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The Case for Vaccinating Those Who Are Incarcerated While Pregnant

All incarcerated individuals must be prioritized for Covid-19 vaccination, but pregnant women are especially vulnerable.

March 5, 2021

Pris­ons and jails across the United States have a history of fail­ing preg­nant women who are incar­cer­ated — one need only look to the prac­tice of shack­ling them during deliv­ery to under­stand the phys­ical and psycho­lo­gical tolls. Preg­nant women are already among the most vulner­able in the prison system. With Covid-19 adding a deadly dimen­sion to this prob­lem, they must be prior­it­ized for vaccin­a­tion.

Last month, the Govern­ment Account­ab­il­ity Office (GAO) released a report detail­ing how the Bureau of Pris­ons and U.S. Marshals Service fail to appro­pri­ately care for preg­nant women in their custody. This report came as a follow-up to a May 2020 report from the agency that found similar refusal to provide preg­nancy related care in Immig­ra­tion and Customs Enforce­ment deten­tion facil­it­ies.

As noted in the most recent report, incar­cer­ated preg­nant and post­partum women are two partic­u­larly vulner­able groups that should receive consist­ent phys­ical and mental health­care. The GAO judged accord­ing to basic stand­ards of care and still found the bureau lack­ing in half of the 16 meas­ured health­care categor­ies; the Marshals Service was found lack­ing in 13.

This study used data from 2017 to 2019, mean­ing that it did not even attempt to meas­ure the impact of Covid-19 on incar­cer­ated preg­nant people. Since the begin­ning of the pandemic, pris­ons and jails across the coun­try have failed to adequately address the risks posed by Covid-19 to the lives of both incar­cer­ated indi­vidu­als and the staff members around them.

When it comes to vaccin­a­tion access, most of the coun­try has prior­it­ized correc­tional staff while leav­ing those behind bars out of initial prior­ity groups, despite clear guid­ance from the public health community that incar­cer­ated people — who are exper­i­en­cing Covid-19 infec­tions and deaths at higher rates than the general popu­la­tion — must be prior­it­ized for vaccin­a­tion. Only eight states have desig­nated their incar­cer­ated popu­la­tions as “Phase One” recip­i­ents for vaccines, and those desig­na­tions have caused a great deal of polit­ical contro­versy.

While men comprise 90 percent of incar­cer­ated people, the rate of women’s incar­cer­a­tion in the United States has risen dramat­ic­ally in recent decades. The U.S. prison system has nonethe­less remained unpre­pared and ill-equipped to accom­mod­ate women in normal times, much less during a global pandemic. Women’s pris­ons tend to be smal­ler and more isol­ated than men’s, which could limit the possib­il­ity of outside expos­ure to Covid-19. But there is often only one facil­ity in a state, ensur­ing that women enter­ing and exit­ing the correc­tional system are often being trans­por­ted for long peri­ods from dispar­ate places, thereby increas­ing expos­ure risk.

There is no nation­wide data­base of Covid-19 in women’s pris­ons, and trans­par­ency varies widely across the coun­try. Rarely do facil­it­ies release inform­a­tion about test­ing and posit­iv­ity rates over time — if they publish the inform­a­tion at all — and access to test­ing has been limited. Despite the barri­ers to inform­a­tion, it is clear from even the minimal avail­able data that Covid-19 has wreaked havoc in women’s facil­it­ies just as it has in other congreg­ate living settings.

But it’s not just the women left inside that remain at risk — 95 percent of incar­cer­ated people will even­tu­ally return home, and incar­cer­ated women are far more likely to be the primary care­takers of chil­dren or other family members than incar­cer­ated men. That means that women leav­ing pris­ons and jails are return­ing to family settings, with all the close contact and care­giv­ing respons­ib­il­it­ies that come with it.

Incar­cer­ated women also tend to have more (and more specific) health prob­lems than those held at male facil­it­ies, often stem­ming from histor­ies of abuse, an inab­il­ity to access health­care, or general repro­duct­ive issues that have gone untreated or ignored. About two-thirds of incar­cer­ated women report chronic ailments, render­ing them partic­u­larly vulner­able to a virus that preys upon preex­ist­ing condi­tions. For preg­nant women, the risk is even more pronounced. Symp­to­matic preg­nant people who contract Covid-19 face an increased risk of severe illness, complic­a­tions, and death.

To be clear, all incar­cer­ated people should be offered a Covid-19 vaccin­a­tion. The pandemic has turned the nation’s mass incar­cer­a­tion prob­lem into an issue of life or death as millions remain behind bars. Despite public outcry and legal chal­lenges, pris­ons and jails have failed to respond with the kind of mass decar­cer­a­tion, personal protect­ive equip­ment provi­sion, and general compas­sion that has been greatly needed for the past year.

Yet if offi­cials are determ­ined not to prior­it­ize all incar­cer­ated people for Covid-19 vaccin­a­tion, they must at least consider the most vulner­able popu­la­tions behind bars. Incar­cer­ated preg­nant women face a very high risk of both infec­tion and death from the coronavirus, and there­fore should be considered one of the highest prior­ity groups in any vaccin­a­tion plan.