In the Medical System, the Concept of General ‘Safety’ Can Be a Pretext to Harm Pregnant Women

In January, a Black woman in Ohio named Brittany Watts filed a lawsuit against a local hospital system and the city of Warren for their treatment of her after she miscarried 22 weeks into her pregnancy in 2023. Watts faced felony charges for “abuse of a corpse.” Her nurse reported her to the cops after Watts was initially denied care for her nonviable, health-threatening pregnancy, and the hospital effectively forced her to go home and miscarry in her toilet; police interrogated her in her hospital bed. “Here, we saw a case of a hospital reporting and retraumatizing someone in her worst moment, without her doing anything,” Ronica Mukerjee, a nurse practitioner and associate professor at Columbia, told Jezebel. That Watts was charged with “abuse of a corpse,” she added, further highlights how “the carceral system bends laws to harm certain racial groups and fit specific agendas.”

Mukerjee is one of the editors of the new book All This Safety Is Killing Us: Health Justice Beyond Prisons, Police, and Borders, along with Carlos Martinez, which presents voices from a range of people—clinicians, public health professionals, and incarcerated people—united in advocating for the reinvention of the U.S. medical system without the looming specter of criminalization. The meaning of the word “safety,” Mukerjee and Martinez posit in the book’s first pages, has been co-opted to mean policing and the enforcement of laws and maintenance of state surveillance systems, when, as Mukerjee put it while speaking to Jezebel, “safety is being able to live and thrive where we are.” Existing in a police state where cops are embedded in hospitals or sicced onto people experiencing mental health crises “produces premature death,” said Martinez, a public health researcher and assistant professor at the University of California, Santa Cruz. Rampant police brutality, the viral spread of diseases in prisons, and systemic inequalities deepened by gutting welfare programs to fund policing, all shorten life spans and make communities sicker, he explained.

In 2021, after years of organizing among health care workers who have seen firsthand how policing and incarceration harm their patients, the American Public Health Association issued a landmark statement called “Advancing Public Health Interventions to Address the Harms of the Carceral System.” The statement details the public health impacts of carceral settings—like prisons, jails, immigrant detention centers, and the surveillance state—and calls for lawmakers and public health workers to “move towards the abolition of carceral systems and build in their stead just and equitable structures that advance the public’s health.” Four years later, public health professionals are still striving toward this agenda, as the threats—especially targeting pregnant patients in the post-Dobbs v. Jackson Women’s Health legal landscape—only continue to rise. Since Dobbs, over a dozen states have enacted criminal abortion bans, rendering reproductive health inextricable from the criminal legal system in large swaths of the country.

 

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All This Safety makes the case that the carceral system goes beyond laws, police, and prisons: Physicians are essentially trained to be cops, Mukerjee told Jezebel, and that innately endangers patients—especially for certain groups like pregnant patients. “We’re taught to have cops in our heads as clinicians, to look for criminality in patients, to always be thinking about whether we should be reporting them—it’s a huge part of the training for any health practitioner,” she explained. “You’re taught to think, ‘When do you report someone to [Child Protective Services]? If someone’s doing XYZ, is it time to report them?’” Mukerjee continued, “Especially when laws change to reflect fascism, health professionals become more invested in legality and protecting themselves than the ‘do no harm’ part of their work.” 

A key pipeline through which the medical system pushes pregnant and postpartum people into the criminal system is nonconsensual drug testing, which is more likely to target Black, brown, and Indigenous patients, Mukerjee and Martinez note. In December, the Marshall Project published an alarming investigation uncovering a trend of pregnant and postpartum women being arrested, jailed, or otherwise punished by the state for testing positive for drugs—which the hospital itself had given them. Before that, the organization reported that hospitals across the country are using inaccurate pee-in-a-cup drug tests, resulting in pregnant people and new mothers losing custody or facing criminal investigation over false positives, including for eating poppyseeds. Hospitals across the country have different standards around prenatal and postpartum drug testing, even as leading medical groups have advocated for hospitals to instead use questionnaires instead of drug tests for more accurate results. 

Mukerjee told Jezebel she’s led several medical programs to help people with opioid-related substance use struggles, and watched as, when some of the members of these programs became pregnant, no OBGYNs would serve them. “What we see is that people are penalized for what they can’t control. Penalizing people for what they can’t control creates trauma,” Mukerjee explained, “and trauma creates or contributes to a predisposition to drugs.” This is a textbook example of how policing, under the guise of safety concerns, only places vulnerable patients at greater risk.

Pregnant people who are reported to police can then find themselves incarcerated; behind bars, what scant rights to health care prisoners have are routinely trampled by both prison personnel and health workers. About a dozen states still allow prisons to shackle pregnant prisoners, including during birth. One chapter of All This Safety features voices from incarcerated and formerly incarcerated women about what medical neglect and severe dehumanization behind bars entails. Some recounted experiences with small infections that drastically grew and became life-threatening because health workers who dismissively “treated” them refused to actually help them; one woman had to get her foot amputated as a result. Others recount friends dying due to medical neglect and gaslighting. Even if they experience severe health problems, they’re forced to work through their pain, and are accused of faking ailments to access drugs. One woman recounted her friend experiencing a medical emergency but choosing not to get help from prison medical staff, saying, “Why? They won’t do nothing anyway.” Her friend died three days later.

All too often, the medical system can comprise a pipeline to prison for pregnant and postpartum patients, as Mukerjee and Martinez show in their book. And in prison, they’ll face systematic medical neglect. “Abolition,” Martinez said (referring to society without criminalization, prisons, and policing), “is impossible without the participation of health care workers.” Mukerjee noted that “most people don’t feel safe in a clinical setting”—and, as this book details, they often aren’t.

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