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A total of ten formerly incarcerated people who were pregnant or postpartum during the height of the COVID-19 pandemic were interviewed for this study; six had been in jail and four in prison during the pandemic. The majority (n = 8) of participants were pregnant when they entered prison/jail and two became pregnant while on work release. Eight participants had been incarcerated at least once before their current sentence. Seven were released while still pregnant, while three were pregnant, gave birth, and were postpartum during their COVID-19 incarceration. The average length of incarceration ranged from 3 days in jail to five years, inclusive of prison and transitional housing, with the median length of stay being 60 days. Participants were spread across four states in the Midwest, Southeast, and Southwest. All participants identified as women. See Table 1.

The goal of this paper is to disentangle challenges associated with incarceration, challenges associated with pregnancy, and challenges associated with the COVID-19 pandemic. We attempt to identify the specific ways incarceration, pregnancy, and the COVID-19 pandemic presented new or compounded challenges and highlight factors that mitigated the impacts of these challenges. We arranged the results in two sections: section one explores factors that exacerbated stress, discomfort, and harm among pregnant and postpartum people incarcerated during the COVID-19 pandemic, and section two highlights factors that mitigated these negative impacts. Exacerbating factors include: (1) the use of quarantine and isolation of pregnant people; (2) unclear and inconsistent prevention guidance; (3) disruptions to communication, visitation, and programming; and (4) negative experiences with correctional officers. While these factors negatively impacted individuals’ birth experiences, postpartum care, mental health, their relationships with their family, and more, interviewees also discussed factors which mitigated these impacts. These mitigating factors included: (1) support they received from external pregnancy or doula organizations; (2) support they received from incarcerated peers; and (3) self advocacy to improve their living conditions or express bodily autonomy. Combined, these themes help us more deeply understand the experiences of pregnant and postpartum women during the COVID-19 pandemic.

Factors that negatively impacted pregnant and postpartum women who were incarcerated during the COVID-19 pandemic

Impacts of quarantine and isolation

Through our analysis, several factors exacerbated pregnancy care and social support for incarcerated individuals emerged during the COVID-19 pandemic. The most common theme focused on the challenges and harms that were associated with COVID-19 quarantine and isolation. Participants described frequently being in quarantine, as they travelled off-site for medical appointments throughout their pregnancy, and were required to quarantine upon their return. One participant shared that she was in quarantine for most of her pregnancy.

Participants described a wide range of experiences with quarantine: in some cases, individuals were quarantined in cells with other people and in other cases, they were completely alone. The length of time people were quarantined also varied greatly. Some described their quarantine experiences as being as short as three days, while others shared that they “[were] on quarantine for sometimes 20 days” (Diana). These lengthy periods of isolation and confinement had material impacts on individuals. Interviewees described how being in isolation limited access to communication with others, programming, and medical care.

For the three participants who had given birth while they were incarcerated, quarantine exacerbated their distressing postpartum experiences. These participants shared how they were quarantined immediately after birth upon return to the facility and described having no access to quality postpartum care while they were in quarantine, describing abhorrent and unsanitary conditions.

“I mean it was just really terrible to be alone and away from my baby. My milk was coming in. I was squeezing breast milk down a moldy drain. The people in there were just, you know, completely clueless as to [how] to deal with us. We had to ask for maxi pads when we could, you know, just to take care of what post birth looks like for a woman. ” – Vanessa

These quarantine conditions not only posed risks to their physical health, but also their mental health and overall wellbeing. One individual shared that after giving birth to twins, she was back in the prison 40 h later and immediately isolated for seven days. This lack of access to necessary care and supports during this critical time had significant impacts on the mental health of these postpartum individuals.

Unclear and inconsistent preventative guidance

Many participants shared that unclear and inconsistent guidance related to COVID-19 mitigation, as well as a limited flow of information, layered on challenges to their experiences. Interviewees described how preventative practices, such as masking, lockdown, and testing, varied widely and ebbed and flowed on a regular basis. Some individuals were told conflicting information, while others were confused at how practices changed over time without communication.

One area in which there was considerable confusion was around quarantine procedures. Notably, several participants experienced similar instances where staff would house COVID-19 negative individuals with COVID-19 positive individuals. This created situations where pregnant and/or postpartum individuals were exposed to COVID-19 and had extended periods of lockdown.This inconsistency and variability made it hard, participants said, for them to take actions to protect themselves, advocate for themselves, and make informed decisions. The unpredictable and illogical nature by which practices were upheld caused confusion and frustration for many individuals.

Participants also expressed confusion about how staff would respond or uphold policies. Several interviewees described that the enforcement of preventative practices varied greatly from staff member to staff member:

“Staff kind of did what they wanted, when they wanted. And it kinda just depended who was on shift, too. I mean some of them would wear masks and other ones wouldn’t, you know what I mean? You just kind of knew which COs listened and which ones didn’t.” – Olivia

In a similar fashion, participants observed that staff discretion influenced how people would or would not receive care. From their perspectives, this inconsistency contributed to the spread of COVID-19 within facilities. In addition, carceral facilities, by design, limit the flow of information into and out of facilities, making it hard for individuals to stay up to date with how the pandemic and outside guidance was evolving. As Vanessa shared, “we had no idea what was going on … I mean, we were just taking guesses really and could turn on the TV if we got lucky.” While these practices impacted many individuals who were incarcerated during this time, they demonstrate a lack of any specific guidance, care, and attention to this population of pregnant and postpartum women.

Disruptions to communication and programming

Access to programs and communication with family members is an important form of support for many incarcerated pregnant people. During the pandemic, interviewees noted that access to these opportunities shifted drastically over time. For example, some prisons and jails halted in-person visits and limited phone calls. Participants noted the importance of family member support while they were incarcerated: family served as essential support, including mental health support (helping to “keep like my head in the right place,” Olivia) throughout their pregnancy. These changes in communication and visiting policies had direct impacts on some peoples’ birthing experiences. Participants grieved about their partners not being able to attend the birth of their children; not having photographs of their child at birth or of themselves while pregnant; and not being able to see their older children for over a year due to suspended and interrupted visits. One participant reflected that because of these disruptions, she had: “No pictures of my birth. No pictures of me pregnant. That’s kind of sad.” – Maya.

Another participant discussed how her partner and family did not know when she went into labor and gave birth. At the time, her partner lived in a different state, so it took a day for him to get to her after the birth. Because her partner wasn’t present, she also was unsure who was legally responsible for the baby after she gave birth. She remembered:

“My family didn’t know anything about me. They called the facility to see and they would update them, but you know, they couldn’t tell them much. It’s a safety concern if they know that an inmate has left to go be transported to deliver at the hospital. So they couldn’t even confirm or deny if I was there unless they got lucky and one of the guards kinda just like ‘She’s okay’…It was just very concerning for our family.” – Tia

She noted that this lack of communication between the DOC, hospital, and her family “monumentally” impacted their birthing experience, which had reverberating impacts on her partner and family.

In addition to halting in-person visits and limiting phone calls at some institutions, some facilities suspended programming, including parenting education. Programming can provide essential support for incarcerated people, and one interviewee observed how it impacted her relationship with her children:

“I didn’t know anything about how to come back home to my two other children and reintegrate as a family with them…they [normally] have all these programs about…reuniting. They put the parents and the kids in therapy and play therapy for that and like we didn’t have that. It was really hard when I got home.” – Vanessa

Overall, interviewees highlighted the negative impacts of disruptions by pandemic policies that limited in-person visiting, suspended programming, and caused disruptions to communication when people left prisons to give birth.

Negative experiences with correctional officers

In addition to the broader staffing practices and policies that influenced the wellbeing of pregnant and postpartum women during the pandemic, interviewees discussed their negative experiences with correctional officers (COs). Many interviewees observed that the prison or jail they were incarcerated in were short staffed during the pandemic. To make up for this, participants observed that COs would work long shifts, supervise units with hundreds of women on their own, or use cameras to monitor rather than staff themselves.

These observed staffing shortages had direct impacts on interviewees in several ways. Several participants observed that they experienced delayed access to essential services like food, medical care, and necessary products like pads, both because of observed staff shortages and the desire for facilities to focus on COVID-19 response over other forms of support. One person noted how it was hard for her and other incarcerated women to access health services:

“You have to beg the CO to give you a pad and if the pod didn’t have a pad, you had to wait. And if you’re bleeding through the first pad you get, you just have to wrap some toilet paper. I mean people made makeshift tampons and those [are] very unsanitary too… People were getting UTIs…like you could have a UTI and it could be really, really painful and it could, you know, cause other bacterial infections and they’re just not taking those as serious as [they] focus[ed] so much on COVID.” – Nicole

Another individual noted that prior to the pandemic, it was easier for loved ones on the outside to advocate for them; one participant stated that “[COs] try something with certain people, but if they know you have family and you got a good support system, they are not gonna do that” (Mary). This reflection highlighted the increased vulnerability of pregnant and postpartum women inside during this time. As a result of limited communication and visiting, the lack of clear channels of communication and opportunities for oversight from loved ones increased opportunities for differential treatment by staff.

Similarly, given COVID-19-related restrictions imposed by carceral facilities and hospitals alike, incarcerated individuals who gave birth during this time did not have adequate supports during labor and birth. As a result, COs were often counted as a birthing person’s “support,” in an effort to reduce the number of individuals present at a birth who could potentially spread the virus. The interviewees that gave birth during this time shared their experiences being mistreated by staff present at their birth. As one individual shared:

“There was an officer at the very end of my bed making disgusting faces the whole time I was giving birth … It was just me there and it was very concerning … There’s no support at all … So, when you give birth, it’s the loneliest thing.” – Vanessa

Across the board, pregnant and postpartum interviewees highlighted how COs were “very coldhearted,” (Diana) and treated them poorly. Unfortunately, inhumane and patronizing treatment was not only endemic to carceral facilities. A few participants recalled the mistreatment and inattention they received from hospital staff. With disrupted programming and lack of access to advocates (e.g., doulas), there was increased vulnerability of pregnant people in hospital settings.

These experiences with staff, while not unique to incarcerated individuals in general, were heightened by the pandemic and the resultant inability for oversight and advocacy from others. This confluence of events created scenarios that impacted both the physical and mental wellbeing of pregnant and postpartum people during this time.

Factors that mitigated the negative experiences of pregnant and postpartum women who were incarcerated during the COVID-19 pandemic

Support received from community-based organizations

Perinatal support organizations played a pivotal role in participant wellbeing and self-advocacy, and support staff from these organizations were active advocates for pregnant and postpartum individuals. Participants who had access to perinatal support organizations reported staff from these organizations provided emotional support, proactively alerted participants of their rights, directed them to existing resources, alleviated administrative burdens, and liaised between participants and their families.

“Well, honestly, [the organization] has definitely been a great help. I support them and everything that they do because without them, I don’t know if I would have been able to continue my process of being a re-entry woman with a baby. You know, I don’t know if I would have been strong enough to handle it, because even with my partner and he’s been here till down. Even with having him, it is not enough. It is just, it’s hard out here.” – Diana

One participant said a community organization advocated to the parole board on her behalf so she could be present for the first four months of her baby’s life. Another participant described how an organization was able to provide her support including paying for computer time so she could communicate with her family and purchasing her a car seat. Another participant said:

“The [perinatal support organization] helped. Okay, cause they emailed me out of nowhere. They gave me stamps on the computer to speak to my family. They sent my family, car seat. They made sure to keep them as informed as they could be about this process and what happens because there’s no, the DOC doesn’t tell your family anything. I signed one paper from the DOC saying this is who picks up the baby from the hospital and that was it. My family never saw paperwork about it. I mean, they didn’t know anything about how to get [newborn from one U.S. state to another state].” – Vanessa

A third participant with access to a perinatal program noted:

“[Program staff member] talked about her experience being pregnant at the prison and her having actually one of her children there. And she would talk to me about like the [State policy] program because, it was so new and to tell me different things about it and then I would ask her about like the conditional release and we would just kind of go over like the semantics of each program and like, kind go over things and she asked me if I would need anything…I remember she would offer and talk about it with [the prison parenting coordinator]. You know what I mean? Like if I need extra sandwiches…or extra fruit and I would let [Doula] know she would tell [the prison parenting coordinator] and I would go through the works.” – Olivia

While not all interviewees had access to these types of programs, for those with access, interviewees reported positive impacts from the emotional support, information, and resources they received.

Support received from other people who had experienced pregnancy while incarcerated

The COVID-19 pandemic exacerbated physical and social isolation, presenting new challenges to providing support to incarcerated people. Several participants relied on their incarcerated peers who had experienced pregnancy or motherhood while incarcerated for social support, pregnancy knowledge, and to abate feelings of isolation. Even for those with supportive partners and available family, the positive rapport with incarcerated peers with shared experiences were invaluable. One participant reflected:

“This support that I had the most I would say was from, there were several women in there who had given birth like a year before me. I believe that they were at that point the biggest support system I had. Now, I had my outside family, but at that point, there’s a feeling that I had that I don’t think anybody else could have understood or felt at that time. It was for you know, only someone who had felt that could know how much of a loss I felt. So like I believe at that point they were my biggest support system. They kept me going at that point.” – Maya

Another participant, who lacked family support, noted that peers were able to answer her questions about pregnancy and motherhood, as they had experienced it themselves:

“My mom died when I was 16, so I had no real guidance. No one I could really call to be like, ‘is this normal?’ The other girls in there were really cool. I knew some of them from the free world and they were all very supportive if I had a question like, ‘what do I do about this?’ And like, ‘how does this work?’ They were all moms, so they kind of helped me a lot.” – Nicole

Participants, who were formerly incarcerated at the time we interviewed them, reflected that the peer relationships they built while incarcerated continued to be sources of support after release.

“I had grown close to my roommates at the time, and they were like, ‘You know, don’t put yourself in a cell by yourself, we care about you.’ My roommates were the closest thing I had to family. And they were good. And I’m still friends with them actually. To this day we still talk.” – Mary

Participants reflected on how being pregnant or postpartum while incarcerated was a unique phenomenon that can only fully be understood by others who have a similar experience. Both first time mothers and mothers who had previously navigated pregnancy on “the outside” found their pregnancy exceptionally challenging while incarcerated during a global pandemic, and that their incarcerated peers served as major sources of support.

Self advocacy among incarcerated individuals

Finally, self advocacy was an important source of care and support for pregnant people during the pandemic. Self advocacy showed up in two distinct ways among our interviewees. First, participants advocated for improved conditions, including access to programming and services that were suspended during the pandemic, as well as opportunities for early release. Second, participants discussed agency and decision making around vaccination.

Several participants discussed how they advocated for themselves and fellow incarcerated people to improve their conditions. One participant described how she and her peers advocated to the prison to allow space for a lactation room:

“We didn’t actually even have a lactation room at that point and we were pushing for it.” – Maya

Another participant successfully advocated for early release, which allowed her to leave prison earlier than her initial sentence and spend time with her newborn baby:

“I petitioned the parole board for an early release so that I could go home with my baby for the sake of both of us. And I was the only offender in the state that they said yes, so I got out just a bit early.” – Vanessa

A second aspect of self advocacy was the choice to receive the COVID-19 vaccine. Multiple participants discussed the complex decision making process they underwent to determine whether they would be vaccinated or not, with several participants ultimately deciding not to get vaccinated. One participant was concerned that there was no communication on how the vaccine might impact her pregnancy. Because she was incarcerated, she had limited ability to do her own research. The only person she was able to ask questions about the vaccine to was a nurse who came to the prison for a parenting class, but the nurse, she noted, had limited information on how the vaccine might impact her pregnancy. She said:

“There was just a lot of questions about like, is this vaccine safe during pregnancy? But [the prison was] giving incentives for it if you did get it. I chose not to just because I had no way of knowing anything about the safety of it…I didn’t get to talk to a doctor or use Google.” – Tia

Participants also discussed fear of side effects from the vaccine. One discussed how the lack of transparency about potential side effects was of concern, while another interviewee witnessed multiple of her incarcerated peers developing symptoms after vaccination and feared getting sick in jail.

Like those who chose not to get vaccinated, those who did choose to get vaccinated did so for various reasons. One participant, for example, noted that she got vaccinated because she felt coerced, while another got vaccinated because she felt she received enough information to make an informed decision. Another, who attended weekly pregnancy classes that included information about the COVID-19 pandemic, was motivated by her fear of becoming sick from the virus. She noted:

“I knew I had a baby and I already was in prison. So what you want to do, you’re sick and die in here? You know what I’m saying? So it was like, I’m going here and [getting] this vaccination.” – Diana

A final demonstration in self advocacy was how one participant chose not to disclose her pregnancy due to fear of punishment. While there were risks associated with not disclosing, for this participant, the risks of disclosing were perceived as greater. Considering the stories other participants shared – the isolation, subpar medical attention, and hostility by carceral staff – we interpreted this decision as a form of self-advocacy.