by Carolyn Sufrin, MD, PhD
“My worst day in jail is better than my best day on the streets.”
This is a phrase that Kima, a woman I came to know while doing fieldwork and practicing medicine in jail, said to me a number of times. Kima’s declaration reflects an unsettling reality, which I describe in my forthcoming book Jailcare: Finding the Safety Net for Women Behind Bars. The intersecting trends of a frayed public safety net and racialized hyperincarceration have meant that jail, even amid its punishing violence, has become integral to society’s social and medical safety net.
Kima was in and out of jail several times during her pregnancy, and jail was the only place where she was able to access prenatal care. What can we expect for reproductive health care that the more than 210,000 incarcerated women will receive in the coming years? With the election of Donald J. Trump as the next president of the U.S., life for Kima, the baby she birthed in custody, and others like her who struggle with addiction, poverty, racial discrimination, and constrained access to medical care, is likely to get worse.
While it is still difficult to predict the details of policies he will enact, Trump’s picks to lead key agencies which might help Kima, such as Ben Carson to lead Housing and Urban Development and Tom Price at the helm of Health and Human Services, are sure to reinvigorate punitive, neoliberal policies that will further fray the safety net. Their expected plans, such as dismantling the Affordable Care Act, its contraceptive mandate, and abortion rights will disproportionately impact poor and already marginalized women.
Trump’s direct effects on mass incarceration and criminal justice and policing reform are less predictable. On the one hand, he campaigned as “the law and order candidate.” Senator Jeff Sessions, nominee for Attorney General, has a record of supporting discriminatory policies and chipping away at civil rights; but his record on criminal justice reform is more mixed. Most of Trump’s “tough on crime” discourse in the campaign was directed toward immigration and national security, so it is hard to know what he will do with sentencing laws, drug policy, and inequitable policing. Most policy reforms to dismantle mass incarceration are at the state and county level. It is conceivable that the bigotry that his election has legitimized may also seep into the local law enforcement and incarceration policies. On the other hand, politicians in several states and cities have already voiced their willingness to defy Trump’s potentially dangerous agenda. What’s more, reforming the criminal justice system has piqued the interest of politicians across the aisle for the last few years, with a steady decline in the number of people behind bars.
Trump’s intended policies have a particularly gendered punitive element to them. In fact, Trump declared that women should be punished for having an abortion, as in Vice President-elect Mike Pence’s home state of Indiana (the conviction of Purvi Patel was eventually overturned, after over 18 months in jail for self-inducing an abortion). Such policies – which criminalize women’s reproduction – are deeply rooted in cultural expectations about motherhood and punish women who deviate from those norms. There has been a recent interest in incarcerating pregnant women who use drugs, for instance, instead of providing treatment; the criminalizing mindset which Trump and Pence support could inspire states to pass laws similar to that passed by Tennessee.
What about reproductive health care behind bars?
Incarcerated women’s reproductive health needs have been largely neglected, from substandard prenatal care to shackling during labor, from denial of access to abortion to limited supplies of menstrual hygiene products. Given that policies about health care in state prisons and county jails are decided by non-federal jurisdictions, Trump will have minimal effect on existing and highly variable reproductive health services behind bars. Likewise, the 28 states with no laws prohibiting shackling of pregnant women could still pass such laws.
But Trump’s rhetoric and plans to diminish women’s health care services in general may embolden correctional administrators to further disregard reproductive health for incarcerated women. The Federal Bureau of Prisons, over which Trump does have jurisdiction, generally has adequate reproductive health policies—with the notable exception of abortion, given federal restrictions like the Hyde Amendment which prohibits federal funds to pay for abortions. Under Trump, such restrictions are sure to remain.
In fact, it is more than likely that Republicans’ promises to further restrict abortion in general will have an impact on incarcerated women’s access. While incarcerated women clearly retain their constitutional right to abortion, in reality access is constrained by non-existent policies, whims of local administrators, and undue burdens like requiring a court order. As more restrictions – such as gestational age limits, waiting periods, infrastructure requirements, funding – are imposed for women across the country, the logistical and ideological barriers that incarcerated women face will deepen.
Doing research in carceral settings is notoriously difficult. What’s more, funding to conduct research among such a vulnerable and often forgotten group—incarcerated women—is fairly limited. While I do not anticipate that the research access issues will change significantly under Trump’s regime, I do foresee that funding from government sources like the NIH will be diminished overall, and more so for women’s health and for vulnerable populations. (Recent proposals to defund the National Endowment for the Arts and the National Endowment for the Humanities do not bode well.) I and others doing similar work will need to rely even more on foundations and other non-governmental sources of research funding.
Anthropology is all the more relevant in these times, and we have much to contribute through the research questions we ask, the ways we teach in and out of the classroom, the publics and counterpublics with whom we share our work, and the power structures we engage. For my part, I will continue to serve on several national non-governmental committees which set standards on health care in correctional settings. Working within power structures is a mode of action I take seriously to translate research and ideological commitments into real policies that could benefit women like Kima.
Those of us in classroom settings can incorporate teaching about mass incarceration into various syllabi. Calls to your representatives in Congress on criminal justice system issues and women’s health issues are one tool of activism, but state and local activism is likely to be more effective in criminal justice reform– showing up to public hearings, talking with council members, and making such activism part of pedagogy too. Many universities and colleges have programs in which students teach classes at local jails or nearby prisons. Expanding such efforts is yet another way to value the lives of incarcerated persons and to teach students about the realities of mass incarceration.
The details of the impact of the election of Trump are only speculation at this point; but we can be fairly certain that people cycling through our criminal justice system and women in need of quality reproductive health services will suffer through policies and attitudes that will further marginalize them. It is essential to bear witness, to enlighten students, and to resist.
Carolyn Sufrin is an Assistant Professor of Gynecology and Obstetrics and Health, Behavior and Society at Johns Hopkins.