The Imprisonment of Pregnant Women under COVID-19

Andrea Circle Bear, an inmate imprisoned on account of drug charges, passed away after giving birth on Tuesday, April 28th while on a ventilator in federal custody in Texas. Her case sparked controversy worldwide in the discussion of reproductive justice and access to health services. As future physicians, the health care considerations of incarcerated individuals are vital to building stronger public health measures for all populations. When incarcerated women, especially those who are pregnant, are taken into custody, there are concerns about the emotional, physical, and mental wellbeing of themselves and their unborn child, urging for reform regarding care of the vulnerable prisoner. With both the mother’s and child’s lives in question, amending health care and prison legislation in the midst of COVID-19 is of utmost importance. New guidelines that protect the health and safety of pregnant women charged under federal law and ensure proper health standards in prisons to minimize contact with other inmates have become an emergency.


As defenders of human rights, physicians and trainees hold a collective responsibility to advocate for the protection of these women. Speaking for those who lack a voice and for human rights to be upheld is every physician’s duty. In light of the COVID-19 pandemic, there is an increased need to reduce the prison population and protect incarcerated individuals, as viruses and diseases are easily spread within prisons. Although it is impossible to anticipate and prepare for every possible health threat posed to prisoners, Circle Bear’s arrest for a non-violent drug charge highlights the urgency of the current moment to protect vulnerable prisoners - especially non-violent offenders - as she was simultaneously pregnant and infected with SARS-CoV-2. Her prison’s conditions, rather than protecting prisoners by enforcing stricter social distancing measures and releasing smaller groups for exercise, recreation, and meals, unfortunately failed to meet the public health guidelines established by the Centers for Disease Control and Prevention (CDC), which contributed to widespread transmission within the prison.

It is disturbing that, in the midst of a global health crisis, the United States federal prison system failed to protect its prisoners by releasing those charged with non-violent crimes or to ground them under house arrest. Pregnant prisoners are especially vulnerable, as they have limited access to timely adequate medical care and are often subject to abuse and mistreatment, inadequate diets lacking fruits and vegetables, and the placement of shackles that limit their mobility. Pregnant women have compared themselves to confined animals while being transported to and from their doctor’s appointments, fearing that they may trip or fall on their stomach and harm the child they are carrying.


Circle Bear is not the only case of incarceration of a pregnant woman with COVID-19. In India, Safoora Zargar is currently behind bars due to her involvement in protests against a controversial citizenship law (the Citizenship Amendment Act of 2019), which gives refuge and citizenship only to non-Muslim immigrants from neighboring countries. The bill is discriminatory against Muslims, portraying them as infiltrators who have entered the country illegally. Safoora has been charged as a conspirator due to her association with the Jamia Coordination Committee (JCC) for inciting hatred and violence, attempted murder, and promoting enemity between different religious groups, even though these charges are largely unfounded. Upon arrest, her right and access to health care were compromised, as she was accused under the Unlawful Activities Prevention Act (UAPA), which makes it impossible for her to post bail. Furthermore, due to COVID-19 restrictions, she has been denied visitations by her husband and lawyer. Police who arrested her and sent her to an overcrowded prison during the pandemic failed to concern themselves with her unique circumstances. To date, she remains in an overcrowded prison with inadequate health precautions in place to protect her from disease.


In light of these cases, we must consider alternative methods to safeguard the health of pregnant incarcerated individuals. Methods of home confinement for prisoners charged with non-violent crimes are necessary if we are to stop the spread of the virus. The benefits are clear: home confinement restructures incarceration, adheres to social distancing regulations, is cost-effective, and reduces the burden on overcrowded prisons. In particular, such measures benefit pregnant women as they are given comfort, safety, and access to health professionals from the enclosures of their own homes. With a tracking system in place to locate these women, authorities may also rest assured that the health and wellbeing of their prisoners is upheld while permitting them to serve for their transgressions.


Additionally, for pregnant prisoners who may not be released, we as physicians and trainees must ensure that women have access to proper nutrition and that facilities set up proper hygiene protocols, including widespread personal protective equipment for both prisoners and prison employees. Prisons must make clear the rights entitled to pregnant women, must prohibit shackling during transportation, and must improve living conditions within their facilities to prevent institutional ignominy of these patients. For pregnant prisoners, there are two lives at stake, and their health rights must be especially protected in light of a deadly pandemic.


More efforts are needed to reevaluate and reform the health care provided to incarcerated populations in light of COVID-19. As the cases of Circle Bear and Zarfar have taught us, pregnant women demand special attention and protections under these circumstances. As medical professionals and trainees, we are in a unique position to give voice to such patients and demand that higher quality care is afforded them through this pandemic.


Leah Sarah Peer is a medical student at Saint James School of Medicine and a graduate of Concordia University, Specialization in Biology, Minor in Human Rights in Montreal, Quebec, Canada.

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