Pregnant Women in Prison Aren't Getting Care, and No One Is Keeping Track

U.S. criminal justice policies have led to a 585 percent increase in the incarcerated women’s population since 1980 and have resulted in the highest female incarceration rate in the world.

Early in her second trimester, Linda Acoff was taken into custody for failing to complete court-ordered mental health treatment. After three weeks in the Cuyahoga County Jail in Columbus, Ohio, she began experiencing intensifying pressure, cramping, and bleeding. But despite her pleas for help, the nurse on duty offered only sanitary napkins and Tylenol. After banging on her cell door for hours, Acoff was eventually taken out of the jail's pregnancy pod on a stretcher—leaving behind the remains of her 17-week-old fetus. 

A recent exposé from The Marshall Project revealed that Acoff had contracted chorioamnionitis, an infection of the fluid and tissues inside the uterus. Although considered a serious pregnancy complication that can threaten both the fetus and the mother, there was hope that Acoff's 17-week pregnancy could have been saved. "If there's early appropriate diagnosis and intervention, that baby can absolutely survive if the patient is treated promptly," Michael Baldonieri, an OB-GYN and assistant professor of reproductive biology at the Case Western Reserve University School of Medicine, told The Marshall Project.

In the end, Acoff lost her baby, and while the nurse on duty was ultimately fired, the tragedy has not inspired change in the way that Ohio handles incarcerated pregnancies or collects data on them. Unfortunately for Acoff, and the estimated 55,000 pregnant women who enter the nation's jails every year, little data exists on the impact incarceration has on pregnancy outcomes. 

A 2024 report by the U.S. Government Accountability Office (GAO) found that "comprehensive data on pregnant women incarcerated in state prisons and local jails do not exist" even though the U.S. has "one of the highest maternal mortality rates" and "incarcerates women at the highest rate in the world."   

This number is trending upward: between 1980 and 2022, the female prison population in the U.S. grew by more than 585 percent, more than twice the growth rate of the male prison population. Much of this increase has been attributed to more expansive policing, post-conviction barriers, and stiffer drug sentencing laws. Women have seen drug-related arrests increase by 317 percent since 1980, while men have seen a 69 percent jump. Today, more than half of the incarcerated women are serving time for drug and property offenses. 

Sentencing for these offenses, which considers the nature of the crime and criminal histories, can disproportionately put pregnant women inmates in harm's way. 

The Prison Policy Initiative estimates that in 2024, about 189,600 women and girls were held in state custody, and 93,000 were held in local jails across the country. Of this number, more than half of the women were held in jail while awaiting trial. Even after a conviction, women were more likely to be sentenced to jail, rather than to prison, compared to convicted men. 

This distribution can be problematic, particularly for pregnant women, because jails are poorly positioned to provide proper health care and often offer fewer services than prisons. This discrepancy, plus negligent care, is ultimately what cost Acoff her pregnancy. 

Given these grim statistics, tracking pregnancy outcomes in jails is essential, Dr. Carolyn Sufrin, board member of the National Commission on Correctional Health Care and fellow at the American College of Obstetricians and Gynecologists, told The Marshall Project. Otherwise, Sufrin believes, it's impossible to know whether the nation's 3,000 jails are failing pregnant women. 

Sufrin is right to demand better data on how incarceration impacts pregnancies, but data alone will not stop the mass incarceration of Americans or reform policies that created the problem.