Bodies in a Zone of Indistinction: a history of the Biomedicalization of Pregnancy in Prison

Prenatal Care and Labor Preparation

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Prenatal Care and Labor Preparation

While federal, state, and local prisons’ policies greatly differ in treating women’s health and prenatal care in prison, many public health articles indicate that better nutrition, regular checkups with a physician, and birthing classes would be beneficial for expecting mothers. At this microlevel of intervention, the results might prove highly successful, but troubling questions remain about the greater political system that labeled many expecting mothers and other women as criminals in the first place. Nevertheless, in adding to the body of research encouraging medical initiatives within this system, those in the healthcare professions legitimate their own roles within the prison and seek novel opportunities to exert control over prisoners’ bodies.

Ella Johannaber, a birthing instructor in Georgia, understands the larger structural barriers to healthcare that expecting mothers face, yet her point of intervention primarily remains at the level of providing childbirthing classes for pregnant prisoners. To this end, she writes, “Advocacy is clearly needed for change…On the other hand, change cannot happen soon enough for the women who are presently bound by these policies and practices. Even while we advocate for change there are women within the system who will have their babies in appalling conditions without benefit of childbirth education.”66 Calling for furthering advocacy for improvement to prison and for participating within the system, Johannaber takes a gradualist approach towards activism and sees her work in facilitating childbirth as a point of intervention as well. Perceiving limits to what her role as an educator, she asks:

How can a childbirth educator make a difference? We can not immediately

change the unjust aspects of the prison environment. What we can offer is a compassionate presence that lets the woman know she is not along, she is not

forgotten… Each prison is different and the degree of openness to change,

and the channels for change to happen, varies. By being present within the

system, we become knowledgeable about what is happening and are then

poised to be a catalyst for change.67
While it is certainly clear that Johannaber has good intentions for the very important work she is doing within prison, it seems like the difference she makes is still premised on changing individual prisons and thinking about the prison itself as a static entity, a-historical reality and does not consider the moments in the last thirty years that have increased prison populations dramatically. Moreover, the question remains—what larger discourses of power and control is she supporting in the action of continuing a very narrow approach for becoming a “catalyst for change” within a particular prison? Is a more radical approach to “change” possible without greater political activism?

As researchers in public health conducting a nation-wide survey of the United States on women’s healthcare, Ferszt and Clarke take a similar gradual approach to change as Johannaber when they make the following recommendations to care for pregnant inmates:

Based on the nineteen responses to our survey, nutrition actually provided

is inconsistent with the dietary recommendations for pregnancy, adequate

rest is compromised and two mattresses are rarely provided. Departments

of Corrections must develop policies ensuring that pregnant women have

two mattresses, are given lower bunks, and meet with the nutritionist to

discuss and plan a healthy diet to meet the nutritional standards for pregnant

women. A written nutritional educational pamphlet for pregnant women is

an additional resource that can be used.68

In focusing intervention on the nutrition of only pregnant women, they overlook likely nutritional deficits of other prisoners. Moreover, in suggesting private meetings with a nutritionist, they both systematize the role of a healthcare professional within prison and further a neoliberal discourse that focuses on a prisoner’s individual responsibility to control their diet, despite a setting in which they have little nutritional options.

Likewise, researchers working for the American Civil Liberties Union of Texas (ACLU) and the Texas Jail Project (TJS) also imply that greater medical surveillance is needed within the state’s prisons and place great responsibility on security personnel to receive some medical education on labor in order to prevent the baby from being born in a prison cell. The following is an excerpt from the recommendations they make for further medical training (encroachments) within prison:

  1. Security personnel must be trained to recognize labor. Security personnel

cannot be expected to have extensive medical knowledge. However, to

avoid liability and keep inmates healthy, security personnel should be trained

to recognize medical emergencies, including the onset of labor. Security

personnel can be educated through the distribution of fact sheets with key

information on how to recognize labor, workshops for security staff taught by

medical staff, and inclusion of this information in the initial training for

security personnel. In order to increase compliance with the law, TCJS

should consider adopting this training as a best practice for all Texas jails.69

The ACLU of Texas and TJP further propose that all medical decisions be

left to licensed medical staff. In jails where medical staff is available around the

clock, security personnel should be required to notify medical staff immediately

of any problems experienced by a pregnant inmate so that medical staff can

determine whether the inmate is in labor even before she is transported to the

hospital. In all jails, but most importantly in those that do not have the resources

to provide 24/7 medical staff, security personnel must be educated on how to

recognize labor.70

In the excerpt, it is interesting to note that the risk of avoiding liability precedes the other imperative to “keep inmates healthy.” Rather than discussing the moral responsibility the state has towards ameliorating the health of those whose freedom they take away, the rhetoric of liability serves as a very truncated argument for strongly encouraging security personnel to heed expecting mothers’ calls when they say they may be in labor. In addition, these organizations also continue to reify the role of medicine in declaring that “all medical decisions be left to licensed medical staff” and that security personal personally should defer to the medical staff if there is any question of “medical emergency” (which they consider the onset of labor to be).

In addition, the ACLU and the TJP’s other recommendations to codify medical guidelines in the prison, conduct assessments to make certain that these guidelines are followed, and administer adequate healthcare for pregnant inmates read as follows:

1. Ensure consistent, proper care for all pregnant inmates incarcerated in

county jails with standardized and specific policies.

2. Empower the Texas Commission on Jail Standards fully to review

medical plans, speak with pregnant inmates, and generally ensure medical

care is sufficient.

3. Ensure appropriate medical care for pregnant inmates by establishing

policies with timelines for initial screenings, provisions for ongoing and

follow-up care, and measures to address high-risk pregnancies and obstetric


4. Ensure appropriate mental health care for pregnant inmates, including

addressing existing mental health issues and monitoring inmates for post-

partum depression.

5. Standardize nutritional, housing and work assignment policies to ensure

the health of fetuses and newly-born children across the state, [sic]71

By proposing that the Texas Commission on Jail Standards to oversee the medical treatment and psychological care provided and speak with inmates about their access for and compliance with healthcare recommendations, this policy adds further layers of surveillance and discipline, both on the part of the healthcare providers at the prison and of the inmates themselves. Moreover, creating further protocol would rigidify further powerful networks of public policy for prison staff and inmates to meet and be judged against. Finally, even fetuses and newborns are also implicated in the suggested network of surveillance, as the standardization of nutritional, housing, and work assignment policies is implicitly correlated with and measured by the health of these infants. Such recommendations thus enforce the will to monitor and control the actions of prison administrators, inmates, and even the inmates’ children.

Furthermore, making these small interventions to improve the situation of pregnant prisoners (though important) may do so at the cost of addressing the larger problems inherent in the prison complex. By taking a stance that is not too politically charged, however, researchers like them may be able gain access into prisons, suggest policies that are relatively uncontroversial, and continue to make similar recommendations to gradually ameliorate the implementation of healthcare in prison. In this manner, such researchers are implicated in the growth of the medical-prison complex.

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