Decarcerating Perinatal Mental Health & Reproductive Care

This blog post was inspired by my participation in IDHA‘s December 2020 “Decarcerating Care Fireside Chat.” I am grateful to Jessie Roth, IDHA co-director, for facilitating a rich conversation with my fellow interlocutors Jess Stohlmann-Rainey, Dustin Gibson, and Stefanie Lyn Kaufman-Mthimkhulu.


When I was diagnosed with bipolar disorder, my first thought is that I was going to be a terrible mother. I don’t know how this got ingrained in my mind as an 18 year old. However, it is understandable given the societal messaging and stigma surrounding motherhood and mental illness. Throughout almost a decade of receiving mental health services, no one talked about my mental wellbeing in relationship to my reproductive health. When I eventually did become pregnant and decided I wanted to become a mother, it was a chaotic journey.

Providers do not handle the issue of taking or not taking psychiatric medication during pregnancy and while breastfeeding with care. More research needs to be done on the ways in which birthing people who take psychiatric medications are perceived by OB/GYNs and social workers and the social consequences that ensue. I suspect that  many pregnant people, especially BIPOC, do not feel safe enough to disclose their mental health history and rightly so. Disclosure can increase the risk of experiencing punitive surveillance and coercive and invasive interventions, such as forced abortions, involuntary institutionalization as well as loss of child custody.

The legacy of eugenics is still present in mental health and reproductive care. As a mad/disabled pregnant person, I received implicit messages: I am not enough, I cannot take care of my child, I will be a danger to my child, and I do not have the skill set to be a good parent. I wasn’t seen as human with valid human struggles who could take care of another human with the right resources and support. When it comes to parenting, disability is not seen as “an identity or a site of resistance but only as a deficit” (Ben-Moshe 2020, 263). This is something that I battled with throughout my pregnancy while also not having access to the psychiatric care that I needed. Instead of receiving the appropriate resources and mental health care during my pregnancy, I was incarcerated for three days while I was in a psychotic state of crisis. When I escaped, I had to navigate many more emergencies until my body and mind leveled out and I became capable of finding my own solutions to save myself.

When mental illness is equated with danger, the “containment and segregation of those labeled as ‘mentally ill’” is legitimized (Ben Moshe 2020, 65). This played out in Britney’s conservatorship that prevented her from having more children by not allowing her to remove her IUD. This is the basis for incriminating and incarcerating Black mothers for “suspected neglect” of their unborn children based on what they do or not consume (like taking street drugs or not taking prenatal vitamins) or activities they do or do not perform (like driving without wearing a seatbelt or skipping prenatal appointments) (Roberts 2001, 77). Another example of this is how pregnant alcoholic Native Americans are put in jail to “protect” their fetuses (Briggs 2020, 118). This begs the question,

In our crisis response, why do we prioritized unborn patients over the people and the parents who are already here?

All of the care and concern directed towards the unborn child neglects the fact that the pregnant person has a life that needs to be nourished and safeguarded. If we focus on the birthing person, maybe that person perhaps they will be more resourced to care for the little human that will exist in the future.

We must break the cycle at pregnancy because the criminalization of pregnancy becomes the criminalization of motherhood once the child is born. This is particularly insidious because authorities attribute the risk of child endangerment to “a symptom of individual parents’ mental depravity” rather than societal inequities (Roberts 2001, 14-5). Research shows that poverty and low parental income is a better predictor of the removal of children from homes rather than “the severity of the alleged child maltreatment or the parents’ psychological makeup” (Roberts 2001, 35). Punishing pregnant people and parents for their mental health needs is counterproductive and extremely detrimental to both the parent and child. The response should never be to incarcerate parents in prisons or psychiatric institutions or to separate parents from their children by removing custody.

The detrimental effects of parental incarceration on the children left behind is well documented. It is known that women’s incarceration is more disruptive to children’s lives than men’s, since they are more often “the primary caretakers of their children, often providing their sole economic and emotional support”  (Roberts 2001, 210). When mothers are imprisoned, children are usually uprooted from their homes to live with relatives or, in the worst-case scenario, enter the foster care system and risk permeant maternal separation.

We were never meant to parent alone. Historically, the process and journey of parenthood has been a collective experience and responsibility because no single person can be everything to their child and provide for all their needs without support from family, friends, our communities, the government, and other institutions. Even able-bodied parents living without mental illness need support. Ironically, they are not penalized for this and are more readily supported by society than disabled/mentally ill parents. The intervention in the name of child welfare is “built upon the presumption that children’s basic needs for sustenance and development must and can be met solely by parents” (Roberts 2011, 89). On the other hand, there is also a willful inattention to the support that all parents need and receive from family, childcare, and schools which does not intrinsically call their parental fitness into question.

Part of a reproductive justice is the decriminalization of mental illness, especially in the postpartum period. When harm does come to the child or infanticide occurs because of the symptoms of postpartum psychosis, care needs to be directed towards the parent in crisis, not removed. How we can support a person who has had that kind of traumatic experience, instead of criminalizing and punishing them (especially for an action that was not purposeful or vindictive)?

This is a compelling justification for the abolition of prisons. The criminal justice system cannot be reformed because it is not a just system to begin with. No justice can come from punishing someone for not being able to mitigate the consequences of untreated postpartum psychosis, especially since there are so few resources to support birthing people in psychiatric crisis. Justice cannot come from robbing children of their parents, especially since perinatal mental illness is temporary when treated.

Finally, this brings me to the contentious issue of mandated reporting. Every state is different, but in New York mandated reporters  (doctors, nurses, teachers, police officers, and child care center workers ) are required by law to report suspected child abuse and neglect when they are presented with a reasonable cause. It is likely that these suspicions are unfounded. Racial bias, misperception, and misinformation make it easy for mandated reporters to draw the wrong conclusions.

Mandated reporting calls our notion of safety into question — safety for and from whom?

What gets triggered in ourselves when we encounter situations that make us fear for other people’s safety? Our reaction may have nothing to do with the person or circumstance in question and we may never know how our intervention may have had devastating effects.

In summary, perinatal mental health and reproductive care and inextricably linked. It is not only an issue that impacts the birthing person, but families and the future generations of children. I look forward to sharing insights and solutions as I grow in my journey as an abolitionist and learn more from my research and practice.


References

Ben-Moshe, Liat. 2020. Decarcerating Disability: Deinstitutionalization and Prison Abolition. Minneapolis: Univ Of Minnesota Press.

Briggs, Laura. 2020  Taking Children: A History of American Terror. Oakland, California: University of California Press.

Roberts, Dorothy. 2001. Shattered Bonds: The Color Of Child Welfare. New York: Civitas Books.


Image Description: Surrounded by butterflies, a birthing person in a field holds an open glass jar containing one blue butterfly.

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