Chained in Labour

Recently, I came across a paper on perinatal shackling which sounds as atrocious as it is: according to Brett Dignam and Eli. Y. Adashi the practice involves “the application of handcuffs, leg irons, and/or waist shackles to the incarcerated woman prior to, during, and after labor and delivery.” The article in question, Health Rights in the Balance: The Case Against Perinatal Shackling of Women Behind Bars, details the legal and medical case against such a barbaric practice. For those that are interested the article can be found here. Although we are used to seeing numerous references and articles in relation to issues such as abortion, access to contraception (such a no-brainer I often wonder why some consider it to be controversial at all), breastfeeding, and birth practices, there is very little awareness on issues involving incarcerated women’s health and rights. As Bignam and Adashi note, “careful consideration of the medical impact of perinatal shackling reveals a multiplicity of potential risks” such as an increased “proneness to falls” when leg irons are applied, the inability of “a woman from breaking a fall and avoiding injury” whist her hands are cuffed, not to mention denying “the benefits of labor acceleration and discomfort alleviation” if she is prevented from walking “during the first stage of labor”. Perinatal shackling can also lead to birth complications due to the inability to move around during labour, including “deep vein thrombosis and its life-threatening embolic complications”, while keeping a woman on her back can exacerbate “fetal distress” or “maternal hypotension [low blood pressure]”.

Since the paper is US based, I wondered if there was anything about perinatal shackling here in South Africa. Not so surprisingly, there is not at all that much information on this specific topic (there is some information on women’s health and health care access while in prison). The best information I could find centred on a Policy Brief made by the University of Cape Town’s Gender, Health, and Justice Research Institute; the authors state that “representing about 2.3% the South African prison population, female prisoners face the possibility of being overlooked in a prison system dominated by a male majority”. They observe that:

The Correctional Services Act stipulates that the use of mechanical restraints (for example, handcuffs, leg irons and belly-chains) should be limited to circumstances where they are necessary to (i) ensure the safety of the inmate or any other person; (ii) to prevent the damage of property; (iii) where there is a reasonable suspicion that the inmate may escape or (iv) where the court requests the use of mechanical restraint (Correctional Services Act, 1998). Clearly none of these apply in the case of a woman who is in labour.

Despite these provisions, they found that “in our study two women revealed being handcuffed throughout the entire process of giving birth, despite giving birth in a state hospital”. This may very well be an underestimate and considering the lack of published material around perinatal shackling we have no idea about its incidence of occurrence. The full article can be found here.

As a society, we tend to forget about women (and men) behind bars. To us they do not exist, and if some newspaper does to decide to run a story on these issues too many dismiss their plight based on emotional justifications on the lines of ‘they did something wrong so why should we care?’ One woman forced through labour whilst shackled is too many; given that “prison populations are often made up of individuals who, prior to incarceration, lived on the margins of society with poor health and health care access” only exacerbates the issue. Ignored by society, these women remain faceless and voiceless while the silences abound.


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