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Shackling Pregnant Women Poses Risks to Mother and Fetus


Image source: Flickr user Crawford Learmonth on Flickr, under Creative Commons

Since 1990, the number of women incarcerated in the United States has more than doubled. Although much has been written about the overall poor health of incarcerated individuals, most of this work has focused on incarcerated men, perhaps understandably, since the overwhelming majority of incarcerated adults are male. Far less is known about the health of incarcerated women, despite high rates of mental health problems, substance abuse, and trauma histories documented in this population.  Furthermore, many women involved with the criminal justice system are of reproductive age.

Of the more than 200,000 incarcerated women in U.S. prisons and jails, it is estimated that 6%-10% of those women are pregnant. Although there is a dearth of research data on these women, we do know that, when compared to women in the general population, pregnant prisoners are more likely to have risk factors associated with poor perinatal outcomes, including preterm and small-for-gestational-age infants. These outcomes are likely a result of exposure to a combination of risk factors, including lack of access to or failure to attend prenatal care, substance use, toxic stress, domestic violence, poor nutrition, and sexually transmitted infections. In addition, African American, Native American, and Hispanic women – three groups that are also at highest risk for poor birth outcomes – are disproportionally represented in the prison system.

These risks for poor birth outcomes may be exacerbated by the care and treatment pregnant women receive during their incarcerations, including the dangerous practice of restraint. Despite strong evidence of danger to mother and child, 13 U.S. states allow indiscriminate use of restraints on incarcerated women and adolescent girls during pregnancy, labor, and recovery, even though the vast majority are incarcerated for nonviolent offenses.

Shackling has negative physical and mental health effects on mothers and their infants:

  1. Shackling women and adolescent girls in transport to prenatal care and during labor and delivery can obstruct necessary medical care and, during labor, lead to extreme physical pain and complications because of the mother’s inability to move freely.

  2. Shackling increases the likelihood of falls, inability to break a fall, life-threatening embolic complications, and impediments to epidurals, emergency caesarian section, and other interventions, all of which may also affect the fetus.

  3. In one documented case, a woman shackled during labor experienced a hip dislocation that caused permanent deformities and pain, stomach muscle tears, and an umbilical hernia.

  4. Mental health problems exist among incarcerated women in higher rates than the general population; pregnancy and the postpartum period bring increased risk of symptoms of mental health problems, such as depression and post-traumatic stress disorder.

  5. Women subjected to shackling during childbirth report severe mental distress, depression, anguish, and trauma, and use of shackles during or immediately following childbirth can cause or exacerbate pregnancy-related mental health problems.

  6. The presence of shackles after delivery may inhibit or interfere with a mother’s ability to bond with and safely handle her infant, to initiate breastfeeding, and may negatively affect the infant’s health.

These risks clearly compromise women’s health, and also have important implications for the health of their future offspring. We know very little about this population and what happens once they return to their families, making intervention and research with pregnant incarcerated women a priority. This also reflects a pressing need for gender-responsive and trauma-informed policies in the nation’s jails and prisons.

APA anticipates legislative action on this issue in the early part of 2016. Please check back or sign-up for our Federal Action Network, to participate in this important public policy advocacy effort.


Danielle Dallaire, PhD is an Associate Professor in the Department of Psychology at the College of William and Mary. She received her PhD in developmental psychology from Temple University. Dr. Dallaire’s research examines children’s social and emotional development in the context of risk, including research on how children cope with the multifaceted risk of parental incarceration.

Rebecca Shlafer, PhD is an Assistant Professor in the Department of Pediatrics (Division of General Pediatrics and Adolescent Health) at the University of Minnesota. She received her PhD in child psychology from the Institute of Child Development at the University of Minnesota. Her research focuses on understanding the developmental outcomes of children and families with multiple risk factors. She is particularly interested in children with parents in prison, as well as the programs and policies that impact families affected by incarceration.  In addition to her academic work, Dr. Shlafer also volunteers as a guardian ad litem.

Image source: Flickr user Crawford Learmonth on Flickr, under Creative Commons

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