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Submission to UN Special Rapporteur on Health — Racism and the right to health

The following is responding specifically to question 1 regarding the main ongoing manifestations of racism, and related forms of discrimination enabled by racism prevalent in the United States in the area of the right to health broadly including in underlying determinants of health, health outcomes and access to health care.

The United States (US) is experiencing a national crisis in reproductive health care and its disproportionate impact on women and pregnant people of color. This response discusses three sites of gendered racial discrimination in the US: the shackling of pregnant prisoners, abortion restrictions, and the criminalization of pregnant people and pregnancy outcomes.

Shackling of pregnant persons in prisons and detention centers

The US has the highest incarceration rate in the world (664 per 100,000 people in 2021)and incarceration is marked by extreme racial disparities. Though the US incarcerates more women than any other nation in the world, the distinct human rights abuses women suffer in prison receive relatively little attention. The barbaric practice of shackling pregnant prisoners, including during labor, delivery, and postpartum recovery, is one such abuse. Though shackling has been recognized as a human rights violation by successive UN bodies, the dehumanizing practice persists and federal efforts to end it have had limited impact. A 2018 study of perinatal nurses in the US found that among those who worked with incarcerated pregnant patients, 82.9% reported that their incarcerated patients were shackled “sometimes” to “all the time.”

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