,,ii #aaeth ,,congress #b;d ,session ,s4 #cfaf ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,november #ad1 #bjah,mr4 ,paul 7for himself and ,mrs4 ,gillibrand7 introduced the following bill2 which was read twice and referred to the ,committee on the ,judiciary ,a ,,bill ,to prohibit the use of restraints and restrictive housing on inmates during the period of pregnancy1 labor and postpartum recovery1 to collect data on incarcerated pregnant women in the ,united ,states and the results of such pregnancies1 to address the health needs of incarcerated women related to pregnancy and childbirth1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,protecting the ,health and ,wellness of ,babies and ,pregnant ,women in ,custody ,act or as the ,pregnant ,women in ,custody ,act 4 #b4 ,findings ,congress finds the following3 7#a7 ,the number of incarcerated women in the ,united ,states increased by #gjj percent from #aihj to #bjad4 7#b7 ,justice-involved women are less likely to be violent or attempt to escape4 ,the majority of female offenders in ,federal custody are housed in minimum or low security facilities4 7#c7 ,eighty percent of all incarcerated women have children under the age of #ah4 7#d7 ,the number of incarcerated pregnant women is unknown1 but it is estimated that #b1jjj women give birth in custody each year4 7#e7 ,prenatal care significantly improves outcomes for pregnant women1 adolescents1 and their babies4 7#f7 ,availability of birth coach and doula services to incarcerated pregnant women has been associated with a drop in the rate of ,caesarean section births from #fc percent to #c percent4 7#g7 ,birth by ,caesarean section on average can cost #g1jjj to #aj1jjj more than a natural birth4 7#h7 ,participation in post-delivery mother-infant residency or nursery programs is associated with lower recidivism rates1 reduced risk of babies entering foster care1 and improved odds that mothers and their babies will remain together after the mother's period of incarceration4 7#i7 ,use of restrictive housing and restraints on incarcerated pregnant women is extremely dangerous to the health of mothers1 fetuses1 and infants4 ,yet1 these practices remain legal and practiced widely in some ,states4 7#aj7 ,use of restrictive housing for pregnant women creates a serious risk of mental and physical harm and can result in deprivation of critical nutritional and medical care4 7#aa7 ,use of restraints can cause injuries to mothers and their babies including physical trauma due to falls1 increased pain during labor from bone separation and muscle tears1 blocked circulation1 and miscarriage4 7#ab7 ,the ,u4,s4 ,department of ,justice has stated its opposition to the use of restrictive housing with pregnant prisoners1 but no ,state or ,federal laws exist that place limits on the use of restrictive housing with pregnant prisoners4 7#ac7 ,some ,states provide strong or comprehensive protections in ,state prisons against the use of restraints on incarcerated women during pregnancy1 labor1 childbirth1 and postpartum recovery4 #c4 ,data collection 7a7 ,in general ,beginning not later than one year after the date of the enactment of this ,act1 pursuant to the authority under section #cjb of the ,omnibus ,crime ,control and ,safe ,streets ,act of #aifh 7#db ,u4,s4,c4 #cgcb71 the ,director of the ,bureau of ,justice ,statistics shall include in the ,national ,prisoner ,statistics ,program and ,annual ,survey of ,jails statistics relating to the health needs of incarcerated pregnant women in the criminal justice system at the ,federal1 ,state1 tribal1 and local levels1 including-- 7#a7 the number of women known to be pregnant while in custody1 the outcomes of such pregnancies1 and whether the delivery was induced or by caesarian section2 7#b7 demographic and other information about incarcerated women who are pregnant1 in labor1 or in postpartum recovery1 including the race1 ethnicity1 and age of the pregnant woman2 7#c7 the provision of pregnancy care and services provided for such women1 including-- 7,a7 whether prenatal1 delivery and post-delivery check-up visits were scheduled and provided2 7,b7 whether a social worker1 psychologist1 doula or other support person1 or pregnancy or parenting program was offered and provided during pregnancy and delivery2 7,c7 whether a nursery or residential program to keep mothers and infants together post-delivery was offered and provided2 7,d7 the number of days the mother stayed in the hospital post-delivery2 and 7,e7 the number of days the infant remained with the mother post-delivery2 7#d7 the location of the nearest hospital with a licensed obstetrician-gynecologist in proximity to where the inmate is housed and the length of travel required to transport the inmate2 7#e7 whether a written policy or protocol is in place to respond to unexpected childbirth deliveries of pregnant inmates and for inmates experiencing labor or other medical complications related to such pregnancy when they are not located at a hospital2 and 7#f7 the number of incidents in which an incarcerated woman who is pregnant1 in labor1 or in postpartum recovery was restrained or placed in restrictive housing1 the reason for such restriction or placement1 the type of restraints used1 and the circumstances under which each incident occurred1 including the duration of time in restrictive housing1 during-- 7,a7 pregnancy2 7,b7 labor2 7,c7 delivery2 and 7,d7 postpartum recovery4 7b7 ,personally identifiable information ,data collected under this paragraph shall not contain any personally identifiable information of any prisoner4 #d4 ,care for federally incarcerated women related to pregnancy and childbirth 7a7 ,in general ,the head of each ,bureau of ,prisons women's facility shall ensure that appropriate services and programs are provided to women in custody at the facility1 including pre-trial and contract facilities1 to address the health and safety needs of inmates related to pregnancy and childbirth4 7b7 ,services and programs provided ,the head of each ,bureau of ,prisons women's facility shall ensure that3 7#a7 ,every woman of reproductive age in custody at the facility has access to pregnancy testing1 contraception1 and testing for sexually transmitted diseases4 7#b7 ,upon learning of an inmate's pregnancy1 either by self-report or clinical diagnostics and assessment1 medical staff immediately notify an assigned case manager and social worker to ensure all appropriate protocols directly pertaining to the safety and well-being of the pregnant inmate are provided and followed1 including the assessment of undue safety risks and necessary changes to accommodate where and when appropriate1 as it relates to-- 7,a7 strip searches2 7,b7 housing or lower bunk for safety reasons2 7,c7 medically recommended bedding or clothing2 7,d7 additional food allotment or modifications to ensure adequate nutrition and health1 including dietary supplements and additional calories2 and 7,e7 modified recreation and transport1 in accordance with standards within the obstetrical and gynecological care community1 to prevent overexertion or prolonged periods of sedentary movement4 7#c7 ,either at intake or not later than #dh hours after the confirmation of a prisoner's pregnancy by a health care professional1 the inmate is provided prenatal education1 counseling1 and birth support services provided by a licensed or certified provider trained to provide such service1 including information about their parental rights and their child's rights4 7#d7 ,every woman in custody at the facility1 who is pregnant or gave birth within the previous six months1 is provided-- 7,a7 appropriate educational materials1 resources1 and services related to pregnancy1 child birth1 and parenting1 including nutrition1 health and safety risks1 breast feeding1 and postpartum depression2 and 7,b7 prenatal education1 counseling1 and birth support services provided by a licensed or certified provider trained to provide such services4 7#e7 ,every woman in custody at the facility1 who is pregnant1 gave birth or experienced any other pregnancy outcome within the previous #f months is provided-- 7,a7 evidence-based screening1 assessment and treatment1 including psychosocial interventions and medication1 for mental health and substance use needs2 and 7,b7 evidence-based therapeutic care for postpartum depression or depression related to pregnancy or pregnancy loss4 7c7 ,exception ,in carrying out subsection 7b77#a71 the head of the ,bureau of ,prisons women's facility may excuse individual officers or employees1 on a case-by-case basis1 from carrying out such actions on the basis of sincerely held religious objections to such actions4 #e4 ,use of restrictive housing and restraints on inmates during pregnancy1 labor and postpartum recovery prohibited 7a7 ,in general ,chapter #cag of title #ah1 ,united ,states ,code1 is amended by inserting after section #dcba the following3 #dcbb4 ,use of restraints and restrictive housing on prisoners during the period of pregnancy1 labor1 and postpartum recovery prohibited and to improve pregnancy care for women in ,federal prisons 7a7 ,prohibition ,except as provided in subsection 7b71 beginning on the date on which pregnancy is confirmed by a healthcare professional1 and ending at the conclusion of postpartum recovery1 a prisoner in the custody of the ,bureau of ,prisons1 or in the custody of the ,united ,states ,marshals ,service pursuant to section #djhf1 shall not be placed in restraints or held in restrictive housing4 7b7 ,exceptions 7#a7 ,use of restraints ,the prohibition under subsection 7a7 related to the use of restraints shall not apply if-- 7,a7 the senior ,bureau of ,prisons or the ,united ,states ,marshal ,service official overseeing women's health and services1 in consultation with senior officials in health services1 makes an individualized determination that the prisoner-- 7i7 is an immediate and credible flight risk that cannot reasonably be prevented by other means2 or 7ii7 poses an immediate and serious threat of harm to herself or others that cannot reasonably be prevented by other means2 or 7,b7 a health care professional responsible for the health and safety of the prisoner determines that the use of medical restraints is appropriate for the medical safety of the prisoner1 and such professional reviews such determination not later than every #f hours after such use is initially approved until such use is terminated4 7#b7 ,least restrictive restraints ,in the case that restraints are used pursuant to an exception under paragraph 7#a71 only the least restrictive restraints necessary to prevent the harm or risk of escape described in paragraph 7#a7 may be used4 7,a7 ,application ,the exceptions under paragraph 7#a7 may not be applied-- 7i7 to place restraints around the ankles1 legs1 or waist of a prisoner2 7ii7 to restrain a prisoner's hands behind her back2 7iii7 to restrain a prisoner using four-point restraints2 or 7iv7 to attach a prisoner to another prisoner4 7,b7 ,medical request ,notwithstanding paragraph 7#a71 upon the request of a healthcare professional who is responsible for the health and safety of a prisoner1 a corrections officer or ,united ,states marshal1 as applicable1 shall refrain from using restraints on the prisoner or remove restraints used on the prisoner4 7,c7 ,situational use ,the individualized determination described under paragraph 7#a7 shall only apply to a specific situation and must be reaffirmed through the same process1 to use restraints again in any future situation involving the same prisoner4 7#c7 ,access to care ,immediately upon the cessation of the use of restraints or restrictive housing as outlined in this subsection1 the ,bureau of ,prisons or ,united ,states ,marshal ,service shall provide the prisoner with immediate access to physical and mental health assessments and all indicated treatment4 7#d7 ,use of restrictive housing ,the prohibition under subsection 7a7 related to restrictive housing shall not apply if the senior ,bureau of ,prisons official or ,united ,states ,marshals ,service official overseeing women's health and services1 in consultation with senior officials in health services1 makes an individualized determination that restrictive housing is required as a temporary response to behavior that poses a serious and immediate risk of physical harm and reviews and affirms that determination at least every #bd hours4 7c7 ,reports 7#a7 ,report to the director and healthcare professional after the use of restraints ,if an official identified in subsection 7b77#a71 correctional officer1 or ,united ,states ,marshal uses restraints on a prisoner under subsection 7b77#b71 that official1 including a designated correctional officer or marshal shall submit1 not later than #cj days after placing the prisoner in restraints1 to the ,director of the ,bureau of ,prisons or the ,director of the ,united ,states ,marshals ,service1 as applicable1 and to the healthcare professional responsible for the health and safety of the prisoner1 a written report which describes the facts and circumstances surrounding the use of restraints1 and includes-- 7,a7 the reasoning upon which the determination to use restraints was made2 7,b7 the details of the use of restraints1 including the type of restraints used and length of time during which restraints were used2 7,c7 any resulting physical effects on the inmate1 fetus1 or the neonate observed by or reported by the qualified health care professional2 and 7,d7 a description of all attempts to use alternative interventions and sanctions before the restraints were used4 7#b7 ,report to the director and healthcare professional after placement in restrictive housing ,if an official identified in subsection 7b77#c71 correctional officer1 or ,united ,states ,marshal places a prisoner in restrictive housing under subsection 7b77#c71 that official1 correctional officer1 or ,united ,states ,marshal shall submit1 not later than #cj days after placing the prisoner in restrictive housing1 to the ,director of the ,bureau of ,prisons or the ,director of the ,united ,states ,marshals ,service1 as applicable1 and to the healthcare professional responsible for the health and safety of the prisoner1 a written report which describes the facts and circumstances surrounding the restrictive housing placement1 and includes-- 7,a7 the reasoning upon which the determination for the placement was made2 7,b7 the details of the placement1 including length of time of placement and how frequently and how many times the determination was made subsequent to the initial determination to continue the restrictive housing placement2 and 7,c7 any resulting physical effects on the inmate1 fetus1 or the neonate observed by or reported by qualified health care professional4 7#c7 ,supplemental report to the director ,upon receipt of a report under subsection 7c71 the healthcare professional responsible for the health and safety of the prisoner shall submit to the ,director such information as the healthcare professional determines is relevant to the use of restrictive housing or restraints on the prisoner4 7#d7 ,report to judiciary committees 7,a7 ,in general ,not later than #a year after the date of enactment of this ,act1 and annually thereafter1 the ,director of the ,bureau of ,prisons and the ,director of the ,united ,states ,marshals ,service shall each submit to the ,judiciary ,committee of the ,senate and of the ,house of ,representatives a report that certifies compliance with this section and includes the information required to be reported under paragraphs 7#a7 and 7#b74 7,b7 ,personally identifiable information ,the report under this paragraph shall not contain any personally identifiable information of any prisoner4 7d7 ,notice ,not later than #bd hours after the confirmation of a prisoner's pregnancy by a health care professional1 that prisoner shall be notified1 orally and in writing1 by an appropriate health care professional1 corrections official or officer1 or ,united ,states ,marshal1 as applicable1 of-- 7#a7 the restrictions on the use of restraints and restrictive housing placements under this section2 7#b7 the prisoner's right to make a confidential report of a violation of restrictions on the use of restraints or restrictive housing placement2 and 7#c7 that the facility staff have been advised of all rights of the prisoner under subsection 7a74 7e7 ,violation reporting process ,not later than #ahj days after the date of enactment of this ,act1 the ,director of the ,bureau of ,prisons1 and the ,director of the ,united ,states ,marshals ,service shall establish processes through which a prisoner may report a violation of this section4 7f7 ,notification of rights ,the head of the ,bureau of ,prisons facility where a pregnant woman is in custody shall notify all facility staff of the pregnancy and of the pregnant prisoner's rights under subsection 7a74 7g7 ,retaliation ,it shall be unlawful for any ,bureau of ,prisons or ,united ,states ,marshal ,service employee to retaliate against a prisoner for reporting under the provisions of subsection 7d7 a violation of subsection 7a74 7h7 education 7#a7 ,in general ,not later than #ahj days after the date of enactment of this ,act1 the ,director of the ,bureau of ,prisons and the ,director of the ,united ,states ,marshals ,service shall each develop education guidelines regarding the physical and mental health needs of pregnant prisoners1 and the use of restrictive housing placements and the use of restraints on female prisoners during the period of pregnancy1 labor1 and postpartum recovery1 and shall incorporate such guidelines into appropriate education programs4 ,such education guidelines shall include-- 7,a7 how to identify certain symptoms of pregnancy that require immediate referral to a health care professional2 7,b7 in the case that an exception under subsection 7b77#a7 applies1 how to apply restraints in a way that does not harm the prisoner1 the fetus1 or the neonate2 7,c7 circumstances under which the exceptions under subsection 7b77#c7 would apply2 7,d7 the information required to be reported under subsection 7d72 and 7,e7 the right of a health care professional to request that restraints not be used1 and the requirement under subsection 7b77#b77;,b7 to comply with such a request4 7#b7 ,development of guidelines ,in developing the guidelines required by paragraph 7#a71 the ,directors shall each consult with health care professionals1 professional associations1 and ,united ,states ,department of ,health and ,human ,services entities with expertise in caring for women during the period of pregnancy and postpartum recovery4 4 7b7 ,clerical amendment ,the table of sections at the beginning of chapter #cag of title #ah1 ,united ,states ,code1 is amended by adding after the item relating to section #dcba the following3 #dcbb4 ,use of restraints and restrictive housing on prisoners during the period of pregnancy1 labor1 and postpartum recovery prohibited and to improve pregnancy care for women in ,federal prisons4 4 #f4 ,definitions 7a7 ,in custody ,the term in custody means1 with regard to an individual1 that the individual is under the supervision of a ,federal1 ,state1 tribal or local correctional facility1 including pretrial and contract facilities1 and juvenile or medical or mental health facilities4 7b7 ,other pregnancy outcome ,the term other pregnancy outcome means a pregnancy that ends in stillbirth1 miscarriage1 ectopic pregnancy1 or other non-live birth outcome4 7c7 ,postpartum recovery ,the term postpartum recovery means the eight-week period1 or longer as determined by the healthcare professional responsible for the health and safety of the prisoner1 following delivery1 and shall include the entire period that the prisoner is in the hospital or infirmary4 7d7 ,prisoner or inmate ,the term prisoner or inmate means a person who has been sentenced to a term of imprisonment pursuant to a conviction for a ,federal criminal offense1 or a person in the custody of the ,bureau of ,prisons1 including a person in a ,bureau of ,prisons pre-trial or contracted facility1 or a person in the custody of the ,united ,states ,marshal ,service1 including a person in the ,united ,states ,marshal contracted facility4 7e7 ,restraints ,the term restraints means any physical or mechanical device used to control the movement of a prisoner's body1 limbs1 or both4 7f7 ,restrictive housing ,the term restrictive housing means any type of detention that involves-- 7#a7 removal from the general inmate population1 whether voluntary or involuntary2 7#b7 placement in a locked room or cell1 whether alone or with another inmate2 and 7#c7 inability to leave the room or cell for the vast majority of the day4 #g4 ,sense of ,congress ,it is the sense of ,congress that ,states should enact comprehensive laws to ensure that the health needs of incarcerated women1 including women during the period of pregnancy and postpartum recovery1 are met1 and that such laws should include a prohibition of the use of restrictive housing and restraints on inmates during the period of pregnancy and postpartum recovery that is substantially similar to the restriction under section #dcbb of title #ah1 ,united ,states ,code4 #h4 ,education and technical assistance ,the ,director of the ,bureau of ,justice ,assistance1 in consultation with the ,secretary of ,health and ,human ,services1 shall provide education and technical assistance1 in conjunction with the appropriate public agencies1 at ,state and local correctional facilities that house women and facilities in which incarcerated women labor and give birth1 in order to-- 7#a7 educate the employees of such facilities1 including health personnel1 on the dangers and potential mental health consequences associated with the use of restrictive housing and restraints on incarcerated women during pregnancy1 labor1 and postpartum recovery1 and on alternatives to the use of restraints and restrictive housing placement2 7#b7 foster a culture of safe1 high-quality care in these facilities that voids the use of restrictive housing and restraints on incarcerated women during pregnancy1 labor1 and postpartum recovery2 7#c7 ensure that in ,states which have in place a law or policy that restricts the use of restrictive housing and restraints on incarcerated women during pregnancy1 labor1 and postpartum recovery-- 7,a7 employees at such facilities can comply with the restrictions in an effective manner2 and 7,b7 administrators at such facilities-- 7i7 understand their responsibilities1 and enforce the responsibilities of their employees in carrying out the restrictions on the use of restraints and restrictive housing2 7ii7 establish an official process by which an incarcerated woman protected by the ,state's restriction on the use of restraints and restrictive housing can report a violation of their rights under such law or policy2 7iii7 provide incarcerated women under their supervision with clear information regarding their rights under the ,state's restrictions1 including information on how to report violations of those rights2 and 7iv7 provide to healthcare professionals who care for incarcerated women information relating to the rights of such women under the laws of the ,state1 including the rights of such health care professionals1 if any1 to require that restraints be removed or the use of restrictive housing be suspended2 and 7#d7 ensure that health personnel outside of correctional facilities understand their right to inform correctional officers to remove restraints1 if applicable4 #i4 ,priority funding for ,states that provide programs and services for incarcerated women related to pregnancy and childbirth ,the ,attorney ,general shall take into consideration when determining the amount provided to a ,state or locality under a covered grant program in accordance with federally authorized grant programs1 if the ,state or locality has enacted and implemented services or pilot programs for incarcerated pregnant women aimed at enhancing the safety and wellness of pregnant women in custody1 including providing services for obstetrical and gynecological care1 resources and support services for nutrition and physical and mental health1 residential substance use treatment1 and post-delivery nursery care or residential programs to keep the infant with the mother and to promote and facilitate bonding skills for pregnant inmates4 #aj4 ,government ,accountability ,office study ,the ,government ,accountability ,office 7,,gao7 shall conduct a study of services and protections provided for pregnant incarcerated women in local and ,state correctional settings1 including policies on obstetrical and gynecological care1 education on nutrition1 health and safety risks associated with pregnancy1 mental health and substance use treatment1 access to prenatal and post-delivery support services and programs1 the use of restraints and restrictive housing placement1 and the extent to which the intent of such policies are fulfilled4