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Harris County Jail Report: Nutrition for Pregnant Inmates

Sep 30th, 2012 | Category: Women and Jails

I. Report by Kristina Sadler, School of Social Work, University of Houston, June, 2012
II. Analysis by Krishnaveni Gundu, researcher and writer for Texas Jail Project, September, 2012
III. Biography of Kristina Sadler
IV. Additional Research on Pregnant Inmates

I. Questions for Harris County (Interviewer: Kristina Sadler)

  1. What is the total calorie intake for pregnant inmates compared to inmates who are not pregnant?
  2. Are pregnant inmates provided vitamins? If so, what kinds?
  3. How many meals per day do pregnant inmates receive and how many snacks?
  4. How much protein do they receive in their diet?
  5. Do pregnant inmates receive additional fruit and vegetables?
  6. Do pregnant inmates receive extra liquids for additional hydration?
  7. What are the reasons why you restrict commissary foods?
  8. What are the different kinds of “special diets” for pregnant inmates?
  9. What kind of medical and religious diets do you provide?
  10. Has a prisoner ever come to you with a significant weight loss issue or other special needs?
  11. What happens if a pregnant inmate has a complaint about sour milk or food that tastes bad?
  12. What makes Harris County jail different compared to other counties in Texas when it comes to the treatment and diet provided to pregnant inmates?
  13. When did Harris County develop policy and diets for pregnant inmates?
  14. Are nutrition classes offered to pregnant inmates?
  15. Do you or other medical staff meet with the dietician regularly?
  16. What is the budget for food and cost per meal?
  17. May we have a copy of the jail menu?

Additional questions for Dr. Michael Seale from Krishnaveni Gundu

1.  How big is your medical team of doctors, nurses and assistants?
2. How many GPs, OB/GYNs, dentists and other specialists are on the medical staff?
3. Are they on the county’s payroll or contracted from other hospitals?
4. What is their availability (a) on a day to day basis (b) after hours and (c) on the weekends.
5. Regarding the OB clinic which is only open 3 days a week, what’s the size of its staff on those 3 days?
6. Do the pregnant women have a say in whether they can consult with a male or female gynecologist?

II. Analysis of findings

Kristina Sadler was a 22-year-old working on a Master’s Degree when she began to consider the plight of women in the Harris County Jail. Then she began to wonder what percentage of this population was pregnant and how they dealt with being pregnant in jail. As she found out, the majority of the population in county jails are pre-trial detainees. In particular, most women detainees are being held for minor misdemeanors related to poverty, substance abuse/possession or mental health issues–rarely on violent or serious charges. Sadler began considering whether their unborn children were getting a fighting chance at a healthy life.

Sadler also discovered that a 2010 state-by-state report card titled Mothers behind Bars, issued by the National Women’s Law Center and the Rebecca Project, reveals that nearly half the states received an overall failing grade, for their lack of pre-natal care. (See end of article for additional information on treatment of incarcerated pregnant women.) 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 inmates in the Harris County Jail received. With approximately 9,000 inmates, 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.  An official source also cited the number of pregnant inmates in July 2012 as 54 but several attempts by this author to verify it have failed. (Please scroll down to the end of the article for additional research on number of pregnant inmates.)

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 inmates 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 inmates 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 inmates 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-inmates and family of inmates about 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 inmates, 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. And, according to jail staff, there is absolutely no formal timeline or protocol for pregnant inmates’ OB/GYN visits.

Ms.Sadler filled out the necessary paperwork and provided ID so the the jail administration could clear her for visiting.  After several weeks waiting, she obtained an appointment with Dr. Michael Seale, chief of medical on the staff who is also a member of the Texas Commission on Jail Standards (TCJS) which oversees all jails in Texas.

Sadler saw  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 inmates.

Harris County Master Menu

Harris County Master Menu

The American Dietary Association (ADA) stresses not to eat uncooked or undercooked meats or fish and also suggests that pregnant women should avoid deli luncheon meats too (bologna for example).  Ms.Sadler’s research into ex-inmate blogs revealed that unpopular baloney sandwiches are a staple at the Harris County jail. Their own menu indicates that luncheon meats make quite frequent appearances.

Harris County Therapeutic Diet Order

Harris County Therapeutic Diet Order

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 inmates. Nurse Kathy added that they have a bigger issue of inmates being overweight than underweight but if any inmate 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 US Department of Health & Human Services (see pages 24 & 25 ‘Pregant Women in California Prisons and Jails‘ report), 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.

For inmates 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 inmates 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 inmates might ferment the fruit and turn it into alcohol! (It is 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 also 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 right there. Also, it’s not apparent from the menu as to how many of those 2,400 calories are empty calories–the  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 these feature prominently on the jail menu and commissary. For inmates with weight 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.

Harris County Pregnancy Nutrition Screen

Harris County Pregnancy Nutrition Screen

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 does look 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. Judging from what is said by family members and inmates are either unaware of how to file grievances or too intimidated to do so.

Ms.Sadler asked if any special nutrition classes were offered to pregnant inmates 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 cost, 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 inmates, each meal 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 inmates. 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 inmates in their own counties.

III. Bio of Ms.Kristina Sadler

Born in Houston and raised in Stafford, TX, Kristina Sadler is a graduate student in the School of Social Work at the University of Houston, specializing in political Social Work. She received her Bachelors in Social Work from 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 the 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 and to see their counselor. She also interns at CHILDREN AT RISK on policy issues. Her responsibilities include conducting research to prepare for legislative session, scheduling meetings with key political leaders, and assisting with advocacy efforts. Sadler is helping TJP by investigating and reporting on nutritional needs of pregnant inmates. 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 inmates and then create a report on what they find.

IV. Additional Research on the treatment of incarcerated pregnant women

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 inmates 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.

Not until 2009 did the Texas Legislature pass a bill (HB 3653), which was signed into law, restricting (not outright banning), the use of shackles on pregnant inmates 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 inmates. Until HB 3654, county jails were under no obligation to even count much less provide special care to its pregnant inmates.  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. (Mothers Behind Bars report)

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1 Comment
jane doe
9 years ago

You should ask them about a pregnant womans diet and healthcare/sleeping arangements during booking, which takes sometimes a week for a jail that size. I’ll tell you, I was 7 months pregnant, slept on cement with no blanket mat, nothing! And most of the time it was one bologna sandwich a day with one oatmeal pie and faucet water from behind the toilet.