Inroads for Advocacy

Given the various forms of trauma the prison system subjects its incarcerated populations to during the perinatal and postpartum period, our general understanding of PPD is not transferrable. Prison-induced trauma must be acknowledged when thinking about and treating PPD among incarcerated mothers. 

However, most research and advocacy rarely focus on the postpartum experience in carceral spaces as it is mostly limited to the perinatal period. While we need to continue advocating for justice in that area, only accounting for the perinatal period leaves incarcerated postpartum mothers with little to no resources. That poses a substantial risk in women not only developing severe PPD but also having it go unchecked. We must hold the prison system accountable for the trauma it induces and the role it plays in exacerbating PPD symptoms among incarcerated mothers.

 Below are examples of baseline-level changes that need to occur along with recommendations for system-informed change.

Baseline-Level Changes:

• Implementation of Mother/Child Prison Nurseries: A model used in only a handful of U.S. prisons; designed to ensure mothers and children can stay together during the first few years of the child’s life. This model must be implemented within all women’s prisons to mitigate the traumatic and cruel separation of mother and child 24hrs after birth which often happens. Allowing mothers to stay with their babies would reduce the fear and trauma they are subjected to before, during, and after birth. This would be a step to take in striving to make the postpartum period as seamless as possible. 

• Passage of Anti-Shackling Laws in all U.S. States: Currently anti-shackling laws vary state by state as well as in specifics (i.e. if shackles can be taken off during the whole birthing experiences from transportation to postpartum or if they are just to remain off during labor). We must establish anti-shackling laws from the point an incarcerated woman leaves prison for the hospital to the point of her return. To give birth or to spend the 24hrs most incarcerated women have with their child shackled is unsafe and inhumane.

• Lactation Programming: Some U.S. prisons allow postpartum mothers who have been separated from their children to pump their breast milk for their child. Transportation services are arranged for the mother’s breastmilk to reach their child. If women are going to be violently separated from their child post-birth they should at least be able to provide their child with their breastmilk. Breastmilk has an array of health benefits for the child and allows women especially those incarcerated to feel further connected with their baby. 

• Increased Transparency: Oftentimes incarcerated mothers are uncertain of where their child is to end up after its birth. Even if the mother has arranged for a family member to care for their child for the remainder of their sentencing, very limited details are shared with them on how that process will work. Incarcerated mothers deserve transparency when it comes to their children. From the start of their pregnancy to when their child is born and in a safe home, each mother should be paired with a social worker literate on the different options each mother has. Individualized processes must be administered for each mother to ensure that the mother knows exactly what will happen to their child, what their options exactly are, and receive answers to all of their questions.

• Prenatal Education: Most U.S. women’s prisons offer prenatal education to incarcerated pregnant women, providing women with the medical and health knowledge they are entitled to. However, oftentimes it is only focused on the perinatal period. While prenatal education during pregnancy is vital, the curriculum must include information on PPD, how to identify it, and ways to treat it. 

System-Conscious Changes:

• Prison Doula Programming During and Post-pregnancy: Prison doula organizations and programming is a relatively new development that acknowledges and validates the trauma prisons induce on pregnant and postpartum women. Prison doulas play a critical role in an incarcerated pregnant woman’s life as oftentimes her only advocate. Prison doula programs often strive to reject carceral logic, providing probably the only space for incarcerated mothers to feel humane. Most prisons that have doula programs pair each mother up with a doula to meet with during the perinatal period, labor, and for one postpartum visit. However, beyond their one follow-up visit doulas rarely play a role in mothers’ postpartum experiences. Incarcerated postpartum mothers must continue to have an advocate available to them whose only interest is them. Extending the time prison doulas meet with mothers is a major step towards accounting for the PPD experience in prison as doulas would be able to reduce an array of risk factors.

• System-Conscious Clinical Training: There have been inroads to standardize trauma and system-informed therapeutic training among clinicians working in prison. To increase the chances of smooth postpartum experiences among incarcerated mothers, each mother must have consistent access to a clinician who can provide trauma and system-informed therapeutic support.  This would look like a therapist understanding the role the prison and the mother’s incarceration play in her postpartum experience.

• Federal Policies: Prison policies vary from state to state, prison to prison. While state victories are to be celebrated, like anti-shackling laws, we cannot let that distract us from the numerous U.S. states where that is still a reality. We must advocate for federal policy changes that support the humane treatment of incarcerated mothers.

In an interview, Dr. Carolyn Sufrin, author of Jailcare describes the variability in prison policies and protocols among U.S. states and counties saying,