It's a practice so hidden, many don't realize it exists: the shackling of incarcerated women during childbirth.
Across the U.S., there are stories of women going from jails or prisons to hospitals, where they labor and sometimes even deliver while restrained with handcuffs, leg shackles or both.
In recent years, a growing number of states have moved to ban the practice. Ten states now have anti-shackling legislation: California, Colorado, Illinois, New Mexico, New York, Texas, Vermont, Washington, West Virginia -- and as of two weeks ago, Pennsylvania.
There have also been lawsuits in a number of states. On Thursday, a jury in rural Arkansas found that a guard had violated the constitutional rights of a woman by shackling her while she was in labor, though they awarded her just $1. In May, a shackling case was settled in Washington state for $125,000. And in Illinois, there's a class action lawsuit against Cook County and its sheriff, Tom Dart.
Legs Chained, Handcuffed To The Bed
Chicago attorneys Tom Morrissey and Ken Flaxman believe there could be as many as 100 to 150 women included in the class action suit, with cases dating back to late 2006. They're seeking an end to the shackling of inmates during childbirth, and compensation for their clients, including Jennifer Farrar, 25.
In November 2008, Farrar was arrested for cashing fake payroll checks. She was charged with forgery, and booked into the Cook County Jail, a sprawling complex on the southwest side of Chicago, and one of the largest jails in the country. She was almost seven months pregnant at the time.
One day the following January, Farrar went to court for a hearing, and there the pains began. An ambulance was called. Farrar says officers cuffed her hands and chained her legs together. Another chain was placed around her belly, connecting her hands to her feet. When she got to the hospital, she says, the belly chain was removed, but her legs were still chained, and one hand was cuffed to the bed.
"The doctor and the nurse," Farrar says, "they were telling the officer, is this necessary, you know? Where is she going to go? She's in labor you know."
She says she remained that way for eight or nine hours, until it came time to push. At that point, the correctional officer unlocked the leg restraints, but left one arm cuffed to the bed. An hour later, Jennifer Farrar delivered her baby girl.
"Here I am, a mother giving birth," Farrar says. "It should be a happy time in my life. I know that I did something wrong, and you have to take the responsibility for what you do. But it wasn't like I was a murderer."
"Tantamount To Torture"
Another plaintiff, Cora Fletcher, was 17 years old in 2006 when she was charged with retail theft. A year later, she missed a court date, and a warrant was issued for her arrest. A year after that, officers showed up at her house, and took her in when she was eight months pregnant.
A couple weeks later, in a prenatal checkup at the jail, it was discovered that Fletcher's baby had no heartbeat. She was taken to the county hospital, where her arms and her legs were shackled to opposite sides of the bed.
Doctors tried to induce her, but it wasn't until three days later that she went into labor. Even then, Fletcher says, she was left with one hand and one leg shackled to the bed. "It was difficult to try to have a baby like that," Fletcher says. "Especially by this being my first baby. It was so painful ... and you can't move around like how you want to."
After delivering her stillborn child, Fletcher was allowed to hold the baby for 20 minutes.
Gail Smith, executive director of the group Chicago Legal Advocacy for Incarcerated Mothers, has worked in Illinois jails and prisons for 25 years and says shackling female inmates during labor is tantamount to torture. "I think that there is a general attitude on the part of some people that they don't deserve to be treated with full human rights," Smith says. "And I find that appalling."
Growth In Female Inmates
The U.S. female prison population has grown eightfold since 1977, according to the Department of Justice's Bureau of Justice Statistics. Approximately two-thirds are in for nonviolent offenses. And yet, says Malika Saada Saar of the Rebecca Project for Human Rights, departments of corrections have not put enough thought into how treatment for women should be different from that for men.
"If a man behind bars has a broken arm, or needs to have his appendix taken out, that individual is put into restraints, into shackles during medical transport," Saada Saar says. "So essentially what is done for those men has been extended to women. And part of what's different is that we have babies."
Labor is the crux of the issue, says Steve Patterson, spokesman for the Cook County Sheriff's Office. "A correctional officer working on a tier on the midnight shift, or any other shift, is not trained to know when a woman is in labor or not," Patterson says.
Therefore, he says, correctional officers rely on medical personnel, either at the jail or at an outside hospital, to make the determination. Only when labor has been determined are all restraints removed. Patterson says that policy is consistent with state law and is necessary in a public hospital.
"We have to bring inmates to the same area that the general public comes to," Patterson says. "So, if you're laying in hospital bed, and in the next hospital bed is a woman who's in on a double murder charge, because she's pregnant she shouldn't be handcuffed to the side of the bed -- I think if you're the person laying in bed next to her you might disagree."
Patterson says in 1998, a pregnant inmate did escape during a medical visit. She was caught just off the hospital grounds. He knows of no escape attempts by pregnant inmates since 1999.
Leg Irons, Belly Chains And Handcuffs
No one is sure just how many incarcerated women give birth each year; Saada Saar estimates it to be about 1,300. Nor does anyone know how widespread shackling is.
Ginette Ferszt, associate professor and psychiatric clinical nurse specialist from the University of Rhode Island College of Nursing, recently conducted a survey of state prisons to learn more about what practices are in place for pregnant inmates.
She and a physician at the Rhode Island Women's State Correctional Facility sent out questionnaires to wardens in all 50 states. The wardens were promised anonymity, and 19 replied. The survey asked about many issues related to pregnancy, including prenatal care, nutritional needs and shackling.
Ferszt says she was quite surprised to find that two facilities continue to use leg irons, belly chains and handcuffs during transport to prenatal visits.
She also learned that among the 19 prisons that responded, six of them cuff either a woman's hands or her ankle when labor begins. During the delivery of the baby, one prison says that handcuffs stay on, and four reported back that an ankle shackle remains on.
While disturbed by the findings, Ferszt did find hope in conversations with two wardens, when she realized their shackling policies weren't something they'd thought much about.
"For many rules and policies whether for women or men, they've existed for them a long time," Ferszt says. "It hadn't really occurred to these two wardens that this could potentially be a health problem, a health issue."
She says the two wardens have since said they'll sit down and make changes.
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When prison inmates go to a hospital for treatment, they're usually wearing handcuffs and other shackles, and that apparently includes some pregnant women in labor. There's evidence around the country that that still happens: women giving birth with an arm or a leg shackled to the bed.
There's a growing movement opposing this. Ten states have outlawed it. Pennsylvania did so just two weeks ago. And there are lawsuits. Just yesterday, a jury in Arkansas found that a guard had violated the constitutional rights of a woman by shackling her in labor. The jurors awarded her one dollar.
NPR's Andrea Hsu went to Chicago to report on a class-action lawsuit there.
(Soundbite of baby crying)
ANDREA HSU: Twenty-five-year-old Jennifer Farrar is home with her third child, a mischievous little girl, Brianna(ph).
Ms. JENNIFER FARRAR: My mom has called her my partner in crime because she was in my belly. She was with me the whole time.
HSU: In November, 2008, Farrar got caught cashing fake payroll checks. She was charged with forgery. Officers booked into the Cook County Jail, a sprawling complex on the southwest side of Chicago. She was almost seven months pregnant.
Then one day the following January, Farrar went to court for a hearing. It was there that the pains began. An ambulance was called. Farrar says officers cuffed her hands and chained her legs together. Another chain around her belly connected her hands to her feet. She says when she got to the hospital, the belly chain was removed but her legs were left shackled and one hand was cuffed to the bed.
Ms. FARRAR: And the doctor and the nurse, they were, like, you know, telling the officer, like, is this necessary, you know? Like, where is she going to go? She's in labor, you know.
HSU: She says she remained that way for eight or nine hours.
Ms. FARRAR: Up until I was ready to push. The doctor is like, she's got to push now, so her legs have to be open. So you have to take the shackles off.
HSU: The correctional officer unlocked the leg restraints but left her handcuffed to the bed. An hour later, Jennifer Farrar delivered her baby girl.
Ms. FARRAR: Here I am, a mother giving birth. It should be a happy time in my life, you know. I know that I did something wrong, and you have to take the responsibility for what you do. But it wasn't like I was a murderer, you know.
Ms. GAIL SMITH (Executive Director, Chicago Legal Advocacy for Incarcerated Mothers): I think that there is a general attitude on the part of some people that they don't deserve to be treated with full human rights, and I find that appalling.
HSU: Gail Smith is with the group Chicago Legal Advocacy for Incarcerated Mothers. She thinks what Farrar went through is essentially torture. The American College of Obstetricians and Gynecologists also condemns shackling, saying that physical restraints have put the health and lives of women and unborn children at risk. And an Illinois statute passed in 1999 clearly forbids the shackling of women in labor.
Mr. STEVE PATTERSON (Spokesman, Cook County Sheriff Tom Dart): The issue is: When is a person in labor?
HSU: Steve Patterson is the spokesman for Cook County Sheriff Tom Dart. The sheriff and the county have been sued by Jennifer Farrar and 21 others.
Mr. PATTERSON: A correctional officer working on a tier on the midnight shift is not trained - or any other shift, is not trained to know when a woman is in labor or not.
HSU: Therefore, Patterson says, they rely on medical personnel to make that call, and only then do the restraints come off. He says that policy is consistent with state law and is necessary in a public hospital.
Mr. PATTERSON: We have to bring inmates to the same area that the general public comes to. So, if you're laying in a hospital bed and in the next hospital bed is a woman who is in on a double murder charge, because she's pregnant, she shouldn't be handcuffed to the side of the bed? I think if you're the person lying in the bed next to her, you might disagree.
HSU: No one is sure of just how many incarcerated women give birth every year. It's thought to be more than 1,000. And no one knows how many women are shackled. Over the past few weeks, I heard stories from around the country but had a hard time finding real numbers.
And then I heard about Ginette Ferszt, a professor of nursing at the University of Rhode Island. She, too, wanted a better understanding of how correctional facilities deal with pregnant inmates. So last year, she and the Rhode Island state prison doctor sent out questionnaires to wardens in all 50 states. Nineteen replied.
One question she posed was about shackling during transport to hospitals for prenatal visits.
Ms. GINETTE FERSZT (Professor of Nursing, University of Rhode Island): I think what I was quite, quite surprised at is that two continued to use leg irons and belly chains and handcuffs.
HSU: Ferszt also found that among the 19 prisons that responded, six of them cuff either a woman's hands or her ankle at the beginning of labor. Then during delivery of the baby, one prison said handcuffs stay on, while four reported that they keep an ankle shackled.
As for the 31 prisons that didn't respond to the survey, Ferszt says she's quite certain that at least some of them still shackle. When she spoke with two wardens about the practice, she found it wasn't something they'd really thought about.
Ms. FERSZT: It sort of was not on their radar screen. You know, they hadn't really considered looking at these policies. It hadn't really occurred to these two wardens that this could potentially be a health problem, a health issue.
HSU: Both have since told her they'll sit down and make changes.
In Cook County, Illinois, Jennifer Farrar's attorneys believe there could be many more women joining their class action suit. Cora Fletcher has already signed on. In 2006, when she was 17, Fletcher was charged with retail theft. A year later, she missed a court date, a warrant was issued for her arrest. A year after that, officers showed up at her house and took her in eight months pregnant.
Ms. CORA FLETCHER: When I got to the police station, there was a sergeant there, and he saw that I was pregnant. He asked the police officers: You all didn't have nothing else to do?
HSU: A couple weeks later, in a prenatal checkup at the jail, it was discovered that Cora Fletcher's baby had no heartbeat. They took her to the county hospital, and there:
Ms. FLETCHER: One arm was cuffed on one side of the bed rail. The other arm was cuffed on the other side of the bed rail. One feet was cuffed on one side of the bed rail, and the other feet was cuffed on the other side of the bed rail.
HSU: Doctors tried to induce her, but it wasn't until three days later that she went into labor. Even then, she says, she was left with one hand and one leg shackled to the bed.
Ms. FLETCHER: It was difficult to try to have a baby like that, especially that is being my first baby, and it was so painful, and it hurted so bad, and you know, you can't even move around and stuff like how you want to.
HSU: After it was over, Cora Fletcher held her stillborn child for 20 minutes. I asked Steve Patterson, the sheriff's spokesman, if Fletcher's case represents a violation of prison policy.
Mr. PATTERSON: I don't know. That goes back to the original question posed of what is labor, what is delivery? And I personally don't know the answer to that. I don't know at what point the doctors deemed her to be in labor. Again, that's not our call.
SHU: Two years on, Cora Fletcher has a healthy baby boy and another baby on the way. Jennifer Farrar says Brianna will be her last her child. It stunk that it was a bad experience, she says, but I'm done.
Andrea Hsu, NPR News. Transcript provided by NPR, Copyright NPR.