Pregnancy, Prison, and the End of Roe

Archival Recording: We have just received word of a decision in one of the consequential cases before the Supreme Court in decades.

Trymaine Lee: It’s been nearly one month since the Supreme Court overturned Roe versus Wade, ending the Constitutional right to an abortion almost 50 years after the right was granted.

Archival Recording: Supreme Court overturning Roe, one of the most significant historic decisions in modern times, and now it means that abortion is no longer the law of the land, it’s up to the states.

Archival Recording: It’s marked a strong, and immediate reaction. Protests and celebrations across the country.

Archival Recording: Never before has the court granted and then taken away a widely recognized Constitutional right.

Lee: As of today, abortion is now illegal with little to no exceptions in at least eight states. Courts have blocked abortion bans in at least five states from going into effect. Other states are expected to pass total bans soon, like Indiana and Tennessee.

In some states like Ohio and South Carolina, courts have allowed older laws to go into effect that were blocked before the reversal. Across the country, those fighting to uphold abortion rights have held protests.

Archival Recording: My body, my choice. Their body, their choice. My body, my choice. Abortion is healthcare. Abortion is healthcare. We trust women, we will vote. We trust women, we will vote.

Lee: And already, stories about the consequences of these total abortion bans have made headlines.

Archival Recording: New information tonight in the case of a 10 year old girl who had to travel from Columbus, Ohio to Indianapolis for an abortion.

Joe Biden: Ten years old. Imagine being that little girl. I’m serious, just imagine being that little girl, 10 years old.

Lee: But there’s one group of people who are often overlooked when it comes to reproductive rights.

Pamela Winn: Incarcerated women are left out of the conversation and not even thought about, but they are at the greatest risk.

Lee: Serving a prison sentence while pregnant is a miserable and dangerous experience. For incarcerated people, access to reproductive care like abortion was already difficult, even in states with little to no restrictions on abortion.

They face barriers like paying for the entire cost of the abortion, access to transportation, and even waiting for court orders to allow the procedure. Now, with the reversal of Roe, advocates and people who study pregnancy and incarceration fear the situation will get worse.

Dr. Carolyn Sufrin: It’s going to have a ripple effect, not only on people who are incarcerated in states where abortion is illegal, but also in states where it’s legal.

Lee: And this comes as more women are behind bars than ever. Federal data shows that the number of incarcerated women increased by more than 475 percent between 1980 and 2020. And Black women continue to bear the brunt of mass incarceration, they’re imprisoned at almost twice the rate of white women.

Archival Recording: Race plays a role in everything. It’s the foundation, it’s the core.

Lee: I’m Trymaine Lee, and this Into America. This week the pain of pregnancy in prison, why reproductive care for incarcerated women is so misunderstood, and what the end of Roe means for those behind bars.

Even before the Supreme Court overturned Roe versus Wade, abortion in prisons and jail was rare.

Sufrin: Many pregnant people who are behind bars, they don’t even think they have a right to abortion. They just assume that because they’re incarcerated they lose all of their rights, including their reproductive rights.

Lee: Dr. Carolyn Sufrin is a researcher and an Associate Professor of Gynecology and Obstetrics at Johns Hopkins.

Sufrin: And so that may remain, that misperception is likely to remain even in abortion supportive states.

Lee: Dr. Sufrin is one of the only people in the whole country who studies pregnancy and reproductive care in the carce [ph] role system.

Sufrin: There really were no data about the number of pregnant people behind bars and what happened to those pregnancies. And it’s quite shocking.

Lee: Over 2016 and 2017 she conducted what’s considered the only comprehensive study into pregnancy outcomes and abortion access in prison and jails around the country.

Sufrin: Facility policies may on paper say that someone can get an abortion, but there are more subtle restrictions like they might say but only up to the first trimester, even if that state allows abortion up until viability. Or they might say to the person, you can access an abortion, but you have to pay for it yourself, the facility will not pay for it.

And even if a person is in a state where Medicaid would otherwise cover their abortion, that can’t happen when they’re incarcerated because Medicaid becomes suspended. You know, many incarcerated people don’t have the ability to raise those funds.

Lee: Dr. Sufrin’s study covered 22 state prison systems, and she found that in practice, only 19 of them actually allowed abortion, even before Roe was overturned.

Sufrin: Abortion was legal in all 50 states, and incarcerated individuals had a Constitutional right to abortion. So the fact that at some facilities they reported not allowing abortion, which is essential healthcare when abortion was legal across the country, this is quite alarming.

Lee: The reversal of Roe means there will be more pregnant people in the United States. Dr. Sufrin says that likely means an increase in pregnancy among people sent to prison or jail too, with disastrous consequences.

Sufrin: We are anticipating an influx of patients in abortion supportive states, right? People traveling from out of state, and so that’s going to strain the system so much that it might be hard for an incarcerated individual to get on the schedule.

Lee: Her concern for incarcerated pregnant people after Roe doesn’t stop there. She’s afraid women will be more likely to face charges for a miscarriage behind bars, accused of aborting babies. And a women raped by someone from a facility’s staff and becomes pregnant, depending on where they live, they could be forced to keep that pregnancy.

Sufrin: If they are in a state where abortion is illegal, even in cases of rape, which some states have already enacted such laws, then they are forced to carry that pregnancy that state violence sanctioned pregnancy without access to abortion. It’s not clear, maybe would that be a situation where a prisoner jail might transport someone to another state? It’s not clear whether they would do that.

Lee: To Dr. Sufrin, the end of Roe is dangerous for anyone who can get pregnant, but especially for people behind bars.

Sufrin: And so, you then have people who are forced to carry unwanted pregnancies, or pregnancies that might pose a threat to their health and wellbeing, or pregnancies where the fetus’ health is affected.

They’re forced to carry these pregnancies in conditions that often have inadequate substandard access to prenatal care where they are forced, if they do give birth, they’re forced to give birth in conditions that really do not live up to the standards of dignity and humanity that we would hope for birthing people.

Winn: For women who are incarcerated, pregnant incarcerated I always say that the price we pay highly exceeds the crime and far exceeds the sentence.

Lee: Pamela Winn is an activist and founder of RestoreHER, an organization in Georgia that helps women recover from the trauma of incarceration, especially those who experience pregnancy while locked up.

Winn: My hope is for women who are incarcerated is to end prison birth.

Lee: And should they also as part of that have access to safe and healthy abortions?

Winn: Yes, if that’s their choice.

Lee: Pamela understands how crucial that choice is, and how terrible it is to be pregnant while behind bars, because she lived it. In 2009 Pamela was living in Atlanta, Georgia. She was the mother of two teenage boys, and she was working as a registered nurse, specializing in women’s health. She also had her own business for perinatal services, until she says poor business decisions lead to her being arrested for bank fraud.

Winn: I found out that I was pregnant when I got there on intake.

Lee: Pamela was six weeks along. She ended up taking a plea deal and while she was awaiting her sentence she had to be shuttled back and forth between the private facility where she was being held and the courthouse.

Winn: Whenever I would be transported I was shackled. And I remember telling them you do know that I’m pregnant. You’re putting chains around my belly. And they told me that it was part of their contract, they have to shackle everyone they transport.

Lee: And for four hours each trip Pamela would be shackled with double chains wrapped around her stomach. Those chains were connected to wrist cuffs with a small black box. She also had ankle cuffs that connected to a chain between her legs limiting her movement and ability to walk.

Winn: The way the cuffs are designed the more you move the tighter they get. So walking to the van was very painful because the ankle cuffs would be cutting into my ankles. And one day stepping into the van, because of the pain, I missed stepped and I fell.

Falling was like a tree falling. Because, again, I am locked into a fixed position, my hands in front of me, and I could not brace myself for the fall. And when I fell there no one even asked me was I OK or anything. Two officers on each side of me kind of scooped me up off the ground, set me on the van and we went on to court.

Lee: Pamela thought that once she returned from court the guards would send her to see a doctor or that someone would come check on her. But nobody ever did.

Winn: From that point I began having spotting, streaking which turned to active bleeding. I had been sending requests to medical for over two weeks that were being ignored, no response back from them. Finally I got a response that told me that this was normal with pregnancy.

I responded by telling them my credentials, that I had several degrees in nursing, I’m a specialist in women’s health and nothing was normal about this.

Lee: Finally after more than seven weeks she was able to meet with the Medical Director and see some physicians who worked with the facility. Only for them to tell her she could go to the emergency room. The approval process for that took weeks.

Winn: So now we’re talking about more than seven weeks later, they’re taking me to the E.R. As I’m sitting in the waiting room I’m shackled. And that was humiliation upon itself because the response and the reaction that I was getting from people in the waiting room, you know, grabbing a hold to their kids, moving away. It was very humiliating to experience that.

And then when we finally made it to the E.R. doctor he said what I already knew that he was going to say. That this was weeks old so it was not an emergency. So they could not see me there. He recommended that they take me to an obstetrician or a perinatologists. At this point because of the fall and the bleeding my pregnancy was considered high-risk.

Lee: The guards took Pamela back to the jail where she had to make another request to see an obstetrician. But when she finally got approval and made it to the appointment the obstetrician didn’t have an ultrasound machine on-site.

Winn: So she asked could we walk across the parking lot to the hospital where she could perform the ultrasound. They told her no that they were only authorized to bring me to her office.

Lee: That meant another request. And another agonizing wait to get it approved. But it was too late.

Winn: I did not make it. I ended up miscarrying my baby. Which looked like me being locked in a cell at 10 o’clock at night, which they do, and there is no emergency call button, no way to get anyone’s attention. You basically have to wait until an officer makes rounds to check on us.

Lee: Pamela was about 20-weeks pregnant at the time. And she vividly remembers that night, in her cell, like a nightmare she can’t wake from.

Winn: the water found in the pod was spouting out brown water so I was not drinking the water. So when we got locked in I hadn’t drank anything all day and I began cramping. Which I felt was because I was dehydrated. And I began drinking water out of the sink, the cramping got worse. So I decided to lay down and go to sleep, you know, hoping that when I woke up we would have water and ice in the pod.

I was awaken out of my sleep by the pain. My cramps had not turned into full blown contractions, I could feel my baby knotting up in my belly. So I got up, I went back to the sink and I’m drinking as much water as I can, and mind you this sink is connected to the toilet, so this is not water that I wanted to drink. But I’m drinking it because I’m worried about the safety of my baby.

As I’m drinking the water I feel a warm gush between my legs. It’s dark in the cell, there is only a slot in the top of the cell for a window. So from my own medical experience I knew to just lay down, you know, squeeze my legs tight and hopefully someone would come around soon.

The pain got worse, I was hurting, I ended up waking up the lady that was in the room with me. And she began beating on the door and screaming through the crack of the door to the other ladies that there was something wrong with Pam, there’s something wrong with Pam. There’s something wrong with her baby.

Lee: The other women around Pamela’s cell started banging on the doors too, yelling and screaming for help trying to get the guards to pay attention.

Winn: It seemed like forever before anybody every came. And when they finally came and they opened up the cell door, the gush that I felt between my legs was blood and it was all over the cell. It was after two in the morning so that’s how long we had been yelling for help.

And even when they opened up the cell door and there was blood everywhere, they were asking me if I could walk down the steps. And I refused. I was like absolutely not. Some kind of way they got a stretcher up there and took me down. But they were still debating about what to do with me.

Once we got to medical, the nurse kept taking my blood pressure because it was steadily dropping. And I said to her, you know, stop taking my blood pressure, I’m hemorrhaging. You need to call 9-1-1 and get me out of here. My blood pressure is going to continue to drop. At this point I was concerned about my own life as well as my baby’s life.

Finally, the young lady called 9-1-1 and when I got to the hospital the officers met me at the door and immediately shackled by an ankle and an arm to the bed, which is how I endured the remainder of my miscarriage with two officers between my legs that refused to give me any privacy. And that also was very dehumanizing as well and embarrassing.

When I finally stopped bleeding enough for them to check me and give me an ultrasound they told me that I had passed my baby. And I remember them searching through everything on my bed looking to make sure because they needed to make sure that I had passed all the parts of my baby. Because if not that would indicate another procedure to be done.

And they couldn’t find anything. So they asked me, Ms. Winn, where is this linen that you came in here with? Your baby has to be in there. And I told the nurse I don’t know. And when she asked the guards about the linen they told her oh, we threw it in the trash.

And I remember her saying her baby was in there how could you throw it in the trash. And I just remember heart sinking to hear, you know, that my baby, something that was a part of me, had been discarded as trash and the nonchalant tone of the officer believing like he really felt like it was trash.

Lee: Pamela left the hospital without her baby. Utterly devastated and alone.

Winn: So that has led me to do the work that I do and my story is just one of many stories. This happens to many women. And sad to say my story may be a minimal story compared to other women’s experiences.

Lee: We’ve reached out to the Robert A. Deyton Detention Facility, the private facility where Pamela was held which is run by a firm called GEO Group.

A spokesperson told us that the allegations were first made back in 2018 and that they were unable to find evidence that “anyone at the facility ever treated a pregnant woman improperly, or that staff treated a woman’s unborn child in the manner described.” They said that they take the healthcare of those in their care especially those who are pregnant, “very seriously.”

We have to take a break. When we come back, Pamela’s fight to protect pregnant people in prison, and we check back in with Marva Sadler, an abortion provider in Texas who we had on the show last year.

Stick with us.

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Pamela Winn was released from prison in 2013, and five years later she founded her advocacy organization RestoreHER, to help women cope with the effects of incarceration.

She also pushes for legislation around the country to end the practices of shackling and solitary confinement for women. So far she’s been able to help get laws passed in Georgia and on the federal level. But she often says the biggest hurdle is education.

Winn: And when I’m saying education, I’m not just talking about to the women. They know they are the experts, they live the experience. I’m speaking about educating stakeholders, legislators that don’t even have a clue that these women exist, don’t even think about them. Educating them on what’s really going on.

Lee: Now Pamela is working on a bipartisan bill in Georgia called the Women’s Care Act. The law would make detention facilities offer pregnancy tests upon arrival, with the option to bond out if the test is positive and delay sentencing for expecting mothers.

Just last week abortion after six weeks became illegal in Georgia after a federal appeals court let a 2019 law go into effect. Pamela says this means these protections are more important than ever.

Winn: If we’re going to do a reversal of Roe versus Wade and women are not going to have any autonomy over their bodies, then that’s all the more reason that these women should be allowed to be at home until 12 weeks after they have their babies to ensure that they have a safe, healthy pregnancy.

Lee: Why do you think you were treated so poorly? And do you think that this is maybe an isolated experience, or is this a more widespread problem, you think, for women who are pregnant and incarcerated?

Winn: This is a widespread issue for women who are incarcerated and pregnant. And the reason that I got treated so poorly is because prisons, jails they are not adequately sound to handle pregnant women. They don’t have the staff, they don’t have the equipment necessary, and they don’t have a plan, they don’t know what to do.

Lee: Pamela believes correction systems across the country could make conditions better for women, but they view it as too expensive. Between prenatal care, the delivery process, and post partum services, the average cost of giving birth in the U.S. is nearly $20,000 and Pamela says these views about women’s health being too expensive go beyond pregnancy and birth.

Winn: Just having women in prison is an issue, because if you’re not pregnant there’s issues with getting hygiene products. You know, women require more wellness care than men. We need pap smears, mammograms and it’s all expensive stuff. We’re more complex, you know, individuals, and they don’t want to spend the money. So --

Lee: The system doesn’t see women incarcerated as worth the cost that it would take to make sure women are taken care of --

Winn: Exactly, exactly.

Lee: Why do you think incarcerated pregnant women are so often left out of the conversation, even in the midst of this kind of big national debate about Roe being overturned? Why aren’t women behind bars considered or even talked about as part of this conversation?

Winn: Well, one, I think America just doesn’t want, like with slavery, like with a lot of things they don’t want to look at and face that they do. They want to continue for everyone in the world and everyone here to think that America is this great place, you know, of equality, and freedom, and justice for everyone and that’s very far from the truth.

When I work on this legislation, the biggest opposition that I receive is from the sheriffs who don’t want to be told how to run their facility.

Lee: So whether it’s, you know, the Supreme Court made up of mostly men deciding how much autonomy a woman has of her body --

Winn: Yes.

Lee: -- the same kind of system is playing out in our prisons and jails.

Winn: Exactly, and we’re talking about men, men that don’t have a clue what it’s like to carry a baby, deliver a baby, or half the things that a woman goes through because they can’t. So how can you make a decision about something that you have no knowledge about, nor experience with?

Lee: Last October I talked with Marva Sadler, the Clinical Director for Whole Women’s Health, a health organization that used to provide abortions in four clinics across the state of Texas, as well as four other states.

I spoke with her a little over a month after SB 8 went into affect in Texas. SB 8 banned abortions after six weeks. Marva recounted the last day in the clinic before the law took hold.

Marva Sadler: With a very small staff, but a very mighty staff and that doctor and myself, we were able to complete 67 procedures that day and actually see over 50 follow-up appointments of patients who had previously done the medication abortion, but wanted to come in and ensure that the medication abortion had worked, because if it didn’t, the next day no matter what the situation was they were going to have to continue with those pregnancies.

And so we saw our last patient that day at 11:56 pm, was when the doctor walked out of the room with four minutes to spare. And there was a moment with the staff where we were really rejoiceful, there were tears, we couldn’t believe it.

We realized we hadn’t ate all day, you know, there was that moment. And that lasted maybe five minutes, and I mean, really quickly at 12 o’clock we realized oh my god, it’s a new day and tomorrow is going to be totally different than today.

Lee: Marva was able to help a lot of people that day, but there was one woman she couldn’t help that stuck with her. A woman who was 12 weeks pregnant and had to report to prison the next day. The woman hadn’t waited the required 24 hours between her sonogram, but still wanted an abortion.

Sadler: Of course she could not leave the state, she was legally prohibited from leaving the state due to needing to report for prison. And so, I am certain that that young lady reported to start a five year prison sentence carrying an unwanted pregnancy. And on so many levels, that’s just so wrong. Sorry.

She had enough on her plate already, and she was literally standing in my lobby, and I could help her. There was absolutely no medical reason why we could not help her, but yet I had to turn her away. And that is heart wrenching.

Lee: We caught up with Marva again recently. She says she thinks about this woman often, she wonders if she actually surrendered herself, and if she’s still pregnant. But mostly Marva hopes she’s OK.

And now, Marva is also left thinking about the many other people she wishes she could still help, because this summer all abortion became illegal in Texas, except in very limited cases to save the life of the mother. Marva says the impact was immediate.

Sadler: The stories have been so vast. From the patients who were (ph) in our lobby on the morning of June 24, who had had their consultations on June 23 or prior to June 23 and were there on Friday June 24 for an abortion procedure and were sitting in our lobbies, and once Roe was overturned we had to turn them away. It’s so incredibly devastating and super, incredibly unnecessary.

Lee: Marva knew this was a possibility with a majority of conservative justices on the Court, many people felt that it was just a matter of time before Roe was overturned. Still, the reality has been hard to handle.

Sadler: You know, I don’t think you could ever be prepared for this. I think for some time, and especially again in Texas where, unfortunately, we have had to learn over the years how to adapt, and how to be in compliance with regulatory issues that were not necessarily in the best interest of the woman.

But I don't think that you're ever prepared for your basic constitutional right to be stripped away from you and to see the effects it is going to take on thousands and thousands of lives not only today but for years to come.

Lee: But Marva and Whole Women’s Health are still working to serve pregnant people in any way they can. It helps that the organization has clinics in other states where abortion is still legal.

Sadler: And even as little as if we can schedule appointments for patients in other states, that’s back and forth right now and we’re learning day-to-day, but what we do know for sure is that we’re not able to do abortions in the state of Texas right now. And so, what we have begun to do instead is to help deliver those other options to patients outside of the state in our clinics and in haven states, Virginia, Baltimore, Maryland, Bloomington, Minnesota, and our virtual care services through those patients who are available and are able to access those services as well.

Lee: Marva says they're helping patients make travel arrangements and figuring out what options they may have for financial assistance. For many black and brown women who are more likely to be poor and unable to take time off work or deal with childcare issues, these out-of-state trips could be impossible, but there’s an overwhelming feeling coming from these women.

Sadler: The overall response has definitely been anger not necessarily at us but an anger of living in a state, paying taxes, worshiping, sending your children to school in a state that has felt like it’s turned. Well it has. It has turned its back on you, and now you're having to plan an unnecessary trip where you're going to have to leave the children that you have or take off from your job to go make a three or four day trip out of state to secure the services that you could get right here at home. They’ve absolutely been super angry about that.

Lee: Marva’s angry about something else, too. Texas has one of the highest maternal mortality rates in the country. Nearly 15 die out of every 100,000 births, and black women die at nearly twice the rate. And Marva says without the constitutional right to abortion the system will become even more overburdened, and more black women in Texas will die.

Sadler: Oh without a shadow of a doubt we’re definitely going to see that increase, right, even more so because now more women are going to be forced to continue with pregnancies that otherwise they may have had an option to not do so with. So we’re definitely going to see more women of color, people of color, more families not able to access post-natal care and mental healthcare. And so, we’re definitely going to see those numbers increase and those statistics become even more deadly and concerning than they’ve ever been before.

Lee: And then there’s what happens when the child is born.

Sadler: I’m super nervous about the children who are going to be born later from those pregnancies that were unwanted and what’s going to happen to them and then what’s going to happen to the infrastructures of Texas that are to protect those children, including the foster care systems, childcare protective services. What are going to happen to those systems when we begin to see them piled on with more and more unwanted children because abortion is not accessible in the state of Texas.

So I’m very concerned about women and children and our futures here in Texas and families overall.

Lee: For Marva, this whole month has been a whirlwind. She’s so focused on her patients and staff. She hasn’t had much time to just stop and think.

Sadler: I don't think I've had a chance to process it for myself. Again, I have really been in go mode, in what can we do now, what can we do next, what can we do to make this as less traumatic as possible? So I do hope. I do have a hope that this is not forever. Even if it’s not in my lifetime that this is not forever. I do have a hope that the great minds in this movement will come together to figure out how to help the women, people, families who need us during this incredibly ridiculous time. I think I have hope for that, but it is hard. It’s hard to hold onto that. Its really hard when the foundation, the very thing in the foundation you’ve stood on seems to have been rocked and eroded right from under you.

Lee: That’s all for this week. Follow us on Twitter, Instagram, and Facebook using the handle @intoamericapod, or you can tweet me at Trymaine Lee, and you can write to us at intoamerica@nbcuni.com.

Into America is produced by Sojourner Ahebee, Isabel Angell, Allison Bailey, Mike Brown, Aaron Dalton, Max Jacobs, Olivia Richard, and Joshua Sirotiak. Original music is by Hannis Brown. Our executive producer is Aisha Turner. Special thanks to NBC’s Char Adams for help this week. I’m Trymaine Lee. We’ll be back this Thursday.