IB 
Union Calendar No. 436 
116TH CONGRESS 
2D SESSION 
H. R. 7718 
[Report No. 116–536] 
To address the health needs of incarcerated women related to pregnancy 
and childbirth, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 22, 2020 
Ms. BASS (for herself, Mr. RESCHENTHALER, Ms. CLARK of Massachusetts, 
and Mrs. LESKO) introduced the following bill; which was referred to the 
Committee on the Judiciary 
SEPTEMBER 24, 2020 
Additional sponsors: Mrs. RODGERS of Washington, Mrs. WATSON COLEMAN, 
Ms. LEE of California, Ms. SPEIER, Mrs. WALORSKI, Mr. CHABOT, Mrs. 
WAGNER, Mrs. LAWRENCE, Mr. CARSON of Indiana, Mr. BLUMENAUER, 
Ms. NORTON, Ms. MENG, Ms. ADAMS, Ms. BONAMICI, Ms. WASSERMAN 
SCHULTZ, Ms. SEWELL of Alabama, Mrs. BUSTOS, Ms. KAPTUR, Mrs. 
BEATTY, Mr. VELA, Ms. ROYBAL-ALLARD, Mr. BROWN of Maryland, Mr. 
HASTINGS, Mrs. HAYES, Mr. THOMPSON of Mississippi, Mr. CA´RDENAS, 
Mr. RYAN, Ms. BLUNT ROCHESTER, Mr. CORREA, Ms. JACKSON LEE, 
Mr. COHEN, and Ms. GARCIA of Texas 
SEPTEMBER 24, 2020 
Reported from the Committee on the Judiciary; committed to the Committee 
of the Whole House on the State of the Union and ordered to be printed 
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A BILL 
To address the health needs of incarcerated women related 
to pregnancy and childbirth, and for other purposes. 
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Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Protecting the Health 
and Wellness of Babies and Pregnant Women in Custody 
Act’’. 
SEC. 2. DATA COLLECTION. 
(a) IN GENERAL.—Beginning not later than 1 year 
after the date of the enactment of this Act, pursuant to 
the authority under section 302 of the Omnibus Crime 
Control and Safe Streets Act of 1968 (34 U.S.C. 10132), 
the Director of the Bureau of Justice Statistics shall in-
clude in the National Prisoner Statistics Program and An-
nual Survey of Jails statistics relating to the health needs 
of incarcerated pregnant women in the criminal justice 
system at the Federal, State, tribal, and local levels, in-
cluding— 
(1) demographic and other information about 
incarcerated women who are pregnant, in labor, or 
in postpartum recovery, including the race, ethnicity, 
and age of the pregnant woman; 
(2) the provision of pregnancy care and services 
provided for such women, including— 
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(A) whether prenatal, delivery, and post- 
delivery check-up visits were scheduled and pro-
vided; 
(B) whether a social worker, psychologist, 
doula or other support person, or pregnancy or 
parenting program was offered and provided 
during pregnancy and delivery; 
(C) whether a nursery or residential pro-
gram to keep mothers and infants together 
post-delivery was offered and whether such a 
nursery or residential program was provided; 
(D) the number of days the mother stayed 
in the hospital post-delivery; 
(E) the number of days the infant re-
mained with the mother post-delivery; and 
(F) the number of days the infant re-
mained in the hospital after the mother was 
discharged; 
(3) the location of the nearest hospital with a 
licensed obstetrician-gynecologist in proximity to 
where the inmate is housed and the length of travel 
required to transport the inmate; 
(4) whether a written policy or protocol is in 
place to respond to unexpected childbirth, labor, de-
liveries, and medical complications related to the 
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(b) PERSONALLY IDENTIFIABLE INFORMATION.— 
Data collected under this paragraph may not contain any 
personally identifiable information of any incarcerated 
pregnant woman. 
SEC. 3. CARE FOR FEDERALLY INCARCERATED WOMEN RE-
LATED TO PREGNANCY AND CHILDBIRTH. 
(a) IN GENERAL.—The Director of the Bureau of 
Prisons shall ensure that appropriate services and pro-
grams are provided to women in custody, to address the 
health and safety needs of such women related to preg-
nancy and childbirth. The warden of each Bureau of Pris-
ons facility that houses women shall ensure that these 
services and programs are implemented for women in cus-
tody at that facility. 
(b) SERVICES AND PROGRAMS PROVIDED.—The Di-
rector of the Bureau of Prisons shall ensure that the fol-
lowing services and programs are available to women in 
custody: 
(1) 
ACCESS
TO
COMPLETE
APPROPRIATE 
HEALTH
SERVICES
FOR
THE
LIFE
CYCLE
OF 
WOMEN.—The Director of the Bureau of Prisons 
shall provide to each woman in custody who is of re-
productive age pregnancy testing, contraception, and 
testing for sexually transmitted diseases and provide 
each woman with the option to decline such services. 
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(2) COMPLIANCE WITH PROTOCOLS RELATING 
TO HEALTH OF A PREGNANT WOMAN.—On confirma-
tion of the pregnancy of a woman in custody by clin-
ical diagnostics and assessment, the chief health 
care professional of a Bureau of Prisons facility that 
houses women shall ensure that a summary of all 
appropriate protocols directly pertaining to the safe-
ty and well-being of the woman are provided to the 
woman and that such protocols are complied with, 
including an assessment of undue safety risks and 
necessary changes to accommodate the woman where 
and when appropriate, as it relates to— 
(A) housing or transfer to a lower bunk for 
safety reasons; 
(B) appropriate bedding or clothing to re-
spond to a woman’s changing physical require-
ments and the temperature in housing units; 
(C) regular access to water and bathrooms; 
(D) a diet that complies with the nutri-
tional standards established by the Secretary of 
Agriculture and the Secretary of Health and 
Human Services in the Dietary Guidelines for 
Americans report published pursuant to section 
301 of the National Nutrition Monitoring and 
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Related Research Act of 1990 (7 U.S.C. 
5341(a)(3)), and that includes— 
(i) any appropriate dietary supple-
ment, including prenatal vitamins; 
(ii) timely and regular nutritious 
meals; 
(iii) additional caloric content in 
meals provided; 
(iv) a prohibition on withholding food 
from an incarcerated pregnant woman or 
serving any food that is used as a punish-
ment, including nutraloaf or any food simi-
lar to nutraloaf that is not considered a 
nutritious meal; and 
(v) such other modifications to the 
diet of the woman as the Director of the 
Bureau of Prisons determines to be nec-
essary after consultation with the Sec-
retary of Health and Human Services and 
consideration of such recommendations as 
the Secretary may provide; 
(E) modified recreation and transpor-
tation, in accordance with standards within the 
obstetrical and gynecological care community, 
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to prevent overexertion or prolonged periods of 
inactivity; and 
(F) such other changes to living conditions 
as the Director of the Bureau of Prisons may 
require after consultation with the Secretary of 
Health and Human Services and consideration 
of such recommendations as the Secretary may 
provide. 
(3) EDUCATION AND SUPPORT SERVICES.— 
(A) PREGNANCY IN CUSTODY.—In the case 
of a woman who is pregnant at intake or who 
becomes pregnant while in custody, that woman 
shall, at intake or not later than 48 hours after 
pregnancy is confirmed, as appropriate, receive 
prenatal education, counseling, and birth sup-
port services provided by a provider trained to 
provide such services, including— 
(i) information about the parental 
rights of the woman, including the right to 
place the child in kinship care, and notice 
of the rights of the child; 
(ii) information about family preserva-
tion support services that are available to 
the woman; 
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(iii) information about the nutritional 
standards referred to in paragraph (2)(D); 
(iv) information pertaining to the 
health and safety risks of pregnancy, child-
birth, and parenting, including postpartum 
depression; 
(v) information on breastfeeding, lac-
tation, and breast health; 
(vi) appropriate educational materials, 
resources, and services related to preg-
nancy, childbirth, and parenting; 
(vii) information and notification serv-
ices for incarcerated parents regarding the 
risk of debt repayment obligations associ-
ated with their child’s participation in so-
cial welfare programs, including assistance 
under any State program funded under 
part A of title IV of the Social Security 
Act (42 U.S.C. 601 et seq.) or benefits 
under the supplemental nutrition assist-
ance program, as defined in section 3 of 
the Food and Nutrition Act of 2008 (7 
U.S.C. 2012), or any State program car-
ried out under that Act; and 
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(viii) information from the Office of 
Child Support Enforcement of the Depart-
ment of Health and Human Services re-
garding seeking or modifying child support 
while incarcerated, including how to par-
ticipate in the Bureau of Prison’s Inmate 
Financial Responsibility Program under 
subpart B of title 28, Code of Federal 
Regulations (or any successor program). 
(B) BIRTH WHILE IN CUSTODY OR PRIOR 
TO CUSTODY.—In the case of a woman who 
gave birth in custody or who experienced any 
other pregnancy outcome during the 6-month 
period immediately preceding intake, that 
woman shall receive counseling provided by a li-
censed or certified provider trained to provide 
such services, including— 
(i) information about the parental 
rights of the woman, including the right to 
place the child in kinship care, and notice 
of the rights of the child; and 
(ii) information about family preserva-
tion support services that are available to 
the woman. 
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(G) Being older than 35 or younger than 
15. 
(H) Being diagnosed with the human im-
munodeficiency virus, hepatitis, diabetes, or hy-
pertension. 
(I) Such other risk factors as the chief 
health care professional of a Bureau of Prisons 
facility that houses women may determine to be 
appropriate. 
(6) UNEXPECTED BIRTHS RULEMAKING.—Not 
later than 180 days after the date of enactment of 
this Act, the Attorney General shall make rules es-
tablishing procedures for responding to unexpected 
childbirth deliveries, labor complications, and med-
ical complications related to pregnancy if a woman 
in custody is unable to access a hospital in a timely 
manner. 
(7) TREATMENT.—In the case of any woman in 
custody who, after an evaluation under paragraph 
(4), is diagnosed as having a substance use disorder 
or a mental health disorder, that woman shall be en-
titled to treatment in accordance with the following: 
(A) Treatment shall include participation 
in a support group, including a 12-step pro-
gram, such as Alcoholics Anonymous, Narcotics 
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Anonymous, and Cocaine Anonymous or a com-
parable nonreligious program. 
(B) Treatment may include psychosocial 
interventions and medication. 
(C) In the case that adequate treatment 
cannot be provided to a woman in custody in a 
Bureau of Prisons facility, the Director of the 
Bureau of Prisons shall transfer the woman to 
a residential reentry program that offers such 
treatment pursuant to section 508 of the Public 
Health Service Act (42 U.S.C. 290bb–1). 
(D) To the extent practicable, treatment 
for substance use disorders provided pursuant 
to this section shall be conducted in a licensed 
hospital. 
SEC. 4. USE OF RESTRICTIVE HOUSING AND RESTRAINTS 
ON INCARCERATED PREGNANT WOMEN DUR-
ING PREGNANCY, LABOR, AND POSTPARTUM 
RECOVERY PROHIBITED. 
(a) IN GENERAL.—Section 4322 of title 18, United 
States Code, is amended to read as follows: 
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‘‘§ 4322. Use of restraints and restrictive housing on 
incarcerated women during the period of 
pregnancy, labor, and postpartum recov-
ery prohibited and to improve pregnancy 
care for women in Federal prisons 
‘‘(a) PROHIBITION.—Except as provided in sub-
section (b), beginning on the date on which pregnancy is 
confirmed by a health care professional and ending not 
earlier than 12 weeks after delivery, an incarcerated 
woman in the custody of the Bureau of Prisons, or in the 
custody of the United States Marshals Service pursuant 
to section 4086, shall not be placed in restraints or held 
in restrictive housing. 
‘‘(b) EXCEPTIONS.— 
‘‘(1) USE
OF
RESTRAINTS.—The prohibition 
under subsection (a) shall not apply if the senior 
Bureau of Prisons official or United States Marshals 
Service official overseeing women’s health and serv-
ices and a health care professional responsible for 
the health and safety of the incarcerated woman de-
termines that the use of restraints is appropriate for 
the medical safety of the woman, and the health care 
professional reviews such determination not later 
than every 6 hours after such use is initially ap-
proved until such use is terminated. 
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‘‘(2) SITUATIONAL USE.—The individualized de-
termination described under paragraph (1) shall only 
apply to a specific situation and must be reaffirmed 
through the same process to use restraints again in 
any future situation involving the same woman. 
‘‘(3) ACCESS TO CARE.—Immediately upon the 
cessation of the use of restraints or restrictive hous-
ing as outlined in this subsection, the Director of the 
Bureau of Prisons or the United States Marshal 
Service shall provide the incarcerated woman with 
immediate access to physical and mental health as-
sessments and all recommended treatment. 
‘‘(4) RESPONSE TO BEHAVIORAL RISKS IN THE 
BUREAU OF PRISONS.— 
‘‘(A) RESTRICTIVE HOUSING.—The prohi-
bition under subsection (a) relating to restric-
tive housing shall not apply if the Director of 
the Bureau of Prisons or a senior Bureau of 
Prisons official overseeing women’s health and 
services, in consultation with senior officials in 
health services, makes an individualized deter-
mination that restrictive housing is required as 
a temporary response to behavior that poses a 
serious and immediate risk of physical harm. 
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‘‘(B) REVIEW.—The official who makes a 
determination under subparagraph (A) shall re-
view such determination every 4 hours for the 
purpose of removing an incarcerated woman as 
quickly as feasible from restrictive housing. 
‘‘(C) RESTRICTIVE
HOUSING
PLAN.—The 
official who makes a determination under sub-
paragraph (A) shall develop an individualized 
plan to move an incarcerated woman to less re-
strictive housing within a reasonable amount of 
time, not to exceed 2 days. 
‘‘(D) 
MONITORING.—An 
incarcerated 
woman who is placed in restrictive housing pur-
suant to this paragraph shall be— 
‘‘(i) monitored every hour; 
‘‘(ii) placed in a location visible to cor-
rectional officers; and 
‘‘(iii) prohibited from being placed in 
solitary confinement if the incarcerated 
woman is in her third trimester. 
‘‘(c) REPORTS.— 
‘‘(1) REPORT TO THE DIRECTOR AND HEALTH 
CARE
PROFESSIONAL
AFTER
THE
USE
OF
RE-
STRAINTS.—If an official identified in subsection 
(b)(1) or a correctional officer uses restraints on an 
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incarcerated woman under subsection (b), that offi-
cial (or an officer or marshal designated by that offi-
cial) or correctional officer shall submit, not later 
than 30 days after placing the woman in restraints, 
to the Director of the Bureau of Prisons or the Di-
rector of the U.S. Marshal Service, as applicable, a 
written report which describes the facts and cir-
cumstances surrounding the use of restraints, and 
includes each of the following: 
‘‘(A) A description of all attempts to use 
alternative interventions and sanctions before 
the restraints were used. 
‘‘(B) A description of the circumstances 
that led to the use of restraints. 
‘‘(C) Strategies the facility is putting in 
place to identify more appropriate alternative 
interventions should a similar situation arise 
again. 
‘‘(2) REPORT TO CONGRESS.—Beginning on the 
date that is 6 months after the date of enactment 
of the Protecting the Health and Wellness of Babies 
and Pregnant Women in Custody Act, and every 6 
months thereafter for a period of 10 years, the At-
torney General shall submit to the Committees on 
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the Judiciary of the House of Representatives and 
the Senate a report on— 
‘‘(A) the reasoning upon which the deter-
mination to use restraints was made; 
‘‘(B) the details of the use of restraints, 
including the type of restraints used and length 
of time during which restraints were used; and 
‘‘(C) any resulting physical effects on the 
prisoner observed by or known to the correc-
tions official or United States Marshal, as ap-
plicable. 
‘‘(3) REPORT TO THE DIRECTOR AND HEALTH 
CARE
PROFESSIONAL
AFTER
PLACEMENT
IN
RE-
STRICTIVE
HOUSING.—If an official identified in 
subsection (b)(3), correctional officer, or United 
States Marshal places or causes an incarcerated 
woman to be placed in restrictive housing under 
such subsection, that official, correctional officer, or 
United States Marshal shall submit, not later than 
30 days after placing or causing the placement of 
the incarcerated woman in restrictive housing, to the 
Director of the Bureau of Prisons or the Director of 
the United States Marshals Service, as applicable, 
and to the health care professional responsible for 
the health and safety of the woman, a written report 
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which describes the facts and circumstances sur-
rounding the restrictive housing placement, and in-
cludes the following: 
‘‘(A) The reasoning upon which the deter-
mination for the placement was made. 
‘‘(B) The details of the placement, includ-
ing length of time of placement and how fre-
quently and how many times the determination 
was made subsequent to the initial determina-
tion to continue the restrictive housing place-
ment. 
‘‘(C) A description of all attempts to use 
alternative interventions and sanctions before 
the restrictive housing was used. 
‘‘(D) Any resulting physical effects on the 
woman observed by or reported by the health 
care professional responsible for the health and 
safety of the woman. 
‘‘(E) Strategies the facility is putting in 
place to identify more appropriate alternative 
interventions should a similar situation arise 
again. 
‘‘(4) REPORT TO CONGRESS.—Beginning on the 
date that is 6 months after the date of enactment 
of the Protecting the Health and Wellness of Babies 
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and Pregnant Women in Custody Act, and every 6 
months thereafter for a period of 10 years, the At-
torney General shall submit to the Committees on 
the Judiciary of the House of Representatives and 
the Senate a report on the information described in 
paragraph (3). 
‘‘(d) NOTICE.—Not later than 24 hours after the con-
firmation of an incarcerated woman’s pregnancy by a 
health care professional, that woman shall be notified, 
orally and in writing, by an appropriate health care profes-
sional, correctional officer, or United States Marshal, as 
applicable— 
‘‘(1) of the restrictions on the use of restraints 
and restrictive housing placements under this sec-
tion; 
‘‘(2) of the incarcerated woman’s right to make 
a confidential report of a violation of restrictions on 
the use of restraints or restrictive housing place-
ment; and 
‘‘(3) that the facility staff have been advised of 
all rights of the incarcerated woman under sub-
section (a). 
‘‘(e) VIOLATION REPORTING PROCESS.—Not later 
than 180 days after the date of enactment of this Act, 
the Director of the Bureau of Prisons and the Director 
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of the United States Marshals Service shall establish proc-
esses through which an incarcerated person may report 
a violation of this section. 
‘‘(f) NOTIFICATION OF RIGHTS.—The warden of the 
Bureau of Prisons facility where a pregnant woman is in 
custody shall notify necessary facility staff of the preg-
nancy and of the incarcerated pregnant woman’s rights 
under subsection (a). 
‘‘(g) RETALIATION.—It shall be unlawful for any Bu-
reau of Prisons or United States Marshal Service em-
ployee to retaliate against an incarcerated person for re-
porting under the provisions of subsection (e) a violation 
of subsection (a). 
‘‘(h) EDUCATION.—Not later than 90 days after the 
date of enactment of the Protecting the Health and 
Wellness of Babies and Pregnant Women in Custody Act, 
the Director of the Bureau of Prisons and the Director 
of the United States Marshals Service shall each develop 
education guidelines regarding the physical and mental 
health needs of incarcerated pregnant women, and the use 
of restraints and restrictive housing placements on incar-
cerated women during the period of pregnancy, labor, and 
postpartum recovery, and shall incorporate such guidelines 
into appropriate education programs. 
‘‘(i) DEFINITION.—In this section: 
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‘‘(1) 
RESTRAINTS.—The 
term 
‘restraints’ 
means any physical or mechanical device used to 
control the movement of an incarcerated pregnant 
woman’s body, limbs, or both. 
‘‘(2) RESTRICTIVE
HOUSING.—The term ‘re-
strictive housing’ means any type of detention that 
involves— 
‘‘(A) removal from the general inmate pop-
ulation, whether voluntary or involuntary; 
‘‘(B) placement in a locked room or cell, 
whether alone or with another inmate; and 
‘‘(C) inability to leave the room or cell for 
the vast majority of the day.’’. 
(b) CLERICAL AMENDMENT.—The table of sections 
at the beginning of chapter 317 of title 18, United States 
Code, is amended by amending the item relating to section 
4322 to read as follows: 
‘‘4322. Use of restraints and restrictive housing on incarcerated women during 
the period of pregnancy, labor, and postpartum recovery pro-
hibited and to improve pregnancy care for women in Federal 
prisons.’’. 
SEC. 5. TREATMENT OF WOMEN WITH HIGH-RISK PREG-
NANCIES. 
(a) IN GENERAL.—Chapter 303 of title 18, United 
States Code, is amended by adding at the end the fol-
lowing: 
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