Bureau of Prisons (BOP) and US Marshals Service (USMS) policies for the treatment of pregnant people are falling far short of national guidelines, according to a recent report by the Government Accountability Office (GAO).
Within the Department of Justice, the USMS is responsible for the custody of people awaiting trial or sentencing, while the BOP is responsible for people who are serving their sentences. The report reviewed national recommendations on 16 pregnancy-related care topics and their corresponding agency standards within BOP and USMS. BOP policies were found to fully align on eight of the 16 topics; USMS policies on just three.
Among much else, the report interviewed seven women detained by USMS while they were pregnant. Six out of the seven described being placed in restraints while pregnant.
The report made six recommendations, including that directors of both agencies more closely align their policies with the national guidelines. Neither agency, however, is actually required to abide by them.
Among the guidelines that the report cited were those of the American Correctional Association’s public policies, the American Medical Association’s “Health Care While Incarcerated” policy and the United Nations Rules for the Treatment of Women Prisoners (better known as the “Bangkok Rules”). The report authors also cited the 2018 First Step Act, which prohibits “the use of restraints on prisoners during pregnancy, labor and the postpartum recovery period—defined as 12 weeks following delivery—barring any exceptions.”
The care standards by which the BOP has abided, and which the USMS has not, include access to abortion, prenatal vitamins and HIV care. BOP policy recommends that HIV testing be offered for all pregnant people; the USMS policy on HIV testing for pregnant people is virtually non-existent.
The report also included interviews with 15 women who were incarcerated at BOP facilities while pregnant. Only nine reported receiving counseling from a psychologist or social worker during their incarceration.
One of the three care topics where USMS policies fully aligned with the national guidelines was the agency’s intake health screening procedures for pregnant people. The USMS Detention Standards require that all people in custody receive medical, mental health and substance use screening.
The report did not include any data on the perspectives of incarcerated pregnant people regarding substance use disorder treatment, withdrawal or access to medications for opioid use disorder (MOUD) while in USMS or BOP custody.
USMS stated that its “policy or Detention Standards do not recommend or require that pregnant women be treated with medication-assisted treatment or counseled about withdrawal risks.” BOP’s stance on MOUD is only slightly more humane: The agency allows pregnant people to access methadone, but does not call for them to be counseled regarding withdrawal risks.
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