Incarcerated pregnant women are a vulnerable population with special needs. For example, national guidance says that they should receive regular prenatal care, screening, and diagnostic tests. However, we found that while the U.S. Marshals Service and the Bureau of Prisons have policies on pregnancy-related care, they do not always align with the national guidance.
We recommended that the Marshals Service and the Bureau take steps to more closely align their policies with national guidance on pregnancy-related care to ensure pregnant and postpartum women in their custody receive appropriate treatment and care.
What GAO Found
GAO analyses of available data show that from calendar year 2017 through 2019, there were at least 1,220 pregnant women in U.S. Marshals Service (USMS) custody and 524 pregnant women in Bureau of Prisons (BOP) custody.
Pregnant Women in USMS and BOP Custody: Number, Age, Race, and Length of Time in Custody from 2017 through 2019
aUSMS does not track pregnancy outcomes, so length of time in custody may include time when the women were not pregnant. For BOP, the length of time represents only the period of pregnancy.
GAO analyses also show that pregnant women were held at a variety of facility types from 2017 through 2019. For example, pregnant women spent 68 percent of their time in USMS custody in non-federal facilities where USMS has an intergovernmental agreement. BOP data show that pregnant women spent 21 percent of their time in BOP custody while pregnant at Carswell—BOP's only female Federal Medical Center.
While USMS and BOP both have policies that address the treatment and care of pregnant women, not all policies fully align with national guidance recommendations on 16 pregnancy-related care topics. For example, national guidance recommends specialized nutrition and when needed, mental health care. USMS policies fully align on three of 16 care topics and BOP policies fully align on eight of 16. By taking steps to more closely align agency standards and policies with national guidance as feasible, USMS and BOP would be better positioned to help ensure the health of pregnant women in their custody.
Why GAO Did This Study
Policymakers and advocacy groups have raised questions about the treatment of incarcerated pregnant women, including the use of restrictive housing—removal from the general prisoner population with the inability to leave the cell for the majority of the day—and restraints. Within DOJ, USMS is responsible for prisoners awaiting trial or sentencing. BOP is responsible for sentenced prisoners. GAO was asked to review issues related to pregnant women in USMS and BOP custody.
This report examines (1) what DOJ data indicate about pregnant women in USMS and BOP custody; (2) the extent to which USMS and BOP policies align with national guidance on pregnancy-related care; and (3) what is known about the care provided and the extent to which USMS and BOP track when pregnant women are placed in restrictive housing or restraints. GAO analyzed available agency data from calendar years 2017 through 2019, which were the most recent data available; compared agency policies to relevant national guidance; and interviewed officials and a non-generalizable sample of prisoners who had been pregnant in USMS or BOP custody.
GAO is making six recommendations, including that USMS and BOP take steps to more closely align their policies with national guidance on pregnancy-related care as feasible, and that USMS require facilities to collect data on and notify USMS when pregnant or postpartum women are placed in restrictive housing. DOJ concurred with our recommendations.
Recommendations for Executive Action
|United States Marshals Service||1. The Director of the U.S. Marshals Service should take steps to more closely align its Detention Standards and policies with national guidance recommendations on pregnancy-related treatment and care, as feasible or appropriate. (Recommendation 1)|
|United States Marshals Service||2. The Director of the U.S. Marshals Service should develop and implement a policy to identify and collect postpartum prisoner data starting with the intake process. (Recommendation 2)|
|United States Marshals Service||3. The Director of the U.S. Marshals Service should develop a plan with a timeline for updating the Federal Performance Based Detention Standards to reflect updated policy restrictions on the use of restraints on pregnant and postpartum women as well as communicating such updates within USMS and to IGA facilities. (Recommendation 3)|
|Bureau of Prisons||4. The Director of the U.S. Bureau of Prisons should take steps to more closely align its policies with national guidance recommendations on pregnancy-related treatment and care, as feasible or appropriate. (Recommendation 4)|
|Bureau of Prisons||5. The Director of the U.S. Bureau of Prisons should develop and implement a policy to identify and collect postpartum prisoner data during the intake process. (Recommendation 5)|
|United States Marshals Service||6. The Director of the U.S. Marshals Service should require IGA and contract facilities that hold USMS prisoners to collect data on and immediately notify USMS when pregnant or postpartum women are placed in restrictive housing, so that USMS can help ensure appropriate use of such housing in accordance with its policies. (Recommendation 6)|