A new investigation by staff at the ACLU Clara Bell Duvall Reproductive Freedom Project reveals that pregnant women incarcerated in Pennsylvania are routinely subjected to wearing leg shackles and handcuffs, including while laboring and giving birth, despite medical dangers and current law that says the practice is illegal in most circumstances.

The Healthy Birth for Incarcerated Women Act (SB 1074) was passed in 2010 to address the fact that incarcerated women in the state were routinely handcuffed and shackled during transport to prenatal and postnatal appointments, and even shackled during labor. The American Congress of Obstetricians and Gynecologists calls this practice “demeaning and rarely necessary” and has outlined the medical dangers it presents to the pregnant person and fetus. The use of physical restraints on pregnant women can increase the risk of venous thrombosis, interfere with labor, and prevent women from breaking a fall.

In fact, the ACLU points to “one particularly egregious example” of a woman imprisoned near Pittsburgh who was seven months pregnant when she tripped and fell face down during a hospital visit due to her leg and waist restraints.

Pennsylvania’s law specifies that starting at the beginning of the second trimester, pregnant incarcerated women can only be shackled during prenatal and postpartum doctor’s visits, transport, and labor under “extraordinary medical or security circumstances.” Additionally, each time shackles are used, the reason for the decision must be documented in reports filed to the Pennsylvania Department of Corrections. Leg and waist restraints during labor are prohibited. In all cases, only the lightest restraint deemed necessary must be used, and medical staff can request removal.

The legislation passed with little opposition.

The problem, however, is that there’s been a lack of training and proper implementation. ACLU staff discovered not only that the practice is still widespread, but that state records are inaccurate; their findings of use of restraints on pregnant women “far exceeds” the number formally reported to the state corrections department.

From a press release about the findings:

During meetings with the Duvall Project staff at 26 hospitals in 2011-2013, hospital clinicians and staff members reported that restraints are routinely used on women in their second or third trimester and during transport, despite the low number of incidents reported to the DOC.

Official reports show that only five county jails submitted documentation, showing 109 overall incidents of restraint on 15 women. Many clinicians working at prenatal care centers are still unfamiliar with the law, according to the ACLU.

The ACLU has turned to the attorney general’s office for help. Carol Petraitis, director of the Duvall Project, recently sent a letter to Attorney General Kathleen Kane requesting “much-needed legal guidance” to close the gaps between the law, implementation, and inaccurate record-keeping. That letter read in part:

The Duvall Project’s investigation of the implementation of the Act confirms that, across the Commonwealth, there are many incidents of restraint use on pregnant women that are not being reported to the Department of Corrections.

During meetings conducted at 26 hospitals in 2011-2013, hospital clinicians and staff members reported that restraints were routinely being used on women in their second or third trimester of pregnancy during transportation; that women were regularly being handcuffed in the hospital, as well as to beds during deliveries and prenatal testing…

The widespread non-compliance with the Act appears to be the result of inadequate training of correctional officers and medical staff on the law’s requirements.

The ACLU is urging Kane to send an advisory bulletin to relevant individuals at state and county jails and detention facilities outlining the requirements of the Healthy Birth for Incarcerated Women Act. The group has also requested assistance with training materials, and that Kane review the April 2014 report from the U.S. Department of Justice regarding best practices for training and implementation.

Nationwide, the number of mothers and pregnant women in prisons has been increasing as the number of incarcerated women increases. According to the Department of Justice, approximately 5 percent of women in U.S. jails reported being pregnant at intake. That number doesn’t include girls under 18 years of age, a group that is “the fastest-growing segment of the juvenile justice population.”

Pennsylvania is one of 18 states that has laws limiting or prohibiting this practice.