Best Practices for Nutrition Care of Pregnant Women in Prison


Approximately 3% to 4% of women are pregnant upon their admission to prison. Pregnant inmates present unique challenges for correctional health providers, including meeting the nutritional needs for healthy pregnancy outcomes. The authors outline six recommendations for nutrition care for pregnant inmates, including (1) test for pregnancy; (2) prescribe prenatal vitamins; (3) follow nutrition recommendations outlined by the Academy of Nutrition and Dietetics; (4) provide additional food, monitor over time, and allow for modifications to meet pregnancy needs; (5) ensure regular access to water; and (6) provide inmates with resources and education on healthy diet. The degree to which correctional facilities address the nutritional needs of pregnant women may have short- and long-term consequences for the health of women and their offspring.

‘It hurts to be hungry like that’

Pregnant women especially need nutrient-rich food. Nutritional deficits can, for example, increase the risk of gestational diabetes, which can cause a fetus’s trunk and shoulders to become too big for vaginal birth. They can also increase the risk of diabetes later in life for both mother and child. 

In jails and prisons, meal times, foods and portions are limited. More than half of the dozen women interviewed by In These Times recalled an overwhelming, unrelenting hunger.

“Withholding healthy food from a pregnant woman is withholding medical care,” says Tess Timoney, a certified nurse-midwife and director of women’s HIV services at New York’s Bronx-Lebanon hospital.

Minna Long, 23, was pregnant with twins when she entered the Clark County jail in Washington state in 2010. She received an extra eight-ounce carton of milk with all three meals, but, she recalls: “There were countless times the milk was expired and sour and I couldn’t drink it.” Her pregnancy also caused her to feel revulsion toward many of the foods served. During her four months in jail, she subsisted on milk, fruit and cold cereal, as well as commissary purchases of donuts, candy, trail mix, meat and cheese sticks, and flavored popcorn.

Even when nutrition and medical care are adequate, the restrictions and confinement inherent in prisons can make pregnancy and birthing traumatic.

It is standard policy in US prisons and jails to strip-search prisoners upon entering and exiting, including a squat and cough, with no exceptions for pregnant or postpartum women.

Sierra Watts, 37, was incarcerated in Washington state just after a ban on shackling incarcerated women during childbirth went into effect. But she learned first-hand that such laws aren’t always followed. While she was allowed to give birth without restraints, she was subsequently cuffed to the bed. Her son was placed in a cradle next to her. “I just had to lean over to get him out, but it’s harder when you can’t move that far,” she says.

The Washington state department of corrections says that “a post-incident review determined she was not supposed to be cuffed”.

For Watts, the worst part wasn’t the shackling, but what followed. Although she had granted her mother temporary guardianship, child welfare workers told her that they would not send the infant to live with his grandmother. After spending 24 hours with her newborn, Watts was taken back to prison without knowing her son’s fate.

Because he was born on a Friday, he was to remain in the hospital until child welfare offices opened on Monday.

“He was going to stay in the hospital with nobody holding him, nobody knows where he’s going, nobody’s even going to tell me where he’s going,” Watts says, her eyes filling with tears. 

She did not learn where he was placed until the following Tuesday. The next – and last – time she saw him in person was during a prison visit one year later, shortly before he was adopted.

Under the 1997 Adoption and Safe Families Act, if a child is in foster care for 15 of 22 months, the state must begin proceedings to terminate parental rights. Watts says that she initially fought to maintain custody, but finally signed away her rights. 

“They told me that if I was to take it to trial and lose, then I wouldn’t be able to get photos or hear how he’s doing or send him cards or anything,” she says. As a condition of the adoption, she receives photos of her son, now aged three, several times a year. But there is no requirement that she be allowed to have contact with the boy, and so she never sees or speaks to him.

That’s relatively common for incarcerated women who give birth; two other women interviewed by In These Times arranged for their babies to be adopted.

At the Washington Corrections Center for Women, incarcerating each woman costs $44,400 per year. Sierra Watts was sentenced to 40 months. What if the $148,000 spent to imprison her had instead been spent to help her stay out of the prison system?

The UN Rules for the Treatment of Women Prisoners and Non-custodial Measures for Women Offenders, known as the Bangkok Rules, recommend that for a pregnant woman or a child’s primary caregiver, “non-custodial measures should be preferred where possible and appropriate”.

But pregnancy and parenting are rarely taken into consideration in the US legal system. 

A few cities and states, however, have recognized that maternal incarceration can devastate children and are exploring alternatives. In November 2014, the Delaware department of correction created New Expectations, a group home for pregnant women with drug addictions who would otherwise be imprisoned. The home provides meals, prenatal vitamins, clothing, toys, intensive substance abuse counseling, and classes on infant care, parenting, breastfeeding, nutrition and budgeting. But the facility is run by the department of correction and its healthcare provider, Connections Community Support Programs, and the doors are locked and alarmed.

By contrast, New York City’s Drew House and JusticeHome operate independently of the prison system. To be eligible, mothers must plead guilty to felony charges – but the charges are dismissed once they complete the program. 

In the meantime, they avoid prison, and their children avoid foster care.

Olgita Blackwood’s youngest child was barely a week old when she was arrested. “I was so worried about my kids,” she told the Associated Press. “They depend on me. They asked for me every day.” The 24-year-old was sent to Drew House, enabling her to stay with her three children. Nearly two years later, as she prepared to take her GED, she said that the program made her independent. “I can make decisions on my own, raise my kids. I can’t imagine it any other way now.”

Excerpted with permission from In These Times magazine; read the full text here.

This investigation was supported by the Fund for Investigative Journalism and the Leonard C Goodman Institute for Investigative Reporting.