From the U.S. Government Accountability Office, www.gao.gov Transcript for: Pregnant Women in Department of Justice Custody Description: Policymakers and advocacy groups have raised concerns about the treatment of pregnant women in custody, including the use of restraints, and so-called solitary confinement. There are also concerns that pregnant women in custody lack access to things like prenatal care and maternal nutrition. We talk with GAO's Gretta Goodwin to find out more. Related GAO Work: GAO-21-147, Pregnant Women In DOJ Custody: U.S. Marshals Service and Bureau of Prisons Should Better Align Policies with National Guidelines Released: February 2021 [Intro music:] [Gretta Goodwin:] Pregnant and post-partum women in custody are a vulnerable group with specialized needs. [Holly Hobbs:] Hi, and welcome to GAO's Watchdog Report. Your source for news and information from the U.S. Government Accountability Office--celebrating 100 years of fact-based, non-partisan government oversight. I'm Holly Hobbs. Policymakers and advocacy groups have raised concerns about the treatment of pregnant women in custody--including the use of restraints, and so-called solitary confinement. There are also concerns that pregnant women in custody lack access to things like prenatal care and maternal nutrition. Today, we talk with Gretta Goodwin--an expert on federal prisons, and a Director in our Homeland Security and Justice Team--about her new report about pregnant women in custody. Thank you for joining us, Gretta! [Gretta Goodwin:] Thank you for having me, Holly. [Holly Hobbs:] Gretta, provide us with an overview of this population. Let's start with how many pregnant women are in custody? [Gretta Goodwin:] So, we don't know the current number of pregnant women who are incarcerated; but for our report, we covered the years 2017 to 2019. There were 524 pregnant women in BOP custody during that time, and at least 1,220 pregnant women in U.S. Marshals custody during the same time period. [Holly Hobbs:] And what else do we know about these women? Who are they? [Gretta Goodwin:] The average age of these women is about 28 to 29, across both agencies. The majority of them are white, and for the ones in the Bureau of Prisons custody, about 43% of them are Hispanic. For U.S. Marshals, the typical number of days for a pregnant woman to be in custody is about 90; and for BOP, typical number of days for them to be in custody is about 76. [Holly Hobbs:] And do we know if any of them gave birth in custody, or were they released first? [Gretta Goodwin:] About 47% of the pregnant women in BOP custody had a live birth. And about 36% were released while still pregnant from BOP custody. [Holly Hobbs:] And what responsibilities do the U.S. Marshals Service and the Bureau of Prisons have for taking care of these women while they're in custody? [Gretta Goodwin:] So, the U.S. Marshals and BOP both have a statutory duty to provide for the safekeeping of these prisoners; and in so doing, they have to provide medically necessary care. There are some differences, however. Because the U.S. Marshals Service doesn't provide direct care, U.S. Marshals doesn't have any facilities of its own. So, if a pregnant woman in U.S. Marshals custody needs care, then that care is going to come from whatever facility they are in. If that particular facility doesn't provide medical care, then they will be sent outside of that facility. The Bureau of Prisons does have facilities, and they hire medical professionals. So, a pregnant woman in BOP custody will get care within that BOP facility, or they will be sent outside of the facility for care. [Holly Hobbs:] How does the Bureau of Prisons' and the U.S. Marshals' policies compare to national guidance for the health of pregnant women? [Gretta Goodwin:] The national guidance that we looked at see pregnant and postpartum women as a vulnerable group with special needs. We compared U.S. Marshals' and BOP policies with these national guidelines set forward by some of the professional organizations. We organize these guidelines across 16 categories of pregnancy-related care. So, we looked at issues related to mental health services, or issues related to nutrition. For the U.S. Marshals Service, 3 of their policies aligned across those 16 areas. When we looked at the Bureau of Prisons across those 16 areas, 8 of those policies were in alignment with those areas. [Holly Hobbs:] So, I'm thinking about all the things you need to know when you're pregnant. Are there programs at these facilities specifically for pregnant women? [Gretta Goodwin:] Yes, for the Bureau of Prisons, specifically. So BOP has 2 programs for pregnant women. One is called Mothers and Infants Together, otherwise known as MINT. And there is a residential parenting program. So MINT is a community-based program at 5 locations across the country. It's similar to a halfway house, where women remain after birth of their child to bond with that child for at least 3 months. The residential parenting program is offered through the Washington State Department of Corrections. That program is for pregnant women in minimum security facilities who have a sentence of less than 30 months. Those women get to reside with their child after birth in a supervised environment. For the 524 pregnant women in the Bureau of Prisons, 124 of them participated in either the MINT or the Residential Parenting Program over the course of our study. [Holly Hobbs:] And so, policymakers and advocates aren't just worried about the health services offered to pregnant women. They're also worried about physical treatment of these women. Did we see any evidence that those concerns were valid? [Gretta Goodwin:] In December of 2018, Congress passed the First Steps Act. That act generally prohibits the Marshals Service, and the Bureau of Prisons, from restraining pregnant or post-partum women. There are exceptions to that. For example, if the woman is a flight risk, or if she is going to do harm to herself and others. Marshals and the Bureau of Prisons do track the use of restraints. And when we looked at the data in 2019, the Marshals Service reported using restraints in 52 instances and BOP reported using restraints in 1 instance. [Holly Hobbs:] Gretta, do we know why the U.S. Marshals Service used restraints more often? [Gretta Goodwin:] For the instances that we found with the U.S. Marshals Service, often they met the 3 exceptions, so the woman might have been a flight risk, or she might have been doing harm to herself or others. [Holly Hobbs:] And what about the use of, you know, so-called solitary confinement? What did we find there? [Gretta Goodwin:] So, we did look at the use of restrictive housing. That's where a pregnant woman would be removed from the general population and placed in a cell with limited to no ability to leave that cell for the majority of the day. That is an issue for all prisoners, and a specific issue for pregnant women. And DOJ guidance states that they should not be held in restrictive housing except in rare circumstances. BOP does track this, and 31 of the 524 pregnant women were in restrictive housing for a variety of reasons. One of them because they were fighting with another prisoner. U.S. Marshals does not track the use of restricted housing as it relates to pregnant women. [Holly Hobbs:] Do we know why they don't track it? [Gretta Goodwin:] That is actually a recommendation that we made for them to start tracking the use of restrictive housing for pregnant women. [Music begins] [Holly Hobbs:] So it sounds like the U.S. Marshals Service and the Bureau of Prisons have policies for the treatment and health of incarcerated pregnant women; but that these policies are inconsistent across the two agencies, and across facilities they operate, and that the healthcare policies for incarcerated pregnant women do not match national guidance. Gretta, did we make any recommendations to either the Bureau of Prisons or the U.S. Marshals Service to improve the care of pregnant women? [Gretta Goodwin:] Yes, we did. We made a total of 6 recommendations, focused on aligning treatment and care policies, colleting post-partum prisoner status, updating detention standards, and notifying about restricted housing. [Holly Hobbs:] And last question, Gretta. What's the bottom line of this report? [Gretta Goodwin:] Pregnant and post-partum women in custody are a vulnerable group with specialized needs. And while U.S. Marshal Service and the Bureau of Prisons both have policies that address the treatment and care of these women, not all of their policies fully align with national guidelines. So both agencies should revisit their current policies with these national guidelines in mind. [Holly Hobbs:] That was Gretta Goodwin, talking about GAO's recent review of the treatment of incarcerated pregnant women in the custody of the U.S. Marshals Service, and the Bureau of Prisons. Thank you for your time, Gretta. [Gretta Goodwin:] Thank you for having me. [Holly Hobbs:] And thank you for listening to the Watchdog Report. To hear more podcasts, subscribe to us on Apple Podcasts, and make sure you leave a rating and review to let others know about the work we're doing. For more from the Congressional Watchdog, the U.S. Government Accountability Office, visit us at GAO.gov.