Tracking pregnancy behind bars: Why Ohio’s House Bill 542 could save lives

Across the United States, there has never been a comprehensive or consistent system for tracking pregnancies and their outcomes in carceral settings, including whether pregnancies result in live births, miscarriages, stillbirths, preterm deliveries, or complications such as infection or hemorrhage. Without that information, there is no way to evaluate the quality of maternal healthcare or ensure that both mother and baby receive adequate support before, during, and after birth. 

In Ohio, lawmakers have taken a tentative step toward addressing this gap with House Bill 542, which would require all jails and prisons to report pregnancy outcomes—a proposal prompted by Linda Acoff’s preventable miscarriage while in the custody of Cuyahoga County Jail in 2024. However, the bill, sponsored by state Representatives Terrence Upchurch (D-District 20) and Josh Williams (R-District 44), does not define what constitutes a “pregnancy outcome,” leaving it unclear whether facilities must report live births, miscarriages, stillbirths, other medical conclusions, or all of the above.

There is a significant gap in the oversight of pregnancy in prisons. The Bureau of Justice Statistics’ most recent report found that more than 700 pregnancies were recorded in U.S. prisons in 2023, with 91 percent resulting in live births, 6 percent in miscarriages, and about 2 percent in abortions. The report did not include data like preterm deliveries, cesarean rates, and maternal complications, making it impossible to understand whether those births were healthy or whether complications were preventable. The report also did not determine how often incarcerated women actually received the prenatal care, nutritional support, or postpartum follow-up that state facilities claim to provide.

Data from the Prison Policy Initiative show that almost half of pregnant women who are incarcerated never receive prenatal testing or basic dietary adjustments during pregnancy, and some are forced to give birth without medical assistance. Without a comprehensive way to track this information, policymakers and health officials are left with an incomplete picture of what care looks like in practice in correctional settings, making it impossible to measure progress or hold individuals accountable.

In February 2024, 30-year-old Linda Acoff was 17 weeks pregnant and detained at the Cuyahoga County Jail in Cleveland. According to an investigation by The Marshall Project and News 5 Cleveland, she screamed in pain for hours, pleading for help as her condition worsened. A nurse, later fired, gave her Tylenol and sanitary napkins but did not call for medical care. When her cellmate eventually alerted a guard, Acoff was taken by stretcher to a hospital, where doctors confirmed she had already miscarried. An autopsy of the fetus later revealed that she lost her pregnancy due to a common infection that went untreated. The baby’s death became the catalyst for the introduction of House Bill 542. Acoff’s death exposed what happens when there is no system for tracking what goes wrong or why. And the “why” really matters—each pregnancy carries unique risks that require timely, evidence-based responses.

Poor outcomes like Acoff’s are not isolated. Across the country, reports of women giving birth alone in jail cells reveal a pattern of preventable harm. A ten-year review of jail births found that among the women who gave birth inside cells, nearly two-thirds delivered only after repeated pleas for medical help went unanswered, and one in four infants was stillborn or died within two weeks. Many of these tragedies stem from untreated infections, premature labor, and delayed medical response.

Beyond maternal healthcare, the risks for infectious diseases are magnified in correctional environments where pathogens spread far more easily than in the community. Studies show that people in custody experience infectious diseases at rates four to nine times higher than the general population. Crowded living spaces, inadequate ventilation, limited screening, and delays in care all heighten the risk. For pregnant women, these conditions can turn manageable illnesses into life-threatening emergencies, as in Acoff’s case. Yet infection control is rarely prioritized, and access to preventive care remains inconsistent across facilities.

On top of these failures, incarcerated people are still charged medical copays to access care, with rates up to $13.50, including for prenatal visits. For someone earning an average of just 55 cents an hour in wages, according to a 2024 analysis of state prison labor data, medical copays of up to $13.50 represent several full days of work. Although some skilled production jobs pay modestly higher rates, these positions account for fewer than 5% of all prison jobs. A 2021 study in the Journal of Correctional Health Care, a peer-reviewed healthcare journal, found that women in prison were 50% more likely than men to forgo medical treatment because of these fees, even when they had greater health needs. When medical care requires copays that exceed what people can realistically pay, it discourages responsible health decisions and undermines the stated goal of reducing long-term healthcare costs. For pregnant women whose health needs are urgent and often unpredictable, this creates another layer of disincentive that worsens an already fragile system.

Further policy recommendations

Data collection alone will not prevent harm if it does not inform intervention. House Bill 542 establishes the foundation by requiring correctional facilities to begin reporting pregnancy data. To make that reporting more meaningful, the state should ensure the data collected is consistent and detailed enough to identify where care is breaking down.

Define and Standardize Data Collection: Pregnancy outcomes and milestones must be clearly defined and standardized across all facilities to ensure accuracy and comparability. These measures should include live births, stillbirths, miscarriages, preterm deliveries, cesarean sections, untreated infections, and maternal complications. Recording these outcomes in a consistent and structured way will allow state health agencies to identify weak points in care—whether that involves inadequate prenatal screening, delays in treatment, or gaps in postpartum follow-up.

Create a Data Review and Oversight Process: To maintain trust and ensure objectivity, lawmakers could allow the data collected under HB 542 to be reviewed by an independent third-party organization—such as a public health research institute, auditing firm, or university partner. These external reviewers could assess the completeness and consistency of the reporting and publish statewide summaries that identify trends without compromising privacy. Independent evaluation promotes transparency while avoiding conflicts of interest that arise when agencies assess their own performance.

Mandate an Annual Public Report: HB 542 should require the Ohio Department of Rehabilitation and Correction to publish an annual public summary of statewide pregnancy data. The report should include total pregnancies, outcomes, and any identified patterns in medical care or response times, while maintaining de-identified and aggregated data to protect privacy. A publicly available brief would allow lawmakers, journalists, researchers, and community organizations to assess progress and hold institutions accountable. 

When implemented together, these policies can turn data into a mechanism for accountability and reform that not only tracks harm but actively prevents it.

Ohio’s House Bill 542 is an important first step toward transparency and accountability in a system where too many pregnancy outcomes still go unrecorded. By simply requiring correctional facilities to document and report this information, the bill fills a long-standing gap in maternal healthcare oversight behind bars. With consistent reporting, independent review, and public access to findings, Ohio can begin to build a framework that not only tracks outcomes but helps reduce the harm already occurring in its correctional facilities.

The post Tracking pregnancy behind bars: Why Ohio’s House Bill 542 could save lives appeared first on Reason Foundation.

Source: https://reason.org/commentary/tracking-pregnancy-behind-bars-why-ohios-house-bill-542-could-save-lives/