Pregnant Women in Custody Act

Floor Speech

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Mr. NADLER. Mr. Speaker, pursuant to House Resolution 1499, I call up the bill (H.R. 6878) to address the health needs of incarcerated women related to pregnancy and childbirth, and for other purposes, and ask for its immediate consideration in the House.

The Clerk read the title of the bill.

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Mr. NADLER. 6878.

Mr. Speaker, H.R. 6878, the Pregnant Women in Custody Act, is bipartisan legislation that would help ensure that women receive the pregnancy, delivery, and postpartum care that they need while in Federal custody.

The number of women incarcerated has grown significantly in recent decades, and most women are incarcerated during their reproductive years. There are an estimated 58,000 admissions of pregnant women into jails and prisons every year.

It is vital for the health of these women and their newborns that they have access to appropriate healthcare, nutrition, and postpartum recovery support.

In addition, research shows that Black women already have a 43 percent higher risk of miscarriage than White women. Since women of color are disproportionately impacted by the criminal justice system, a lack of support and care for pregnancy and reproductive health while incarcerated can lead to increased risk of negative pregnancy outcomes.

By establishing a national standard of care for incarcerated pregnant women, as well as by prohibiting the use of restrictive housing and providing for transfers to residential reentry centers for women with high-risk pregnancies, this bill will help protect the health and safety of pregnant women and their newborns. Restrictive housing and solitary confinement have been called psychological torture, and the use of solitary confinement can further damage the physical and mental well-being of pregnant women.

In addition to setting a national standard of care, this bill also requires the Government Accountability Office to study the services and protections provided to pregnant women incarcerated at the State and local levels.

The impact of incarceration of pregnant women is complex and far- reaching. The reality of pregnancy, delivery, and postpartum recovery while incarcerated requires significant mental and physical health interventions and broader protections in order to address the trauma both mothers and newborns experience.

This bipartisan bill is supported by a broad range of organizations across the ideological spectrum, including the American Psychological Association, the National Alliance on Mental Illness, the Association of Maternal and Child Health Programs, Dream Corps, the Vera Institute for Justice, R Street Institute, and the American Conservative Union.

Mr. Speaker, I thank our colleague, Representative Karen Bass, for her leadership on this issue and on so many criminal justice issues throughout her career in Congress. I thank her bipartisan cosponsors for introducing this important legislation with her.

Mr. Speaker, I urge all of my colleagues to support the bill, and I reserve the balance of my time.

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Mr. NADLER. Jackson Lee), a member of the committee.

Ms. JACKSON LEE. Mr. Speaker, I rise in support of H.R. 6878, the Pregnant Women in Custody Act, because women's lives matter, pregnant women's lives matter, their babies' lives matter, as do the lives of incarcerated women and their babies.

I have worked on this issue for a very long time and am delighted to be able to support this legislation introduced by my friend and colleague, Congresswoman Bass.

This works to ensure that we recognize the increasing population of women incarcerated. Unfortunately, women are the fastest-growing segment of the incarcerated population in the United States. Conversations about criminal justice reform often overlook their unique experiences and the needs of women and girls within the criminal justice system.

For instance, Mr. Speaker, the United States has the second highest rate of women incarcerated in the world, with 64 women per 100,000 in custody and nearly 60,000 pregnant women admitted into American jails and prisons every year. That is a lot.

Some States have yet to prohibit the shackling of women when they are giving birth. We have to do something.

This bipartisan legislation would establish Federal policies to prohibit the use of restrictive housing on incarcerated pregnant women and develop a national standard of care to add to the pregnancy-related needs of incarcerated women, including access to prenatal and post- delivery care and support.

My legislation, the SIMARRA Act, also complements this by creating a pilot program in the Federal system for mothers to stay with their infants for a period of time. This humane response and the humane response of this bill are what we need to do.

Oftentimes, pregnant women lack access to appropriate nutrition while incarcerated, and the use of restrictive housing can have detrimental effects on a woman's health, as well as the health of her baby. While women of color are disproportionately impacted by incarceration, they also face higher risks of both miscarriage and maternal mortality.

This bill would make certain that incarcerated pregnant women receive vital prenatal healthcare and postpartum support and ensures the Bureau of Prisons and the Marshals Service protect the health and safety of incarcerated women through their pregnancy, when they deliver their child, and as they receive postpartum care. They should not be shackled, and they should not be intimidated or frightened.

The one thing I want to say, Mr. Speaker, even though many of us have different views--and I am an avid supporter of the right to choose-- this is not an abortion bill. This is a healthcare bill.

We also know that the prisons make their determinations on how they help women in their contraceptives. H.R. 6878 would allow BOP to collect data on healthcare needs of pregnant women so that we may have a better understanding.

Let me clearly say that separating a newborn from its mother gives it less chance for both survival and success in life.

We know in Harris County, Texas, there are approximately 1,000 women incarcerated in the Harris County Jail. This bill would require a GAO study, setting national standards, and endeavor to do a landscape to understand reproductive freedom in this country.

Ms. JACKSON LEE. Mr. Speaker, that is why I was glad to see my bill, the Stop Infant Mortality And Recidivism Reduction Act of 2021, or the SIMARRA Act, included in the Violence Against Women Act, which passed earlier this year. That bill established a pilot program to allow women incarcerated in Federal prisons and their babies to reside with each other while the mother is incarcerated for a period of time.

Mr. Speaker, let us continue to be innovators in the treatment of those who are incarcerated, and let us make sure that we give every newborn a healthy life. I ask my colleagues to support the underlying legislation.

Mr. Speaker, I rise in support of H.R. 6878, the ``Pregnant Women in Custody Act,'' because women's lives matter, pregnant women's lives matter, their babies' lives matter--as do the lives of incarcerated women and their babies.

Although women are the fastest growing segment of the incarcerated population in the United States, conversations about criminal justice reform often overlook the unique experiences and needs of women and girls within the criminal justice system.

The United States has the second highest rate of women incarcerated in the world, with 64 women per 100,000 in custody, and nearly 60,000 pregnant women admitted into American jails and prisons every year, while some states have yet to prohibit the shackling of women when they are giving birth.

This bipartisan legislation would establish federal policies to prohibit the use of restrictive housing on incarcerated pregnant women and develop a national standard of care to address the pregnancy- related needs of incarcerated women, including access to prenatal and post-delivery care and support.

Oftentimes pregnant women lack access to appropriate nutrition while incarcerated and the use of restrictive housing can have detrimental effects on a woman's health as well as the health of her baby. And while women of color are disproportionately impacted by incarceration, they also face higher risks of both miscarriage and maternal mortality.

This bill would make certain that incarcerated pregnant women receive vital prenatal healthcare and post-partum support and ensure the Bureau of Prisons and the Marshal's service protect the health and safety of incarcerated women throughout their pregnancy, when they deliver their child, and as they recover post-partum.

H.R. 6878 would also require BOP to collect data on the healthcare needs of pregnant women, so that we may better understand the challenges incarcerated women face and determine how to address the needs of this vulnerable population.

In Harris County, Texas, on average, there are approximately 1,000 women incarcerated in the county jail and on average 25 to 30 of them are pregnant. The jail offers specific programs for mothers to reduce recidivism and help them support their families upon release.

This bill would require GAO to study state and local corrections facilities to understand the services and protections provided for pregnant women, like the program offered in Harris County.

Setting national standards for the treatment of incarcerated pregnant women in federal custody would set an example for state and local facilities to follow and the data collected by BOP would farther inform Congress of the additional health and safety needs of this vulnerable population.

As we endeavor to navigate a new landscape for reproductive freedom across the country, we must recognize that incarcerated women will continue to face challenges in carrying healthy pregnancies to term.

That is why I was glad to see my bill, the ``Stop Infant Mortality and Recidivism Reduction Act of 2021'' (or the ``SIMARRA Act''), included in the Violence Against Women Act which passed earlier this year. That bill established a pilot program to allow women incarcerated in Federal prisons and their babies born during their incarceration to reside together with while the mother is incarcerated.

Let us continue to be innovators in the treatment of those who are incarcerated. And let us make sure women receive proper health care and humane treatment whether they are incarcerated or not--because all women deserve proper health care and to be treated with dignity--no matter their circumstance.

I thank Representative Karen Bass for her steadfast commitment to addressing this important issue. I urge my colleagues to join me in support of this long overdue legislation.

I include in the Record a Prison Policy Initiative document titled: ``Unsupportive environments and limited policies: Pregnancy, postpartum, and birth during incarceration.'' [From Prison Policy Initiative, Aug. 19, 2021] Unsupportive Environments and Limited Policies: Pregnancy, Postpartum, and Birth During Incarceration (By Leah Wang)

Making up for a serious gap in government data collection and understanding, researchers are discovering what pregnant incarcerated women should expect when they're expecting (or when they give birth while in custody). Findings indicate that jails, prisons, and youth facilities have yet to adequately recognize pregnancy and postpartum needs either in policy or in practice.

Recently published findings from the groundbreaking Pregnancy in Prison Statistics (PIPS) Project and other datasets shed light on a common but rarely discussed experience: being pregnant, postpartum or giving birth while incarcerated. Spearheaded by Dr. Carolyn Sufrin of the Johns Hopkins University School of Medicine and School of Public Health, this series of studies is our best look yet at pregnancy prevalence and outcomes in U.S. jails, prisons, and youth facilities.

In total, 22 state prison systems, all federal prisons, 6 jails, and 3 youth confinement systems participated in the PIPS Project, a systematic study of pregnancy and its outcomes among incarcerated women. Historically, the government has not collected data about carceral pregnancy on a regular basis, meaning no national effort has been made to understand maternity care for thousands of incarcerated pregnant women. The project's sample represents 57 percent of all women in prison, 5 percent of all women in jail and about 3 percent of young women in youth facilities.

Our takeaway: Carceral pregnancy, whether in jail, prison, or youth confinement, is characterized by a lack of supportive policies and practices. Some of the major findings to come out of these publications are:

There are an estimated 58,000 admissions of pregnant women into jails and prisons every year, and thousands give birth or have other outcomes while still incarcerated. Pregnancy rates among confined youth were similar to those among adults.

In some state prison systems, miscarriage, premature birth, and cesarean section rates were higher than national rates among the general population.

Only one-third of prisons and jails had any written policy about breastfeeding or lactation, and even where policies supporting lactation did exist, relatively few women were actually breastfeeding or pumping.

There are an estimated 8,000 admissions of pregnant women with opioid use disorder (OUD) into prisons and jails each year, but long-term treatment using medication is the exception, not the rule.

A related (non-PIPS Project) study finds paternal incarceration is also linked to adverse birth outcomes like low birth weight, which are widely known to impact long-term health.

The researchers' findings add complexity to a growing body of literature and consensus linking incarceration to negative health impacts. And although PIPS Project data can't be broken down by race, ethnicity, or gender identity, measuring the scale and outcomes of pregnancies in prison and jail is a major public health research accomplishment. The fact that academic researchers had to conduct this research to fill the data gap--and the shortage of appropriate policies they found--makes it clear that many correctional agencies have yet to even acknowledge the needs of pregnant incarcerated women. every year, thousands of incarcerated expecting mothers and babies face adverse outcomes from exposure to incarceration

Over the 12 months of the Pregnancy in Prison Statistics (PIPS) study period, there were nearly 1,400 admissions of pregnant women to participating state and federal prisons with over 800 pregnancies ending in custody (births, miscarriages, and others), and over 1,600 admissions of pregnant women to jails with 224 pregnancies ending in custody. Unsurprisingly, given the short length of most jail stays, more pregnant women are admitted to jails each year, but more births take place in prisons, where the average stay is longer. Based on their data, the authors estimate that, nationally, 4 percent of women entering prison (in line with Bureau of Justice Statistics 2016 estimates) and 3 percent of women admitted to jail (lower than BJS' most recent 2002 estimates) are pregnant.

Pregnancy outcomes in prisons and jails in some places were worse than national trends across the general population. When pregnancy did end in custody, in some states like Arizona, Kansas and Minnesota, rates of miscarriage ranged from 19 to 22 percent, exceeding estimates of the national rate. In Ohio and Massachusetts, premature births exceeded the general population rate of about 10 percent. Among live births, which were 92 percent of birth outcomes in custody, one-third (32 percent) of these were caesarean section births, in line with the national average rate. In some states, the C-section rate was much higher, suggesting that C-sections may be taking place when not medically necessary, risking short- and long-term health problems in babies.

pregnancy among confined youth is not uncommon, and better testing might reveal it's even more widespread

Upon hearing about the Pregnancy in Prison Statistics (PIPS) Project, three juvenile justice systems (one state- level, and one county-level system) volunteered to complete a survey about pregnant adolescents in the custody of 17 of their ``juvenile residential placement'' facilities, providing a window into this population for the first time. One takeaway from the survey's findings was that adolescent pregnancies--both in confinement, and upon release--may risk poorer outcomes because of a lack of continuity of medical care between confinement facilities and the community. Even though all three state systems provided basic prenatal care, with the typical length of stay for young women lasting a few months or less, justice-involved youth would benefit enormously from consistency in medical care throughout pregnancy.

The survey also showed that the rate of pregnancy among confined youth (3.3 percent) was similar to that of the adult incarcerated population (3.5 percent). However, the youth facilities reported less routine pregnancy testing, bolstering a 2004 study revealing that only 15-17 percent of 1,255 juvenile facilities nationwide tested youth for pregnancy at admission (with about two-thirds of facilities providing tests only if requested). Therefore, it's possible the youth carceral pregnancy rate is a very conservative estimate, and that thousands of pregnant youth are going without prenatal care when their health needs are likely complicated.

Eight pregnancies ended among youth confined in the surveyed facilities during the 12-month study period, including four miscarriages, three induced abortions, and one live full-term birth. It would be misleading to view these outcomes as representative of all pregnant confined youth, but the authors advise youth confinement facilities to be prepared for high rates of miscarriage and other adverse birth outcomes, seeing as justice-involved pregnant youth are going through highly stressful life experiences.

Services and policies regarding prenatal and postpartum care were variable: All three juvenile systems allowed abortion, and some covered the cost; all three systems also allowed lactation through either breastfeeding or pumping. Still, the small sample size (which represented just 2.8 percent of all confined female youth) and the potential influence of self-selecting facilities make it difficult to draw conclusions about the experience of pregnant youth in confinement. breastfeeding and lactation are not guaranteed to new mothers and babies, ignoring the enormous benefits of breast milk

When the cohort of 22 prison systems and 6 jail systems described their lactation-related policies to the researchers, they painted a discouraging picture of how correctional facilities largely don't support breastfeeding, a practice chosen by some mothers for its unique benefits.

To begin, only one-third of prisons and jails had any written policy on lactation, leaving many incarcerated women to the whims of facility staff who may not be trained in this area or understand its importance. Even where women were formally allowed to lactate, milk was sometimes discarded at the study sites due to mother-infant separation, providing only a benefit to the mother of maintaining milk supply.

Because it is a matter of health equity to provide the opportunity to lactate and breastfeed (among other parental choices), researchers extend the ``further research is needed'' statement in order to understand the probable racial disparities within carceral pregnancy: ``. . . research in collaboration with current and formerly incarcerated women, specifically Black, Indigenous, and women of color, is needed to fully understand breadth of experiences and perspectives related to breastfeeding and lactation while in custody.''

opioid use disorder among incarcerated women is treated under some

circumstances, but leaves mothers without help postpartum

In addition to known medical needs during pregnancy, some women enter incarceration with other health problems. Researchers accessed six months of activity and policy related to opioid use disorder (OUD) treatment of pregnant women in the Pregnancy in Prison Statistics (PIPS) study sites and found that 26 percent of those entering prison and 14 percent entering jail had OUD. The gold standard of care for these women would be medication for opioid use disorder (MOUD), which is linked to better pregnancy outcomes and increased engagement with addiction treatment and other medical care.

Twenty-two of 28 sites did offer this avenue for treatment of pregnant women in some way, but the narrow window in which they could be treated for OUD leaves much room for improvement. In most facilities offering MOUD, it would not be initiated in the facility; they would only continue someone on MOUD if they were already on it. This unfairly excludes women who were unable to begin treatment before admission; for example, if someone was in jail before being transferred to prison, their access would then depend on the jail's policy. Postpartum, most facilities providing MOUD would discontinue treatment, showing a clear disregard for the mother's well-being after birth.

Still, one-third of surveyed sites managed OUD among pregnant women through detoxification, some with and some without medication to manage symptoms. Detox, or ``medically supervised withdrawal,'' can be a painful process and has a high rate of failure for pregnant women, increasing the risk of future overdose.

These exclusionary policies and practices are troubling given the fact that opioid overdose is a major cause of death for pregnant and postpartum women in the United States, and remains a huge concern for formerly incarcerated people. In Rhode Island, where MOUD has been implemented comprehensively in their unified prison-jail system, there has been a huge reduction in post-release overdose deaths; replicating their initiative would have a great impact on carceral pregnancy and postpartum outcomes.

the incarceration of fathers is also linked to worse birth outcomes

As if it's not bad enough that incarceration prevents expecting mothers from receiving care and providing care to their babies, another recent study finds that incarcerating fathers during pregnancy or at the time of birth is also harmful to babies' health.

In another recent study--unrelated to the Pregnancy in Prison Statistics (PIPS) project--Youngmin Yi and fellow researchers matched hundreds of thousands of birth records to jail records in New York City between 2010 and 2016, observing trends in birth weight, preterm (premature) birth, admission to the NICU (neonatal intensive care unit), and more. Paternal incarceration was associated with nearly all adverse outcomes, even after other characteristics of mother and father were accounted for statistically. ``Exposed'' to their fathers' incarceration--even for as little as one day-- babies were born with these vulnerabilities, such as low birth weight, known to have an impact later in life. incarcerated pregnant people and their babies deserve better care that is codified in policy

The findings by Sufrin, Asiodu, Kim and fellow researchers offer a desperately-needed look into pregnancy during incarceration. And the findings by Yi et al. contribute to an even more holistic picture of what it means to be a growing family entangled in the criminal legal system. Families experiencing pregnancy are impacted by incarceration whether the mother or the father is incarcerated, and whether or not the baby is born during the mother's incarceration.

Both adolescents and adults in confinement should be afforded comprehensive prenatal care, including education, lactation support, and opioid use disorder treatment that continues beyond the end of pregnancy. And babies born right after or during their parents' incarceration, who risk health issues like lower life expectancy and social and emotional challenges, deserve the chance to begin life with one or both parents as much as possible. These efforts and programs should be clearly written into agency policy so that facility staff can be trained and expected to provide care.

One way that prisons and jails can begin to assess and improve their care for pregnant women is by reviewing the American College of Obstetricians and Gynecologists' recently updated comprehensive set of guidelines for carceral reproductive health care. Facilities should also consider subscribing to the National Commission on Correctional Health Care's standards for health services, which have clear ways of addressing many of the above topics. Prisons and jails should make their policies publicly available, and create ways to keep healthy mothers and their babies together. note about the language used

Throughout these publications, the terms ``pregnant women'' and ``mother'' described those people who were pregnant in custody during the study period. While we've deferred to the terminology used by the authors, we acknowledge that pregnancy can overlap with multiple gender identities, and our conclusions and recommendations apply to all pregnant people.
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Mr. NADLER. Lois Frankel).

Ms. LOIS FRANKEL of Florida. Mr. Speaker, I thank our distinguished Judiciary Committee chairman and Representative Karen Bass for their leadership on this bill.

Mr. Speaker, all of our children should have the opportunity to thrive. Getting them off to a good start in life is critical for their well-being, as well as for society as a whole. That is why prenatal care and safety for pregnant women are so important. It lowers the risk of complications that can affect the ability of a child to thrive and can have far-reaching impacts on their future.

Alarmingly, recent reports indicate that Federal prisons are not aligned with national guidance for the treatment of pregnant women, and in extreme cases, Mr. Speaker, women have been shackled to their beds during and after childbirth.

I think we can all agree that children should not be punished for their mother's mistakes or misdeeds. The Pregnant Women in Custody Act will strengthen and promote the health and safety of pregnant inmates, providing a national standard of care allowing children to have the opportunities they deserve.

Mr. Speaker, I urge passage of the bill.

Mr. Speaker, H.R. 6878 is bipartisan legislation that would support the health and safety of women in Federal custody by establishing a national standard of care and prohibiting the use of restrictive housing for incarcerated pregnant women.

Mr. Speaker, I urge all of my colleagues to support this important legislation. I also want to take this opportunity to express my dual feelings--on the one hand, the sponsor of this legislation, Ms. Bass of California, will no longer be with us in the next Congress, which is, on that level, unfortunate. On the other hand, the reason she won't be with us is because she is the mayor-elect of Los Angeles, and that is not unfortunate. I am very happy about that, but I have mixed feelings because we won't be seeing her here again.

Mr. Speaker, I urge all of my colleagues to support this important legislation, and I yield back the balance of my time.

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