Dr. Carolyn Sufrin is a physician and associate professor at the School of Medicine and the School of Public Health. Her career is rooted in family planning and women’s reproductive health: a medical specialization she enriches in her roles as an anthropologist, advocate and researcher. Sufrin has been involved in advocacy for incarcerated birthing people at multiple legislative levels and works at the Johns Hopkins Family Planning Service. In an interview with The News-Letter, she discussed her research, work in obstetrics and gynecology, and advocacy for the reproductive rights of incarcerated people.
The News-Letter: As a researcher, reproductive advocate and practicing obstetrician gynecologist (OB/GYN), can you share how you came to this specific career path?
Carolyn Sufrin: I was always interested in reproductive health care, particularly abortion rights. When I was in college, I took my first anthropology class on gender and learned about Western biomedicine as a cultural construct and the ways that it had contributed to often adverse representations and expectations of women's gender roles [that were] connected to expectations about pregnancy and access to abortion. Then when I got to medical school, I knew that I wanted to pursue an area that would allow me to apply those intellectual curiosities to clinical care, so I continued down that path of being an OB/GYN.
When I was in residency training, I found myself delivering the baby of a woman who was shackled to the bed. She was incarcerated at a local jail. I had never thought about the fact that there were women in jail, let alone pregnant women. I was just overwhelmed with all these complexities. Why? Why was she shackled? Why didn't I, as a physician, do more to address the situation? I wanted to learn more, so I started a research study particularly on access to contraception and abortion care for incarcerated individuals.
When I finished my residency training, I moved out to San Francisco to do a fellowship in complex family planning. It was there that my mentors encouraged me to pursue my interest in reproductive health care for incarcerated women. I started doing some clinical work at the San Francisco County Jail, and within a few months of working there, I was confronted with all kinds of complexities. What did it mean to provide care in a space of punishment? What did it mean that, as I learned, incarcerated individuals have a constitutional right to health care? And that for many of the pregnant individuals I was caring for, jail was the only place where they were able to access health care? I was nudged by all kinds of curiosities and contradictions, and that's what prompted me to go back to graduate school and get my PhD in medical anthropology.
Then I did my ethnographic field work at the San Francisco Jail with pregnant and non-pregnant individuals both in the jail and when they got released. Along the way, as I saw violations of human rights in terms of various issues facing incarcerated women, I got really involved in advocacy. Over the years, I have been involved in advocacy at state, local and federal legislative levels but also with professional societies. I've helped write national policies and standards of care for incarcerated women when it comes to reproductive health care.
So, none of this happened overnight. This has happened over the course of over 15 years, and it all started with the patient whose care and situation — and my own complicity in the shackling of pregnant birthing people — really troubled me.
N-L: It seems that across your various roles, you have a drive to challenge and investigate assumptions, in research specifically. Your Pregnancy in Prisons Statistics Study was a first step to addressing the huge gap in data on the number of pregnancies and births occurring in jails. Tell me about that.
CS: To your first question, that's my anthropologist disposition. As an anthropologist, I'm grounded in questioning assumptions and asking why. I had been doing this work on access to pregnancy care and services in carceral settings for almost a decade when I realized that we actually had no idea how many pregnant incarcerated individuals there were. I wondered: why this omission? I think it signifies the systematic disregard of these individuals — willing them into nonexistence by not counting them. And so, [the Pregnancy in Prisons Statistic Study] was an attempt to fill that gap.
And methodologically, it was not very complex. We had prisons and jails across the country, who were in our study report, aggregating pregnancy outcomes on a monthly basis for a year. Our analysis was very simple: we just added up those counts and calculated proportions. But the most striking finding was simply being able to document that they exist. There were over 1,600 admissions of pregnant individuals to our six jails, and well over 1,000 admissions to all of our prisons. There were births, miscarriages, abortions, stillbirths, pregnancies.
N-L: You also work at an abortion clinic. From your experience, how has the reversal of Roe v. Wade impacted women’s reproductive health services in Maryland?
CS: Maryland has some of the most progressive abortion laws in the country, so I'm very fortunate to be able to practice here. That being said, I think initially, after the Dobbs decision, people in Maryland were confused, and there was a lot of misinformation. People thought that abortion was now illegal everywhere, [and] we had some patients contact us with misinformation.
We have also seen an influx of patients from around the country [and] from abortion-restrictive states, who are often further along or have more serious comorbidities or conditions with their pregnancies because they can't access abortion care in their states.
N-L: You’ve touched on what are some of the biggest challenges regarding reproductive health in incarcerated. What changes would help address them?
CS: There are two big buckets of challenges. One is, again, the fact that [pregnant incarcerated individuals] exist. There are pregnant individuals in our institutions of incarceration. One of the biggest challenges is thinking about why they are there and, as a society, is this really what we want to be doing to pregnant individuals and birthing people? Can we think about viable, safe, robust, community based alternatives for these individuals — most of whom are charged with non-violent crimes [and] do not pose threats to society? I think that's one big element — thinking about the potential for alternatives to incarceration.
The second bucket of issues is that, until that time comes, there are still pregnant individuals in custody, and we need to ensure that they have access to comprehensive pregnancy and postpartum care. That includes screening them at intake. There are many jails and prisons that don't routinely screen for pregnancy. If they don't know that they are housing a pregnant individual, it makes it very easy for them to say, “Oh, we don't have them, and so we don't need to provide care.”
Despite the fact that 41 states as well as the District of Columbia and the federal government have laws prohibiting shackling in labor, we know that it still happens even in states that have these laws. That is not safe; it’s also an affront to their dignity and considered a human rights violation. And then postpartum, we know that most people who give birth while they're incarcerated are separated from their newborns pretty soon after giving birth. At best, they get to bond with their newborn while they're in the hospital for those one, two or three days after delivery. But the anxiety of being forcibly separated from your newborn is an incredible source of trauma for individuals. So, there are a lot of ways that we can do better in terms of ensuring access to comprehensive pregnancy care and postpartum care for this population.
N-L: Are there any developments in the field that give you hope about the future?
CS: Yes. One is the example of Colorado and Minnesota and their recent legislation investing in alternatives to incarceration for pregnant individuals. Another is the enhancing of birth support for those who are still in custody through doula programs. There's a national network of prison birth workers who provide, in many cases, volunteer doula support for pregnant individuals during their pregnancy. [Incarcerated pregnant individuals] are separated from their usual support networks; they're isolated, and so these trained, non-medical pregnancy and birth support people can be an essential source of education and support.
N-L: If a reader is interested in any of these issues, how can they get involved?
CS: To learn more, you can go to my website, and then, in terms of getting involved in advocacy in Maryland, there's an advocacy group called Reproductive Justice Inside that advocates for legislative change in Maryland and improves reproductive health conditions for incarcerated women. You can also get involved by learning about the work of the National Council for Incarcerated and Formerly Incarcerated Girls and Women. You can learn more about the jails and prisons in your community and recognize that incarcerated individuals are part of the community. There are organizations — including at Hopkins — that train students to tutor incarcerated individuals.
So there are some ways to directly get involved in supporting, but I would say go in with humility and don't think that you know what's best. Recognize that by entering into some of these spaces, potentially as a volunteer, it's really a way to educate yourself about the reality and to learn from people experiencing incarceration so that you can learn about ways to help improve conditions.
