Better data collection is the key to improving pregnancy care behind bars

Across the United States, at least 1,157 pregnant women are admitted to prison each year, based on U.S. Bureau of Justice Statistics (BJS) data. The true number is likely higher, as these figures do not fully capture state and local systems where reporting is inconsistent. 

States like Ohio are beginning to act to fill this information gap by introducing measures such as House Bill 542, which requires statewide data collection in prisons and jails. But without more consistent, standardized data collection across jurisdictions, policymakers face real limitations in assessing risks and ensuring accountability for care. States need clearer, standardized data collection and reporting on pregnancies during incarceration, and Reason Foundation’s model policy helps outline how to make that happen.

While the BJS has begun collecting data on pregnancies in state and federal prisons through national surveys of correctional facilities, participation and reporting vary across jurisdictions. The data do not fully capture local jails, where reporting remains inconsistent and often nonexistent. The surveys collect facility-level information, such as the number of pregnant admissions, pregnancy outcomes, and whether services like prenatal care, testing, and counseling are offered. It also includes basic counts of births, miscarriages, and abortions within facilities. 

However, these data reflect what facilities report offering or experiencing in the aggregate, not how care is delivered at the individual level. For example, the most recent BJS report shows whether facilities provide prenatal care services but does not assess whether individuals actually receive that care, how quickly they access it, or whether there are additional barriers. A facility may report that prenatal care is available, yet in practice, access often depends on correctional staff who serve as gatekeepers to medical attention.

There is a plethora of narratives recounting personal experiences behind bars that offer insight into what quantitative data misses. In interviews conducted by the U.S. Government Accountability Office, some pregnant women described delayed or denied care, including being unable to access prescribed medications or being refused transport to the hospital despite concerning symptoms. In one case, a woman named Nicole Guerrero, serving time in a Texas jail, reported bleeding and severe pain late in pregnancy but was told there was no cause for concern. Hours later, she was placed in a holding cell without access to care as her condition worsened. She gave birth there, alone, after repeated requests for help, and her baby did not survive. 

Unfortunately, Guerrero is not an isolated case. According to the Prison Policy Initiative, nearly half of pregnant individuals in custody do not receive basic prenatal testing or nutritional support, and some are forced to give birth without medical assistance. These experiences do not appear in outcome statistics, but more complete and standardized data could reveal patterns in delayed care, barriers to access, and systemic failures that are otherwise obscured.

As outlined in principles for correctional health data collection, measurement should capture how care is delivered in practice and allow for continuity across stages of care, rather than relying solely on isolated outcomes. This includes when and how pregnancies are identified, how long individuals remain in custody while pregnant, and whether they are transferred between facilities. It also requires tracking access to prenatal care, including the number and timing of visits and any missed or delayed appointments. Documenting how pregnancy-related complaints are handled, including what symptoms are reported, how long it takes to receive clinical evaluation, and whether treatment is provided, is equally critical. The conditions of labor and delivery should be recorded, including where births occur, whether medical personnel are present, and whether individuals are transferred to outside facilities. Finally, postpartum care must be captured, including bonding time for mother and baby, follow-up visits, mental health support, and continuity of care after release. 

Data collection also needs to be paired with independent oversight and public reporting. Without external review, the same institutions responsible for delivering care are often left to evaluate their own performance, limiting transparency and weakening accountability. U.S. Immigration and Customs Enforcement detention facilities audit themselves, and the result is a long track record of delayed care, missed warning signs, and preventable deaths. To avoid these mistakes, pregnancy-related data in correctional settings must be subject to third-party auditing and made available in aggregated, public-facing reports.

Reason Foundation’s model state legislation establishes a framework to:

• Standardize data collection across prisons and jails so information is consistent and comparable in that state;
• Create a complete picture of care, rather than fragmented or outcome-only reporting;
• Introduce independent oversight through a third-party review;
• Ensure public transparency through aggregated, accessible reporting; and
• Allow policymakers to identify patterns and intervene where care is falling short. 

When the government takes custody of someone, it is responsible for their care, including pregnancy. The Supreme Court has made it clear that ignoring serious medical needs can violate the Eighth Amendment’s ban on cruel and unusual punishment. At a minimum, we should be able to see where and how pregnancy care is happening. That is what data collection, paired with independent oversight and public reporting, makes possible.

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