In Prison, Pregnant, and Overheating
A high-consequence intersection of climate change and prenatal care behind bars
To stay cool, prisoners have been known to soak their clothes in water before dressing or to flood their cell floors with toilet water, said Lauren Johnson, a woman formerly incarcerated in Texas who is now a policy and advocacy strategist for the ACLU of Texas. Johnson gave birth to her son while in jail in 2004—a birth location that was both strategic and lucky. For Johnson the birthing protocol in jail was preferable to the one in prison so she agreed to her plea deal on the condition she would only be moved into a prison after she gave birth. “Most of the time” in jail she said, she was kept in temperature controlled environments, but once she gave birth and was moved to prison, the luxury of air conditioning was gone.
Johnson compared the prison intake process—in an area nicknamed the “dog pound” because of the chain link “cages” they were held in—to a convection oven, saying “I’m glad I wasn’t there pregnant.”
The summer of 2023 was the hottest on record worldwide and with rising temperatures comes adverse symptoms associated with heat exposure: rapid pulse, nausea, dizziness. For pregnant women in America’s prisons, heat can be especially problematic.
Pregnant women have long been advised to stay out of the heat. Excess temperatures can bring on adverse symptoms for anyone, but pregnant women are more likely to experience cardiac arrest, eclampsia, sepsis during labor and delivery. New research published in the Journal of the American Medical Association indicates that both long- and short-term heat exposure can affect mother and baby during labor and delivery more than originally understood. In fact, exposure to elevated heat for 30 days or more during a pregnancy increases the risk of severe maternal morbidity, a classification the Centers for Disease Control and Prevention characterizes as “near misses” with death.
Air conditioning in prison is scant, said Amite Dominick, founder of Texas Prison Community Advocates and the 85 To Stay Alive initiative. If it exists at all, it is often only installed where guards or visitors spend time, said Johnson, and not for the general population.
In prisons in Alabama, Minnesota, Wisconsin, Texas, and California, women are moved “immediately” into air conditioned housing quarters upon learning they are pregnant, said Erica Gerrity, founder of Ostera Institute, a non-profit that offers doula services in women’s prisons across the aforementioned states and five federal institutions too. Sometimes the prisoner doesn’t know she’s pregnant, she said, until a test is administered as a routine part of intake.
At the Julia Tutwiler Prison for Women in Alabama, where Ostera offers services, air conditioning only exists in the dorm room reserved for pregnant women. Meals are still served in too-hot dining halls which women access through walking down too-hot corridors.
Women arrive to prison at all stages of pregnancy, said Gerrity, from not knowing they’re pregnant to on the cusp of labor. Furthermore, their living or environmental conditions prior to incarceration can be unknown which in many parts of the country can mean unchecked heat exposure, putting them at risk for, as the new research would suggest, undue complications.
When it comes to prenatal health, Gerrity worries more about other environmental factors like toxic water or the lack of nutritional food, both of which contribute to a pregnant woman’s overall risk exposure. Rather than champion those causes outright, the role of doulas is to be present with the mother-to-be, to support her in whatever way she requires. Still, she notices patterns of problematic living conditions, the fixing of which could benefit everyone from guards, administrators, and visitors, to prisoners.
In her experience, Gerrity said, wardens do want new ideas, and sometimes she’ll make strategic suggestions to this effect. Using the toxic water example, she might offer to make a donation of a water filtration system: one to benefit the staff and guards and another to benefit the prisoners. Even though this is an example, it illustrates a valuable intervention tactic: appealing to the workforce.
The most effective interventions are to meet employers where they're at, said Dr. Ronda McCarthy, the National Medical Director for Medical Surveillance Services at Concentra, a network of occupational health providers headquartered in Texas. As someone who makes recommendations for implementing heat illness prevention programs, she often relies on the business case for how cooler temperatures can support staff retention and ultimately boost an organization’s bottom line. This logic applied within a prison environment has the compounding effect of not only being good for officers, but also good for prisoners, which, she said, is her ultimate goal.
The public pressure to cool down prisons has mounted over recent years as summer temperatures rise. In lieu of air conditioning though, prisons have been installing fans as a stopgap measure. Even installed as large industrial versions, fans can be counterintuitive. “After 90 degrees, you're actually adding more heat to your body… which is going to be pretty much most of the summer,” said McCarthy. The fans may be more performative, than substantive, she said, as fans enable prisons to say they have addressed the heat problem, but in fact fans only make the prison hotter.
Without access to cooler environments, the body works in overdrive to lower its temperature, sometimes—and especially so for pregnant women.
Paths for accountability are fraught, said Savannah Kumar, staff attorney with the ACLU of Texas who specializes in prisoners rights. First, the legal standard for proving a prison has acted with indifference is extremely high, she said. Secondly, the Prison Litigation Reform Act of 1996 makes it difficult for people to file lawsuits. “It requires them to jump through a series of hoops on their hardest days,” she said. “This would be a challenge for even an [experienced] attorney” who understood the protocols that vary from institution to institution. She is not deterred though because setting legal precedent in court lays the groundwork for future cases to be tried—and won.
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