As calls to end police violence swept the nation during the summer of 2014, the New York City Police Department demonstrated that pregnancy is no protection against brutality. Sandra Amezquita was five months pregnant when police threw her, belly first, onto the ground. An officer straddled her body, adding his weight to the pressure, before handcuffing and arresting her. Her offense? Trying to stop them from harassing her 17-year-old son, who had been arrested for robbery the year before.
A member of El Grito de Sunset Park, a neighborhood police watchdog group, recorded the entire event and posted it online. The video sparked outcry and local protests, drawing attention to the fact that women - even women who are visibly pregnant - are not immune to police violence. That same summer, Idaho police shot and killed Jeanetta Riley, a pregnant mother of three who pulled a knife on her husband when he attempted to take her to the hospital after she had threatened suicide.
"They asked me, 'Are you sure you want to go to the hospital? You're about to go see the judge.'"
But for pregnant women, law enforcement violence isn't limited to physical brutality. Police and other law enforcement frequently subject pregnant women to other, less visible forms of violence. For instance, in many precincts and jails, pregnant women are subject to inhumane practices such as shackling or the denial of food, clothing and medical care. But in many states, if a woman subjects herself and her fetus to such practices, she risks criminalization and arrest, often on charges such as child endangerment, child abuse or fetal homicide. Both the criminalization of pregnancy and the arrests of pregnant women constitute their own forms of police violence, but are often overlooked by much of the larger organizing movements against police violence sweeping the country after the deaths of Michael Brown, Eric Garner and Tamir Rice. But they are no less torturous and brutal than the violence being protested on the streets nationwide.
The violence that Jessica Venegas experienced was not the same physical brutality that the New York City Police Department inflicted on Sandra Amezquita. Instead, the violence and pain were inflicted by police protocol - or, in some cases, lack of protocol - as well as a lack of regard for her pregnancy and overall well-being.
In November 2011, Venegas, then six-and-a-half months pregnant, was driving when a police car cut her off. The police found 300 bags of heroin in the car, which belonged to Venegas' heroin dealer. Despite her requests to be handcuffed in front, officers placed her hands behind her back. On the ride to the precinct, she recalled being unable to hold onto anything and sliding across the vehicle. "It was really, really painful," she told Truthout.
Because of her pregnancy, police held her at the precinct rather than transport her to central booking to await arraignment. The next morning, Venegas woke up in pain. "At first, I thought I was dope sick and morning sick," she remembered. Nonetheless, the pain was alarming enough that she told the police that she needed to go to the hospital. At first, she recalled, the officers were reluctant to bring her to the hospital. "They asked me, 'Are you sure you want to go to the hospital? You're about to go see the judge.'" Venegas insisted and so she was handcuffed, placed in a police van and driven to Elmhurst Hospital, the hospital in Queens where women held at Rikers Island, New York's island jail complex, are taken for pregnancy-related care.
At the hospital, Venegas was placed in a wheelchair with both her wrists and ankles cuffed. Doctors discovered that her blood pressure was high and the baby's heart rate was dropping. She spent the night with one hand and one foot cuffed to the hospital bed. Her feet were also shackled together. An IV was inserted into the arm cuffed to the bed.
"It was very uncomfortable," she said. "I couldn't turn. I could sit up a little, but that was it." An officer sat in the room with her. Venegas was allowed to draw the curtain for privacy so long as the curtain exposed her feet. When she had to use the bathroom, the officer detached her from the bed, but left her feet shackled so that she could wobble to the bathroom and back. Then her hand and foot were cuffed to the bed again. Venegas pointed out that she had, at that point, yet to see a judge or hear the charges against her. "I wasn't technically a prisoner yet," she said. "I hadn't even been arraigned."
The following morning, Venegas noticed blood in her urine and called for a nurse. A few hours later, she went into labor and was rushed to the delivery room. Her leg shackles were removed, but her left hand remained cuffed to the bed while she was given an emergency C-section.
In the recovery room, the officer, who had left the room during her surgery, returned and shackled her legs again. According to Venegas, the nurse tried to dissuade him, arguing that the anesthesia prevented her from feeling, let alone moving, her legs. She was unsuccessful; the officer shackled Venegas.
At 3:30 am, Guerrero was taken to a different cell where she gave birth on the floor. The baby died.
Venegas spent several days recovering in the hospital. Her baby was placed in the intensive care unit. Venegas was not allowed to call family members to tell them her whereabouts or that she had given birth. After not seeing her daughter in court for arraignment, Venegas' mother called the precinct. Only then did she learn that her daughter had been taken to the hospital and given birth.
After Venegas was released from the hospital, she was immediately taken to the courthouse for arraignment. The judge set bail at $10,000. Unable to afford that sum, she was sent to Rikers Island where she spent one month before appearing in court again. This time, the charges against her were dismissed.
But her ordeal was not over. Three days after Venegas was released, her daughter was placed in foster care. Although Venegas had agreed to attend outpatient drug treatment, caseworkers told her that they would not give her the baby unless she went to a residential program. Fortunately, she found a program with an open slot and, six months later, was granted custody.
Police violence - whether in the form of physical brutality or institutionally sanctioned violence - is not limited to New York City. In 2008, Juana Villegas was nine months pregnant when Tennessee police asked for her driver's license during a routine traffic stop. Villegas, who was undocumented, could not produce one. Police took her to Nashville's Davidson County jail where authorities learned that she was undocumented and held her under the 287(g) program allowing local police to detain people on federal immigration violations. After three days, Villegas went into labor. Officers handcuffed and ankle cuffed her before transporting her to the hospital. She was unshackled when she gave birth, but then cuffed to the hospital bed a few hours later.
"The Tip of the Iceberg"
But shackling is only one form of law enforcement violence against pregnant women. "The combination of pregnancy and being held lengthy periods pre-trial can be incredibly dangerous," said Diana Claitor, executive director of the Texas Jail Project, which advocates for improved conditions in the state's 247 county jails. Claitor told Truthout that she receives numerous complaints about jail conditions from concerned family members. In one extreme case, Nicole Guerrero was five months pregnant when she was incarcerated at the Wichita County Jail for violating probation. After nine days, she noticed blood and other bodily fluids coming out of her vagina, then began experiencing contractions. A nurse told her that she was fine and had her returned to her cell where her cries for help were ignored for hours. At 3:30 in the morning, Guerrero was taken to a different cell where she gave birth on the floor. The baby died.
"When you hear of cases like that, you realize it's only the tip of the iceberg," Claitor said, adding that Guerrero's experience is not uncommon. In 2014, Jessica De Samito, a 30-year-old Navy veteran, was jailed for violating parole. She was 24 weeks pregnant and on a methadone maintenance program. Sudden withdrawal from methadone is medically contraindicated and, for pregnant women, can cause miscarriage. The United Nations recognizes the withholding of methadone as cruel and degrading treatment. However, the Guadalupe County Jail did not offer methadone, and so De Samito reached out to National Advocates for Pregnant Women (NAPW), an organization that defends the rights of pregnant and parenting women.
"I can continue getting methadone treatment every day or I can buy groceries."
NAPW filed an affidavit arguing that denying her treatment would violate her constitutional rights. NAPW also reached out to RH Reality Check, which amassed 5,000 signatures on an online petition, and started a social media campaign called #JusticeforJessica. "People started calling the county jail," said Kylee Sunderlin, a Soros Justice fellow at NAPW who took the lead on De Samito's case. The public pressure worked - after two-and-a-half days of feeling "clammy," "sick" and "incredibly terrified," De Samito was given a half dose of methadone. A few days later, the parole board announced it would not remand her to prison.
However, Sunderlin noted that the consequences extended beyond the week in jail. De Samito was released under strict surveillance with exact times in which she was allowed to go to the methadone program and in which she had to be home. For the first few days, a police officer was stationed outside her home to ensure compliance. In addition, she had lost her job during that week, in part because of the publicity necessary to secure her treatment and release, but the methadone program was not covered by Medicaid, so De Samito had to pay out of pocket for each visit. Although she found a program in the neighboring county, which both accepted Medicaid and offered support services for pregnant and parenting patients, she was unable to enroll because of the inflexible hours she was allowed out of her house. Sunderlin recalled a conversation with De Samito in which her client explained, "I can continue getting methadone treatment every day or I can buy groceries." Others pitched in to buy her groceries so that she could continue getting treatment during her pregnancy. "All of this was a result of this one week of unnecessary detention," Sunderlin said.
Shackling and access to much-needed medication are two issues facing pregnant women behind bars. But these are two extremes among an array of medical concerns facing women across the country.
When Medical Care Constitutes Another Form of Violence
Tina Tinen was 41 years old, had already suffered an ectopic pregnancy and had been warned that she might never have a successful pregnancy when she arrived at Rikers Island. She doesn't remember receiving much medical care, let alone a test to see if her pregnancy was ectopic.
"Every afternoon, around the same time, I'd get a cramp," she told Truthout. "I'd bleed a little bit." She tried to see the doctor, but recalled giving up after sitting in the pen for hours. After three days, she asked the women around her, some of whom had been pregnant before, about the cramp. "They told me I needed to go to medical because I might be having a miscarriage," she said. The women fetched an officer and insisted that they take Tinen to the medical unit. When she arrived, medical staff told her to remove her clothes. As she did, she recalled that a drop of blood fell on the floor. "They made faces like, 'Oh shit. This one's about to drop dead,'" Tinen recalled. When staff could not find a heartbeat for the fetus, they sent her to Elmhurst Hospital. But first, jail staff shackled her. "The shackles really hurt," she said. "My ankles are really skinny and the cuffs hurt your ankles, but no one lets you wear two pairs of socks." At the hospital, she remembered that the officer became angry with her for walking slowly. Hospital staff located the heartbeat and explained to Tinen that she needed to lay down, rest and only get up if absolutely necessary. She received no follow-up care when she returned to Rikers.
"The anxiety that I experienced from them shackling me was just as profound for me as the act of losing my baby."
But Tinen was fortunate compared to women who had previously been on the island. In 1989, a woman experienced an ectopic pregnancy while at Rikers Island. She had not been given a pregnancy test when she arrived and, a few weeks later, began experiencing extreme lower back pain. Medical staff sent her to Elmhurst Hospital. "I was in a great deal of pain, bleeding, and in shock," the woman recalled. Nonetheless, she was shackled at her wrists and ankles "while I laid there in my blood, pain and shock. This was quite horrible and I went into a panic attack. I was begging the officer not to put me in these restraints. I informed the officer that I was not a flight risk because I was due to be released within a couple of weeks. I was informed that this was basic procedure and that it was the only way that I would be transported to the hospital." There, she learned that she had an ectopic pregnancy. "The anxiety that I experienced from them shackling me was just as profound for me as the act of losing my baby," she stated.
Even when medical care is regularly scheduled, the ways in which it is administered can impede having a safe and health pregnancy. Miyhosi was two months pregnant when she entered the jail in Middletown, New York. She was taken to prenatal visits at an outside clinic. During her first few months, she was fully shackled with handcuffs, ankle cuffs, a waist chain and a black box. After several months, she told a sergeant that the restraints caused excruciating pain not just then, but for days following. After that, she was taken to the clinic without restraints.
However, at every visit, a jail officer was stationed in the room with her. "It was hard to confide in the doctor that something was wrong," she told Truthout. "The officers repeat information to other officers [back at the jail] and then the whole world knows about it. It frightens people into not saying anything." Miyhosi had a urinary tract infection, which was diagnosed and then treated. After that, she was told that she was being tested regularly in case of another infection. When she suspected that she had another infection, and even when she was urinating blood, she did not voice her fear out loud with the officer in the room. Instead, she recalled asking at each visit, "Can you check to make sure I don't have any infections? I have lower abdominal pain." The untreated infection affected her baby who had to be sent to the neonatal unit a few days after birth.
Criminalizing Pregnancy - A Combination of Police and Medical Violence
Pregnancy criminalization laws have widened the number of women forced to endure these dehumanizing, violent and sometimes pregnancy-threatening conditions. Take the case of Tamara Loertscher and her first pregnancy. In 2014, unemployed and lacking health insurance, she went to the Mayo Clinic in Eau Claire, Wisconsin. There she disclosed that she had used methamphetamine and marijuana in the past, but had stopped using when she suspected that she was pregnant. A urine test confirmed both that she was pregnant and that she had previously used drugs. Medical staff shared this information with social services personnel. The state began secret proceedings against Loertscher, including appointing an attorney for her fetus, but not for her. She was ordered to attend drug treatment. When Loertscher refused, she was arrested and jailed under Wisconsin's Cocaine Mom Law. The law, passed in 1997, allows the state to detain, arrest, incarcerate and force pregnant women who are accused of using alcohol or drugs into treatment.
The state began secret proceedings against Loertscher, including appointing an attorney for her fetus, but not for her.
At the jail, because she refused to take a pregnancy test, Loertscher was placed in solitary confinement, where she spent nearly 24 hours confined to a small cell with little to no human contact. The cell consisted of a metal bed frame with no mattress or blankets. She was given no additional food. She spent 36 hours in isolation before she was placed in a different unit with other women. According to Sara Ainsworth, director of legal advocacy at National Advocates for Pregnant Women (NAPW), a guard threatened to tase her. Only the intervention of another guard stopped him from doing so.
In addition, she was denied medication for her hypothyroidism for the first few days, increasing her risk of miscarriage. She also began experiencing cramping and asked to see an OB-GYN. The jail did not allow her to do so. After 18 days, Loertscher was released on the condition that she submit to weekly drug tests at her own expense and be subjected to surveillance by child welfare. The surveillance included random unannounced visits to her house as well as access to all of her medical records. However, all of these forms of violence and trauma could have been avoided had the state not incarcerated her.
But Loertscher's case is no anomaly. According to Ainsworth, who acted as counsel, NAPW hears similar cases happening across the country. But quantifying them is nearly impossible. "All proceedings are in secret because they're handled by child welfare. There's no way to get information on how often or how many times this happens unless the women themselves come forward," she told Truthout. However, she does note that the increased surveillance and prosecution doesn't happen to all women equally - the hammer of these proceedings tends to fall on women of color and low-income white women, like Loertscher. "We're not seeing this among middle-class white women with more resources," she said.
Ainsworth points to the case of Alicia Beltran, another woman imprisoned under Wisconsin's Cocaine Mom Law. In 2013, Beltran told medical providers that she had taken Suboxone as a way to wean herself from painkillers. When she realized that she was pregnant, she weaned herself off Suboxone. Medical providers insisted that she begin taking Suboxone again; when Beltran refused, she was arrested. Although she was 14 weeks pregnant, police forced her to kneel on the floor before cuffing both her wrists and ankles. She was brought to the jail where she spent an entire day without food or water. Like Loertscher, Beltran was not assigned a lawyer, but her fetus was.
Beltran was ordered into drug treatment for 75 days. During that time, she lost her job. The treatment facility provided no prenatal care but fortunately, Beltran's mother was allowed to drive her from the center to prenatal care two hours away. Had her mother not been willing or able to do so, Beltran would have had to go without; the program did not provide transportation.
Had anyone other than a government official inflicted these kinds of scenarios - including physically restraining, denying medical care and failing to provide food or water - on Loertscher, Beltran or Venegas, they would risk criminal charges. In 38 states, violence against women that results in pregnancy loss is called fetal homicide.
"A punitive approach to perinatal mental illness is troubling."
Indiana is one of those states. But fetal homicide isn't limited to people who inflict harm on pregnant women. Women themselves can also be held criminally responsible if their actions result in miscarriage, stillbirths or infant deaths. In 2011, Bei Bei Shuai was 33 weeks pregnant when her boyfriend informed her that he was married and that he was leaving her. Distraught, Shuai attempted to commit suicide by eating rat poison. Friends found her and rushed her to the hospital where she was given an emergency C-section. Her daughter died three days later, triggering charges of murder and attempted feticide. Shuai was jailed without bail for one year. Her case drew considerable media attention.
"The prevalence of suicidal ideation during pregnancy is relatively high, and, in this country, suicide has been ranked as the fifth-leading cause of death among pregnant women," wrote Dr. Vivien K. Burt, Professor Michelle Oberman and Dr. Margaret Spinelli in a brief in support of Shuai. "A punitive approach to perinatal mental illness is troubling," they continued. "Decisions about treatment for mental illness during the perinatal period are challenging to both clinicians and patients. Criminal law has no place here."
Shuai eventually pled guilty to lesser charges and was sentenced to 178 days in jail and given credit for 89 she actually spent at the Marion County Jail and for another 89 days of "good time." But Shuai now has a criminal conviction and must pay the cost of her home detention.
Parvi Patel was not as fortunate. In 2013, Patel arrived at an emergency room bleeding after an apparent miscarriage. She told hospital staff that she had miscarried, but had dumped the fetal remains in the garbage. Staff contacted law enforcement and Patel was charged with neglect of a dependent for allegedly giving birth to and abandoning a live newborn. The prosecutor also charged her with a second charge contradictory to the first one of feticide for allegedly "knowingly terminat[ing] ... her own pregnancy by ingesting medication."
Patel's conservative Hindu background, in which premarital sex is frowned upon, as well as her text messages, in which she had expressed ambivalence about her pregnancy, became part of the investigation and subsequent trial. The state presented the results of a "lung float test," a test in which lungs are placed in a container of water. If the lung floats, the test claims, it proves that the owner had breathed in air and had thus been alive. The test has been deemed unreliable for the past 100 years. In addition, the state's own toxicologist admitted not finding evidence of abortifacients in Patel's system. Nonetheless, a jury found her guilty of both charges. She was sentenced to 41 years in prison.
But When the State Commits Violence ...
But what are the consequences if police, jail or prison staff hold a pregnant woman under similar circumstances? If Patel had suffered a miscarriage while in police custody, would they be criminally charged?
"Of course not!" Ainsworth answered. She points to the many lawsuits filed by women who have experienced pregnancy - and pregnancy loss - behind bars. "There's never been a criminal prosecution of jail staff. There may be some potential civil liability, but the criminal justice system doesn't respond to this kind of deprivation."
"There are no sanctions that the state will impose on its own actors."
"It's very difficult [to hold jails responsible]," Claitor agreed. "To meet the legal standards of medical negligence, you'd have to prove that the neglect directly caused the death." In addition, she pointed out that a woman seeking legal accountability also faces the challenge of finding a law firm with enough money to hire experts. Considering that many women are held in jail because they cannot afford relatively low amounts of bail, this can be close to impossible. In contrast, local governments have numerous resources and protections to dispute any allegations of wrongdoing.
"There are no sanctions that the state will impose on its own actors," Ainsworth noted. "Traditional police violence is enabled in this setting. Pregnant women are viewed as deserving of this kind of violence. Women are brutally arrested, shackled, placed in solitary confinement and threatened with violence." But, she is quick to add, arrests can lead to violence which is less visible yet no less damaging. "The coercion to end your pregnancy or to give up your medical privacy because of the risk of having your child taken from you, all of these things basically force women's cooperation to something that they don't really consent to. This is coerced, whether you want to call it police violence or medical violence or both."
But some of the women who have experienced this violence are determined to hold local and state officials accountable for their actions. In Texas, Nicole Guerrero has filed a lawsuit against Wichita County, its sheriff, the private health-care provider and the nurse who dismissed her concerns for the death of her baby. Similarly, National Advocates for Pregnant Women intends to file a lawsuit on behalf of Alicia Beltran, remains involved in Parvi Patel's appeal and is actively seeking plaintiffs in Alabama to challenge the state's Chemical Endangerment Law. It has already filed a civil rights lawsuit on behalf of Tamara Loertscher challenging Wisconsin's Cocaine Mom Law. "This law is bad for pregnant women and bad for babies," Ainsworth stated, "and it demonstrates why there should be no role for coercive, punitive state action in the provision of prenatal health care."