Incarcerated California women are denied abortion services, prenatal care, and even menstrual pads, according to a scathing American Civil Liberties Union (ACLU) of California report released Tuesday that finds some county jails deny, delay, and ignore prisoners’ reproductive health care.

The 36-page report—the product of jailhouse interviews, a review of complaints and jail policies, and public records requests at five county jails—issues a sweeping call for reform of practices that the organization says jeopardize the reproductive health of incarcerated people.

“Jails are putting people’s health at risk by denying, delaying, and ignoring crucial reproductive health care,” Melissa Goodman, one of the report’s authors and director of the LGBTQ, Gender & Reproductive Justice Project at the ACLU of Southern California, told Rewire in an interview. A jail has “a legal obligation to provide medical care to the people it incarcerates, but sadly that often ignores reproductive health,” Goodman continued.

Two years in the making, the report identifies coercive practices, such as forced pregnancy tests, and wide-ranging problems in timely, lawful access to reproductive health care, including:

• Delayed and denied abortion access: Some county jails draw inappropriate distinctions between “elective” and “medically necessary” abortions, and others even have illegal policies against “elective” termination procedures. One county’s policy required a mental health clearance before a woman could obtain an abortion. One woman interviewed by the ACLU had to wait two months for an abortion, despite repeated requests. The jail told her she had to prove she could pay for the procedure before she could get it, she said, which is illegal.

• Influencing abortion access: Interviews with one jail administrator indicated that jail staff would encourage certain women—those with multiple children or those with chemical dependencies—to have an abortion.

• Dangerous conditions for pregnant inmates: Pregnant inmates were denied prenatal and emergency visits with medical staff and were shackled while pregnant, a practice California outlawed in 2012. One pregnant woman, suffering intense abdominal pain, was seen at a jail clinic, where nurses failed to find a fetal heartbeat. The woman, who was sent back to her cell because an OB-GYN wasn’t available to perform an ultrasound, said, “I was really scared because I didn’t know what was going on and I started getting more depressed as time went by because I didn’t know if my baby was alive or dead.”

• Lack of accommodations for nursing inmates: Most lactating parents were unable to pump breast milk or provide it to their child. One nursing woman reported that her infant developed bronchitis because the jail wouldn’t let her pump milk for the child. Lactation is subject to a confusing mishmash of policies. One county assessed in the report allows postpartum women with less than two weeks on their sentence to pump milk in order to maintain lactation, but women with more than two weeks left on their sentence are not allowed to pump. These women are instead taught to “suppress lactation” and given a tight bra to minimize discomfort from engorged breasts.

• Shortage of menstrual supplies: Many jails’ supplies of menstrual pads are insufficient. One former inmate reported that in one jail’s solitary confinement, people were not given any sanitary products and were forced to bleed on the floor.

• Lack of safeguards for LGBTQ people: The vast majority of transgender women are still automatically placed in male housing locations despite the serious safety risks, violence, and increased isolation they encounter there.

• Poor tracking of sexual assault: Two of the five counties surveyed did not track the number of people who had experienced sexual assault in custody.

The report calls for a variety of reforms, such as new reproductive health care and sexual assault policies based on medical best practices, and ones that address the transgender community.

The report urges the abolition of jailhouse policies that limit reproductive health care to cisgender women, or women whose gender identity matches their biological sex at birth. Other recommendations include addressing the fact that incarcerated transgender women are at a heightened risk for sexual assault, and providing menstruation pads to all people who need them, regardless of gender identity or whether the person is housed in a men’s or women’s jail.

To accompany the report, Goodman said the ACLU has released a tool, which includes model policy language, to help jails enact and follow policies in keeping with state law and medical standards.

“At the end of the day, the message we have for jails is reform is important, legally necessary, and feasible,” Goodman said, citing reforms enacted in Los Angeles County jails following a 2012 analysis by the ACLU. She said these jails made widespread reforms and now allow family members to pick up pumped breast milk, and are considering a doula program.