Harris County Jail: A Nutritional Survey of Pregnant Incarcerated People

Report by Kristin Sadler, June, 2012, graduate student in the school of Social Work, University of Houston
Analysis by Krishnaveni Gundu, co-founder of Texas Jail Project, September, 2012

Earlier this year, a 22 year old graduate student named Kristina Sadler, working on her Masters in Social Work at the University of Houston, found herself thinking about the plight of pregnant [incarcerated persons] in the county jails of Texas. Not prisons, but county jails where a majority of the population is pre-trial detainees. In particular, most women detainees are in there for minor misdemeanors related to poverty, substance abuse/possession or mental health issues. Rarely for  violent crimes.

While most of us would move on to other thoughts, she began to wonder what percentage of this population was pregnant and how they dealt with being pregnant in jail. She knew they were most likely treated as criminals even if they were pre-trial but she wondered if their unborn children were getting a fighting chance at a healthy life. As she read and researched, she discovered to her horror that according to a 2010 state-by-state report card titled Mothers Behind Bars, issued by the National Women’s Law Center and the Rebecca Project on the treatment of incarcerated pregnant women and their babies, nearly half the states received an overall failing grade, and over two thirds received a failing grade for their lack of pre-natal care.

Forty-nine out of 50 states fail to even report all incarcerated women’s pregnancies and their outcomes; 43 states do not require medical examinations as a component of pre-natal care; and even though a Federal law banning shackling came into effect in 2008, 36 states still engage in the barbaric practice of shackling pregnant women, often with ankle, wrist and belly chains, before, after and sometimes even during labor. The report graded each state on three areas: pre-natal care, shackling policies and alternatives to incarceration. Even by the low standard of care for [incarcerated persons] one comes to expect from the US prison system, the conclusions are shocking. Texas scored a C in pre-natal care, A- in shackling policies, A in alternatives to incarceration and a B+ in the composite grade. The report focused completely on federal prisons which have a better set of policies and regulations in place compared to state run county jails.

But it bears repeating that 49 out of 50 states did not even report pregnancies and their outcomes.

When one considers the 400% increase in incarcerated women since the 1980’s, (more women are sentenced for drug-related offenses now than men), one can begin to grip the enormity of the issue. If the federal facilities were so lacking, what could one really expect from county jails.

As Ms.Sadler went on to discover, not until 2009 did the Texas Legislature pass a bill (HB 3653), which was signed into law, severely restricting (not outright banning), the use of shackles on pregnant [incarcerated persons] during childbirth. Until then shackling even during labor was a common practice. The same year the legislature passed another bill (HB 3654) requiring Texas county jails to write and implement policies and procedures for the care of pregnant [incarcerated persons]. Until HB 3654, county jails were under no obligation to even count much less provide special care to its pregnant [incarcerated people]. While there is no systematic documentation at the state or federal level of how many women give birth while incarcerated, in 2007, the Bureau of Justice Statistics stated that, on average, five percent of women who enter into state prisons are pregnant and six percent of women in jails are pregnant. (see Mothers Behind Bars report)

Armed with these numbers, for the purposes of her research and advocacy outreach, Ms.Sadler decided to focus on the quality of pre-natal care that pregnant [incarcerated persons] in the Harris County Jail received. With approximately 9,000 [incarcerated persons], Harris County jail ranks the largest among the 245 county jails in Texas and the third largest in the nation. According to official sources, as of September 10th 2012 Harris County Jail was housing 1166 females and 7843 males  making that a total of 9009.

In 2011, the ACLU of Texas and the Texas Jail Project (TJP) released a report on the implementation of the two laws mentioned above. On the matter of pre-natal care, the authors state that ‘internal jail policies related to pregnant [incarcerated persons] and required by state law vary greatly from facility to facility.’  For instance, while some jails may not even screen the women to check for pregnancies during intake, other jails do it routinely and some others leave it to the [incarcerated persons] to ask for a test.

Harris County falls in the first category. The routine pregnancy test is undertaken only as part of the 12 day health check up. So if a woman does not declare that she’s pregnant or is unaware of it, it may be almost two weeks before the medical staff determines her condition. In addition, the authors also reported that Harris County had failed to establish procedures to ensure that pregnant [incarcerated persons] are examined by medical staff as soon as pregnancy is discovered. Although the intake screening process (nurse screening and x-ray), main medical clinic, medical and mental health infirmaries and pharmacy are staffed on a 24/7/365 basis, the obstetrical clinic is only open three days a week – Mondays, Wednesdays & Fridays. The clinic is staffed by a physician (not clear if the doctor is an OB specialist), nurse and a medical assistant, all of whom are female.

TJP has received numerous reports from ex-[incarcerated persons] and family of [incarcerated persons] about the unusually long wait times at the OB clinic. Despite 400 full time equivalent health care personnel (which includes Harris County employees and staff from temporary agencies), the county only schedules two physicians to provide on-site coverage each evening/night and three physicians to provide coverage during the weekends. That’s for the entire jail not just the women’s section. There’s only one general physician on-site in the women’s section for acute needs. In case of any emergency, a pregnant inmate has to be sent to the hospital district ER. Considering the extremely stressful nature of jails, and the particularly vulnerable state of pregnant [incarcerated persons], TJP is of the opinion that they should have better access to obstetric care.  The American College of Obstetricians & Gynecologists (ACOG) strongly recommends prenatal visits once a month from the first prenatal visit until 29 weeks of every two to three weeks from 29 to 36 weeks of pregnancy and visits once a week from 36 weeks of pregnancy onward but in the case of Harris County, decisions regarding consultations are made on a case-to-case basis. According to the ACOG, pregnant [incarcerated persons] are at a substantially higher risk for poor pregnancy outcomes than women in the free world. By the jail’s own admission, there is absolutely no formal timeline or protocol for pregnant [incarcerated persons] ’ OB/GYN visits.

After a couple of months of sending requests, Ms. Sadler was granted an audience with the chief of medical on the staff of the Texas Commission on Jail Standards (TCJS) Dr. Michael Seale and the sole dietician on staff, Nurse Kathy, on the 6th of July. She interviewed them about the type of diet and medical care being offered to pregnant [incarcerated persons].

According to Dr.Seale, every inmate in Harris County jail, pregnant or otherwise, receives a 2,400 calorie diet which includes 95.9 grams of protein spread over three meals. Except for prenatal supplements and folic acid pills, there is no special diet designed for pregnant [incarcerated persons]. Nurse Kathy added that they have a bigger issue of [incarcerated people] being overweight than underweight but if any [incarcerated person] is found to have weight loss issues or not putting on the recommended amount of weight during pregnancy, she prescribes an additional drink ‘Boost’ which is said to have added nutrition. According to the American Dietetic Association(ADA) (see page 24 and 25 here), pregnant women should increase their usual servings of a variety of foods from the four basic food groups (up to a total of 2,500 to 2,700 calories daily) to include fresh fruits and vegetables, whole grains & enriched breads/cereals, dairy. Protein intake should be approximately 60 grams/day. The ADA stresses not to eat uncooked or undercooked meats or fish and pregnant women should avoid deli luncheon meats, too (bologna for example).  Ms.Sadler’s research into ex-inmate blogs revealed that inedible baloney sandwiches are a staple at the Harris County jail. Their own menu indicates that luncheon meats make quite frequent appearances.

For [incarcerated people] carrying twins or quite obviously malnourished, the physician/dietician prescribe an extra snack consisting of a weekly basket of granola bars, peanut butter, and other snacks. In some instances, a pregnant inmate is given two trays of food and allowed to eat separately from the general population.

For Ms.Sadler, one of the most striking things about the diet was that not only were pregnant [incarcerated persons] not provided any fresh fruits or vegetables which are so critical in pre-natal nutrition, but they’re not even given fruit cups due to a fear that the [incarcerated persons] might ferment the fruit and turn it into alcohol! (It’s not clear how common this practice was but this author has not been able to unearth a single report of such an incident). So instead they’re provided fruit juices. It’s not clear what sort of juices but given the cheap abundance of ‘juices’ that lack any fruit content and are loaded with mostly sugar and high fructose corn syrup, one wonders if part of the blame for the jail’s overweight problem lies there. Also, it’s not clear from the menu as to how many of those 2,400 calories are empty calories. Meaning calories that come from solid fats and sugars without any significant nutritional value such as the ones found in white bread, ramen noodles, sandwich cookies, sugary drinks, hot dogs and other highly processed foods which are notorious for weight gain. All of which feature prominently on the jail menu and commissary. For [incarcerated persons] with overweight issues, the dietician prescribes a “Hardcore diet” in which calories are reduced to 2,000 and their access to food items from the commissary is restricted as well.

Based on her online research of ex-inmate complaints, Ms.Sadler was concerned about the issue of ‘sour food’ or ‘food gone bad’. When asked if she had ever received such a complaint from a pregnant inmate, the dietician admitted that she had but she usually turned a ‘deaf ear.’  She looks at their assessment to see if it is affecting their weight or health and if she feels that it’s not, then she sticks to her judgment. If the inmate continues to complain they can fill out a grievance form and speak to a counselor about the issue. As survey upon survey has shown, most [incarcerated people] are either unaware of how to file grievances or too intimidated to do so.

When questioned about the differences between Harris County and other jails in the state, Dr.Seale stated that size was one of the biggest challenges. He said, “Harris County is a large jail, housing over a 1,000 [incarcerated people] and currently having 54 [incarcerated people]. We have a good team of nurses and doctors and good equipment to handle our [incarcerated people]. We have great resources, however, with funding issues we are having difficulty handling with mental health issues and hiring more social service workers to assist with this growing issue.”

Ms.Sadler asked if any special nutrition classes were offered to pregnant [incarcerated people] so they could make better choices when buying food from the commissary but given the funding issues, it is quite apparent  that it’s not really on the jail’s priorities list.

When asked how much all the food costed, Dr.Seale stated that according to the 2011 budget, the jail could spend no more than 91 cents on each meal served. So for 9,000 [incarcerated people], each meal time costs $8,190. The daily cost for three meals would be $24,570 and the annual cost $8,968,050.

Given the critical role that pre-natal nutrition and care plays in the long-term health and quality of life of an infant, Ms.Sadler believes that it’s the state’s moral responsibility to take much better care of its pregnant [incarcerated people]. Surely a state that spends such a great deal of its political will agonizing, advocating and legislating for the rights of the fetus can afford to feed and care for it better, especially in the most vulnerable of environments such as its jails.

Perhaps other social work students and advocacy groups across the state can take inspiration from Ms.Sadler’s investigations and do their own research and report on the conditions and nutritional needs of pregnant [incarcerated people] in their own counties.

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About Ms. Kristina Sadler
Born in Houston and raised in Stafford, TX, Ms. Sadler is a 22 year old graduate student in the school of Social Work at the University Of Houston Her specialization is in political Social Work. She received her Bachelors in Social Work at Prairie View A&M University. Sadler has always had a desire to bring positive change into people’s lives. At Prairie View she was part of the Social Work Action Club in which she chaired the community service group. Her responsibilities were to plan community service activities so that members could be a part of and give back to their communities.  At University of Houston she was Advanced Standing Macro Representative. Currently, she volunteers at the Children Assessment Center Playroom monitoring and planning activities for children who are awaiting services to see their counselor. She also interns at CHILDREN AT RISK on policy issues. Her responsibilities include conducting research to prepare for legislative session, schedule meetings with key political leaders, and assist with advocacy efforts. Sadler  is helping TJP by investigating and reporting on nutritional needs of pregnant [incarcerated people]. Working with TJP director Diana Claitor, she is laying the groundwork and creating a plan for graduate students in other Texas colleges and universities, so  that other students can visit their local county jails, inquire as to care and food provided to pregnant [incarcerated people] and then create a report on what they find.