UCSF UC San Francisco Electronic Theses and Dissertations Title Jailcare: The Safety Net of a U.S. Women's Jail Permalink https://escholarship.org/uc/item/88w6d295 Author Sufrin, Carolyn Publication Date 2014 Peer reviewed|Thesis/dissertation eScholarship.org Powered by the California Digital Library University of California Jailcare: The Safely Net of a U.S. Women's Jail by Carolyn B, Sufrin DISSERTATION Submitted in partial satisfaction of the requirements for the degree of DOCTOR OF PHILOSOPHY in Medical Anthropology in the GRADUATE DIVISION of the ii for my parents. iii ABSTRACT Institutions of incarceration are widely understood for their punitive, depriving, and at times even violent characteristics. Yet prisons and jails also provide medical care and other services that people marginalized by poverty, addiction, racism, and other forces of structural inequality might not otherwise have. This dissertation investigates the everyday contours of care in an urban women’s jail in California. Based on six years of clinical work as an Ob/Gyn in the jail’s clinic; ethnographic fieldwork throughout the jail and its surrounding community; and over 40 interviews with jail workers, medical staff and inmates, I describe how this jail was constituted by caregiving relationships which were inextricably linked to disciplinary structures, particularly for pregnant women. Deficiencies in the public safety net, market shifts, and trenchant problems in the criminal justice system meant that cycling between jail and the streets was a normative rhythm of everyday life for many of the urban poor. Recidivism was less a statistic and more an intimate relationship between inmates and jail workers. First, I describe how the medical triage system upon entry to jail diagnosed the deficiencies of people’s lives on the streets. Next, I explore the quotidian rhythms of the jail medical clinic, and how health providers cultivated ambiguity as a form of caregiving to a patient who is also a prisoner. I then focus on reproduction as a key site where the deficiencies of public services and their substitution with incarceration were made visible. Custody and medical apparatuses in jail managed the figure of the pregnant inmate, with her gestating fetus, both as worthy of tender care and as a liability threat to the institution. Pregnant women similarly experienced jail with ambivalence, even desiring the relative safety of this punitive space. The ambiguity surrounding pregnant, incarcerated women, combined with their experiences of marginality outside, produced jail as a place—often the only place—where these women could enact a normative ideal of motherhood. Particularly for marginalized, reproducing women, jail has become an integral part of America’s social and medical safety net. iv TABLE OF CONTENTS PREFACE ....................................................................................................................................................... vi ACKNOWLEDGMENTS ................................................................................................................................. xii ABBREVIATIONS .......................................................................................................................................... xvi INTRODUCTION ............................................................................................................................................. 1 CHAPTER 1 Triaging the Everyday, Every Day ....................................................................................... 45 CHAPTER 2 Cultivating Ambiguity: Routinzing Care in the Jail Clinic .................................................... 80 CHAPTER 3 Documents and the Intimacy of Bureaucracy .................................................................. 127 CHAPTER 4 Gestating Care: Incarcerated Reproduction as Participatory Practice ............................. 160 CHAPTER 5 Reproduction and Carceral Desire .................................................................................... 198 CHAPTER 6 At Home in Jail .................................................................................................................. 228 CONCLUSION ............................................................................................................................................. 276 REFERENCES .............................................................................................................................................. 289 v PREFACE In the early, still-dark hours of a winter morning in 2004, I was in a hospital room preparing to catch the baby of a pregnant woman in the final stages of labor. I was a first-year resident physician in obstetrics and gynecology in Pennsylvania. As a young doctor, I was mostly focused on the mechanics of safely facilitating a birth. I nervously watched the electronic fetal heart rate monitor for signs of fetal distress; I went through in my head the maneuvers I was taught to perform if the baby’s shoulder got stuck in the birth canal. With IV poles and monitors, nurses and doctors, and a woman pushing with contractions, it was by most accounts a typical hospital delivery room scene. Except for one detail: the mother-to-be was handcuffed to the hospital bed. She was incarcerated at the local jail. I had no idea what got her there, but I had some idea that it would be unlikely for her to abscond between painful contractions. She pushed her baby out, and cradled it in her one unrestrained arm. Not surprisingly, I was deeply troubled by this moment, and horrified at my own complicity in the act. Among my many disbelieving thoughts, the simplest one was this: there were women— pregnant women—behind bars. Like most Americans, I had not given much thought, other than what the news media and popular culture had fed me, to institutions of incarceration and the people inside of them. Having come to medicine with a strong sense of social justice, I then became committed to learning about and improving reproductive health services available to incarcerated women. When I was finished with my residency training, I moved to California, to a city I call Bridgetown, known for its progressive politics and creative, entrepreneurial spirit. I sought out the opportunity to work with women in Bridgetown’s jail, and began volunteering intermittently as the jail’s only on-site Ob/Gyn (a very skilled women’s health nurse practitioner was already providing routine services there). After a few months of doctoring in this setting, I became overwhelmed with the complexities of providing medical care in this charged environment that was both constraining— it was a jail —and Preface vi enabling— I provided clinical services that most of these women did not access outside. The relationships I had with other medical staff, with deputies, and with patients at the Bridgetown jail were, I sensed, telling a larger story about care and inequality in America, one that was different than the standard narratives of mass incarceration. I turned to anthropology for guidance. The material in this dissertation is drawn from my experiences at the Bridgetown jail from 2007 to 2013 as a doctor and an ethnographer, a duality with methodological complexities I explore further. This dissertation is about how those nuanced interactions around health care in Bridgetown’s urban county jail are working through broader social, economic, racial, and health inequalities which are the conditions of possibility for contemporary incarceration in the U.S. I explore this phenomenon through the everyday experiences of those who work (including those providing medical care) and live in jail. This on-the-ground focus highlights routines of caregiving which arise from and exceed the usual disciplinary and punitive dimensions we have come, through hundreds of critical analyses of prisons, to expect. This is not a story of institutional violence, although I do not deny that violence in its many forms is part of the fabric of our country’s system of incarceration. Instead, this dissertation sheds light on the human intimacies, even kindness, of jail that do not fit neatly into stereotypical prison-worker/ inmate power dynamics. There are times that my descriptions make jail seem like a safe, nurturing, fun place to be. Narrative and ethnographic accounts of carceral institutions frequently begin with an entry story: a heavy metal door clanging shut, irrationally long wait times to enter, storing all of one’s belongings in a locker, going through a metal detector. Indeed, every time I entered the Bridgetown jail, I walked through a metal door which an all-seeing guard clicked open, and my bag was searched. But my entry was usually unremarkable. I could bring my bag inside the jail (since the deputies knew I had a space in the clinic to store it); my cell phone, usually discretely buried at the bottom of the bag, was never confiscated. I exchanged small talk with the deputy who inspected my bag and looked at my Preface vii “permanent clearance” jail identification badge. The ease with which I entered (and exited) the jail was largely due to the fact that I worked there. But it also speaks to the porosity of jail, an institution that is not the same as prison. The majority of a vast critical literature on institutions of incarceration focuses on prisons. When jails are considered, both in scholarly works and in popular consciousness, they are usually conflated with prisons as interchangeable institutions of confinement; or jails