It is well established that most prisons and jails in the United States do not follow or meet the minimum health care standards for pregnant women’s reproductive care as set by prominent medical and public health groups. Incarcerated women require specialized medical services due to high rates of victimization and abuse, poor health, and poverty. The lack thereof poses significant threats for incarcerated pregnant women who are routinely shackled during labor as well as other inhumane practices. It is incumbent upon social work to understand the impact that these experiences have on women’s health in order to shape policies, social work education and training, and clinical practices that promote reproductive justice (RJ) for incarcerated women. Using a critical phenomenological research design, this study seeks to offer an in-depth understanding into the lived experiences of formerly incarcerated pregnant Black women and how they narrate their reproductive healthcare experiences and agency over their own bodies.
Methods: This study recruited key informants (formerly incarcerated pregnant Black women) and key stakeholders (doulas, social workers, advocates, health care providers, and activists). A total of eighteen interviews were conducted (N=9 key informants and N=9 key stakeholders ). Key informants and key stakeholders were recruited through purposive snowball sampling. Semi-structured interviews were used with key informants to understand how they narrate their pregnancy and birthing experiences through a RJ lens. Interviews were audio-recorded and ranged between 60-90 minutes. Interviews were transcribed verbatim and coded thematically using NVivo qualitative software, guided by the principles of thematic content analysis.
Results: Qualitative interviews revealed four primary themes: (1) Women shared stories of fear, anxiety, pain, and trauma from prison policies that forced them to birth in chains, alone, and without a support person who they trusted. (2) Women discussed being actively denied services when requested that sometimes led to miscarriages, difficult pregnancies and birth experiences. (3) Being incarcerated sometimes forced women to carry a pregnancy to full-term when that was not their choice. (4) Prison policies disrupt critical bonding between mother and infant, and can cause deep emotional pain and trauma that can last for decades.
Conclusions and Implications: Understanding issues of mass incarceration through a RJ lens and Black Feminist Thought that centers the experiences of Black women can help us to move beyond mere reform to transformation. Nearly all formerly incarcerated pregnant women who participated in this study uniformly shared that their incarceration added to their unique health challenges and other stressors. They shared experiencing barriers to receiving adequate services that made their pregnancies extremely stressful. This is particularly concerning given that incarcerated women already have a history of poor health due to a myriad of structural factors which overwhelmingly and disproportionately impacts Black women. Ensuring that the reproductive rights are protected for some of our most vulnerable members of society requires that we examine mass incarceration at the intersections of race, gender, and reproduction.