is only the tip of the iceberg when it comes to the care of pregnant and postpartum women in custody.
Rachel D. Cohen is an intern on NPR's Science Desk.
Andrea Hsu and Jessica Smith produced and edited this conversation for broadcast.
AILSA CHANG, HOST:
There's not much time left before Congress leaves town for the holidays, and one piece of legislation waiting for a vote is a criminal justice reform bill known as the First Step Act. It is now up to Senate Majority Leader Mitch McConnell to bring the bill up for a vote. We've been reporting on how this bill would reduce lengthy prison sentences, and that remains a sticking point for some lawmakers.
But today, we're going to focus on a less controversial provision in this bill - a ban on shackling pregnant women. About two dozen states already ban it in their own correctional facilities, but the practice persists in many parts of the U.S. And for more on why, we're joined by Dr. Carolyn Sufrin. She's a medical anthropologist and an obstetrician gynecologist at Johns Hopkins School of Medicine. Welcome.
CAROLYN SUFRIN: Thank you so much.
CHANG: I understand you've worked a lot with incarcerated women. Why are pregnant women being shackled in the first place?
SUFRIN: Well, part of the reason has to do with the fact that our correctional system was really designed with men in mind, maybe not intentionally, but they are presumed to be the default prisoner. And when taken off-site, all incarcerated persons are presumed to be dangerous and a potential flight risk. And a pregnant person needs to be taken off-site for medical attention at times and when it's time for child birth. And so when she's in a public space, the presumption is that she must be a flight risk, and she must be a public safety risk. That is the default assumption.
CHANG: And what do we mean when we say shackled? Are we talking about just, like, one handcuff on one wrist?
SUFRIN: So the more general term that the laws refer to is restraints, the use of restraints in pregnancy. And that includes many different ways of applying restraints. It can include handcuffs in front or behind the back. It can include chains around the ankles, belly chains, chaining a person to another person. When the term shackles is used, it often refers very specifically to a configuration that can sometimes look like four-point restraints. But when people use it...
CHANG: You mean four limbs being restrained.
SUFRIN: Four limbs, but it's often colloquially used to describe more generally the use of restraints in pregnant women in a variety of ways.
CHANG: You're an OB-GYN. Can you just explain, why is it dangerous for a pregnant woman to be shackled?
SUFRIN: There are so many risks involved with shackling a pregnant woman. In labor, there are emergencies that arise unexpectedly where we might need to do an emergency C-section if there are signs of distress or the baby's shoulder could get stuck in the birth canal. As a health care professional, we need to focus on our patient, not on asking a guard to unshackle her. If a pregnant woman falls, she could have a dangerous condition where the placenta separates, and she could hemorrhage, and shackles can increase her risk of falling and also prevent her from breaking a fall if she does fall. But on top of all of that, you know, the chances that a woman in the middle of labor or even not in labor but a pregnant woman could outrun someone and be a flight risk are just ludicrous to me.
CHANG: And what's the criminal background generally of most of these women who have been pregnant while incarcerated?
SUFRIN: Most of the pregnant women who are incarcerated in our country, and this is true of women in general who are in custody, have been arrested or convicted of nonviolent charges. The majority have other conditions in their lives that have determined their pathways to the criminal justice system that I as an OB-GYN also think of as social determinants of health, such as poverty. They struggle often with addiction, with histories of untreated mental illness, especially sexual and physical trauma histories. These women are not hardened, violent criminals.
CHANG: Have you ever been present during the delivery of a woman who was giving birth while being shackled?
SUFRIN: I have. When I was a first-year OB-GYN resident in training in Pennsylvania, I delivered the baby of a woman who was shackled to the bed. I had no idea that this was even possible, and I didn't know if I was authorized to ask the guard to unshackle her. And I just kept worrying about what I would do if there was an emergency. Luckily, the birth itself went fine, but this was a deeply troubling moment for me - of course much more so for the woman herself. But it's a pretty harrowing experience to have to practice medicine with someone who is in chains.
CHANG: Dr. Carolyn Sufrin of Johns Hopkins School of Medicine, thank you very much for coming in today.
SUFRIN: Thank you so much for having me, Ailsa. Transcript provided by NPR, Copyright NPR.