The goal of this project was to examine the shifting politics of incarceration and reproduction, health care, and justice in the United States by focusing on doula programs for incarcerated pregnant and postpartum people. Specifically, this project looked at how doulas, as a particular type of healthcare (para)professional, care for incarcerated women; how they navigate the unique priorities, conventions, and complexities of medical and carceral institutions (e.g., prisons and jails); how they attempt to implement changes in those systems to help improve incarcerated clients' health and wellbeing; and in all of these, how the pursuit of reproductive justice is facilitated or constrained. As emerging professionals in relatively powerless positions, doulas must walk a "tightrope" between advocating for clients and maintaining relationships with carceral and biomedical institutions, whose priorities and conventions do not (necessarily) match doulas' orientations towards health and reproductive justice. The study thus examined the possibilities and limits for harm reduction strategies in complex institutional circumstances among stigmatized groups. Between 2021 and 2022 the co-PI spent 19 months conducting participant observation with four prison and one jail doula program; interviewed 50 jail/prison doulas, 4 formerly incarcerated women, 8 healthcare providers, 5 jail/prison staff and administrators, and 14 program donors, interns, and/or volunteers; and collected social media and documents across several programs. In total, she gathered data from 24 programs across 16 states. 

Overall, the data showed that doulas use multiple strategies to "care" for incarcerated clients through different types of encounters, including group-based education and support, one-on-one emotional and informational support, labor/birth support, "separation visit" support (when women returned to custody without their infants), lactation support, and sometimes community-based support. Doulas contrast the ways in which they "treat clients like human beings" and provide nonjudgmental support to clients to the sometimes punitive and callous ways in which clients are treated in medical and carceral settings. Some doulas, drawing on reproductive justice principles, also work to "horizontalize" their relationships with clients by paying careful attention to power dynamics, elevating clients' voices whenever possible, designing programming explicitly based on client feedback, and working to "meet women where[ever] they are" in their parenting journeys. If clients are receiving inadequate physical and/or mental healthcare, doulas can both witness and advocate for improved medical treatment and provide emotional support where it is otherwise lacking. 

While doulas feel that these strategies can and do improve certain health outcomes for clients, their services are extremely dependent on the permission and goodwill of carceral staff and administrators. Doulas feel their positions to be extremely precarious (they can be kicked out at any time) given the uneven power dynamics, opacity, inconsistency, punitive attitudes, racism, sexism, and lack of communication that can characterize carceral settings. Doulas therefore try to strategically "pick their battles" when it comes to client advocacy, though this can lead to feelings of being complicit with harmful systems. Doulas that center reproductive justice principles thus characterize their intervention as a form of harm reduction that is necessary, but limited, in what can be achieved without the cooperation of institutional partners. Doulas fear that their care may be coopted if it is presented as a singular "solution" to the harms of prison birth. Some organizations, therefore, are simultaneously working to "end prison birth," while others form quiet partnerships with other advocacy organizations that are not involved in direct service. 

These results demonstrate both the importance and limitations of harm reduction strategies and third-party support in institutions that enact structural violence. In current systems, doulas provide an important intervention to improve physical and mental health outcomes for clients but cannot address the full scope of challenges that clients face inside and outside of custody. At the same time, doulas' positions as third-party providers allow them to form trusting relationships with clients, even though that position also limits their ability to negotiate within institutions. 

In addition to training a PhD/MPH student in ethnographic research methods, analysis, and writing, this project has a range of wider impacts. The first product of the research will be a doctoral dissertation in Anthropology produced by the co-PI and chaired by the PI. The co-PI has shared preliminary results of the project thus far with a variety of audiences, including scholars, correctional staff, advocates, and incarceration survivors at an anthropology and criminal-justice conference respectively; to prison doulas at the National Network of Prison Doula Programs' quarterly call; to university students, faculty, and local doulas via a presentation with Mercyhurst University and The Script Project; and to the advisory board for a jail-based doula program. The co-PI intends to produce additional academic articles and lay-audience publications that can be distributed to policymakers, correctional audiences, prison doula groups, and reproductive justice organizations. These outputs may influence conversations, advocacy efforts, and policies around the development of reproductive healthcare and programming for incarcerated pregnant and postpartum people.

Last Modified: 11/26/2024
Modified by: Lauren N Marsh