You need not go overseas to find violations of women's rights and health care rights, say opponents of restraining female prisoners while they give birth.
In 40 states, non-violent women prisoners are shackled by their feet, hands and sometimes bellies during labor and delivery. These American moms-to-be are giving birth in leg irons, handcuffs or waist chains in state prisons and county jails, in federal immigration detention centers and inside juvenile detention facilities.
And the humiliating journey often starts as soon as an inmate or prisoner tells guards that she's going into labor, a statement that is often met with disbelief and distrust.
Kimberly Mays of Tacoma, Wash., still bristles when she talks about having her ninth baby while serving a sentence for drug possession and intent to distribute. Now 47, Mays was well into a high-risk pregnancy when she went into labor on Aug. 2, 2000, in the Washington Corrections Center for Women.
After an initial delay, she was handcuffed to a gurney for the ambulance ride to the hospital in Tacoma. Once inside, guards chained her hand to a wheelchair as she yelled for relief from the worsening pain of contractions.
An annoyed nurse "put one hand over my mouth and put the other hand on top of that like you're doing CPR," Mays said. The guards only glared -- as if Mays was "some animal," she recalled.
"I have never been so humiliated in my life. I felt so exposed and vulnerable, like something was dirty about me," she said in an interview Wednesday. The stress and helplessness made her block out the birth; she recalled having one leg chained to the bed after delivering a son, and having to ask a guard to free her every time she needed the bathroom.
"There are things I lost that I'll never get back. I was robbed of the memory of giving birth to a life."
This year, she shared her story during testimony in favor of a Washington State law, signed in March by Gov. Christine Gregoire, which bans the shackling of pregnant women during labor or post-partum recovery. Recounting her ordeal brings out old anger in Mays.
"That shouldn't have happened," she said. "The person I am now, I'm worth dignity and respect. My behavior that got me into prison should not have dictated my worth as a mother in labor."
Mays, a repeat felon who began turning her life around in 2004, eventually earned associate's, bachelor's and master's degrees and found work with the King County Juvenile Court's Parent-to-Parent program, helping other offenders keep their children -- an ironic twist, she said, given that she lost parental rights for nine of her 10 children. However, she's raising her youngest daughter and is back in touch with eight of her other sons and daughters.
Stories like Mays' have moved lawmakers in several states to restrict or ban shackling. California passed an anti-shackling law in 2005, followed by Illinois, New Mexico, New York, Texas and Vermont. The Texas measure had the backing of Democrats and Republicans, reproductive health organizations and the U.S. Conference of Catholic Bishops. This year, Colorado, West Virginia, Washington and Pennsylvania passed anti-shackling measures. The momentum continues on other fronts.
The American Medical Association's House of Delegates voted in June in favor of a model law that states could adopt, which would extend the prohibition on shackles during labor and delivery to the second or third trimesters of pregnancy, when facilities should use the "least restrictive restraints necessary."
The U.S. Court of Appeals for the Eighth Circuit last year ruled that the shackling of an Arkansas woman's legs to a hospital bed when she was in the late stages of labor violated the 8th Amendment prohibition on "cruel and unusual punishment."
Malika Saada Saar, founder and director of The Rebecca Project for Human Rights in Washington, D.C., was instrumental in lobbying the U.S. Bureau of Prisons for a 2008 policy change that prohibited the shackling of pregnant federal inmates while they're in labor and delivery.
On Thursday, the Rebecca Project and the National Women's Law Center released a new report, "Mothers Behind Bars," with report cards for each state, and an analysis of federal policies affecting pregnant women in custody. The two organizations are part of a broad coalition of civil rights and reproductive rights groups that have lobbied vigorously for a statutory end to what they call "barbaric policies" affecting the growing numbers of expectant mothers doing time in prison. Most of them are non-violent, first-time felons sentenced for drug-related offenses, credit fraud, or parole violations. "There really isn't a security justification for having women shackled during labor and delivery," Saada Saar said.
Saada Saar said incarcerated women who are giving birth in custody tend to have traveled a similar path. Most are drug felons who "ought to be in the public health system because they're struggling with untreated addiction." Most have been sexually or physically abused, and self-medicate their pain and depression.
"They turn to what's available: crack cocaine on the corner, as opposed to a therapist," Saada Saar said.
At some point, they've tried to get treatment, but dropped out of "one of these family-unfriendly, single adult treatment programs. With mothers, you have to deal with them as mothers."
Saada Saar said these women encounter an attitude that, because of their wrongdoing, "they are in some way not worthy of being mothers, and not worthy of dignity in childbirth because they are incarcerated."
In addition, Saada Saar said she also perceives a lack of understanding among many of the men who implement corrections policies.
"I don't have a sense a lot of those men have personally witnessed labor and delivery, and if they have, something stops them from recognizing the women who deliver behind bars go through the same agony and physical hardship as their wives when they gave birth," she said.
Restraining a pregnant woman by the arms, legs or belly can pose significant medical risks to her and her unborn child, said Dr. Carolyn Sufrin, an ob-gyn at UC San Francisco, who cares for incarcerated women at the San Francisco County Jail. Pregnant women have a different center of gravity from others and are more prone to tripping and falling. Shackling their arms or ankles could increase the risk of them falling on their bellies, which could jeopardize the baby's health.
Labor and delivery are "completely unpredictable," she said. A baby's heart rate may suddenly drop, requiring doctors to begin a series of maneuvers to get the baby out of distress.
"We're changing the position of the mother in order to increase blood flow to the baby" by putting the mother on her hands and knees, or having her put her legs into a frog's-leg position, she said. But a woman whose ankles are restrained cannot quickly switch positions, and there may not be time to wait for a guard to unshackle. If doctors need to do an emergency C-section, "how do you transfer a woman into an operating room if she's shackled to a bed?" Sufrin asked.
Sufrin said common sense should dictate that a woman in labor is in a lot of pain and the chances she might escape are "pretty slim." In addition, if she's been given epidural anesthesia, the numbness "makes it impossible to run off."
Saada Saar and other activists seeking shackling reforms are optimistic that more states will come around.
"There's an intense effort going on in Arkansas right now," Saada Saar said. She's also hopeful that Tennessee and Georgia will adopt legislation in the next year.
In California, where 4 percent to 7 percent of incarcerated women are pregnant, Gov. Arnold Schwarzenegger on Sept. 28 vetoed a statute that would have broadened the current prohibition on shackling during labor by extending that right to incarcerated women throughout their pregnancies. Legislative supporters plan to revive the legislation in 2011, said Alicia Walters, a reproductive justice consultant for the ACLU of Northern California.
"We're hopeful that California will become the first state to ensure the health and safety of incarcerated pregnant women and a new governor will not be as short-sighted as Gov. Schwarzenegger has been," she said. "Our legislative efforts thus far encountered no opposition. We've been successful in gaining the support of law enforcement and the corrections community."
Diana Kasdan, staff attorney for the ACLU Reproductive Rights Project, has been working with U.S. Immigration and Customs Enforcement officials on a broad revision of detention policies that she hopes will bring those policies on pregnant women in line with the federal Bureau of Prisons standard on the use of restraints.
Kasdan, who believes restraining a pregnant woman is unconstitutional, said she is heartened by actions of forward-thinking local officials, whose efforts may influence states. She cited Darron Hall, the sheriff of Davidson County, Tenn., who in 2008 instituted an internal policy change following a highly publicized incident in which a pregnant inmate was restrained on the way to a Nashville hospital. In 2009, he endorsed proposed state legislation -- which was not enacted -- modeled on the changes he made after researching the use of restraints on pregnant inmates and finding several states had outlawed or limited it.
That "led us to change how we do business. It is imperative that we develop procedures that are sensitive to the unique needs of pregnant inmates in our custody," Hall said.
On an average day, the Davidson County Sheriff's Office is responsible for the care and custody of 25 pregnant inmates, he said.
Saada Saar is looking forward to a mid-November meeting with representatives of the U.S. Department of Justice "to address how this practice might be ended." The gathering stemmed from a meeting with Attorney General Eric Holder, "where he did not know this practice was occurring and was quite upset to hear about it, especially because his wife is an ob-gyn."