Karlee Clements was six months pregnant, “full on into addiction” and begging to go to jail because she was afraid she would kill her child.

Soon after, she was incarcerated at Riverside Regional Jail for a violation. Because of her baby’s low heart rate, she was sent to Chippenham Hospital, where she spent the remainder of her pregnancy.

Zip-tied to a hospital bed, with a Riverside officer next to her, Ms. Clements gave birth to a baby girl and spent three days with her, per Virginia law. Restraints are no longer allowed on inmates during labor, except under certain circumstances.

Ms. Clements went back to jail, and her baby experienced withdrawal for 30 days.

Once she was released, Ms. Clements gave her baby up for adoption and started using drugs again.

“It became a way of living,” Ms. Clements said. “That’s the way I got through life.”

The number of jailed pregnant women fighting addiction has increased amid the skyrocketing opioid use in the past decade that led Virginia to declare a public health emergency in 2016. While the state has started to fund more recovery and treatment efforts, incarcerated mothers have fewer resources.

Women in jail say facing motherhood and addiction is a specific struggle that needs more attention, in addition to more uniform prenatal care.

There is no official census of how many pregnant women are incarcerated, or their overall maternal health, a data gap the U.S. Department of Justice acknowledges and is addressing.

Approximately 3% of women admitted to U.S. jails are pregnant, according to a 2020 peer-reviewed study published in the Obstetrics & Gynecology journal. If that number was applied to the national jail population, there could be an estimated 55,000 pregnant women in jail.

Spike in Rates of Pregnant Women Using Opioids

Ms. Clements is now incarcerated at Chesterfield County Jail and involved in its recovery program, Helping Addicts Recover Progressively. She said security is the most beneficial thing she’s gotten out of HARP.

“I’m actually learning to love myself, and my feelings are coming back,” Ms. Clements said. “It’s okay to feel, I’m not used to feeling at all.”

The number of women with opioid-related diagnoses at the time of delivery increased by 131% between 2010-2017, according to a JAMA Network study. In Virginia, the number of infants exposed to a substance — including drugs and alcohol cases — rose 533% between 2000-2018, with a spike that also parallels the increased use of opioids.

Finding Recovery Behind Bars Chesterfield County Sheriff Karl Leonard started the HARP program after annual overdose deaths in the county hit double digits on March 8, 2016.

People would get clean and sober in jail and then go back to the community. In reality, nothing was being done to help them, Sheriff Leonard said.

“We wanted to start releasing recovered addicts back into the community with the tools, the knowledge, the equipment to be able to deal with all those issues that led them to use drugs before they got into the jail,” Sheriff Leonard said.

HARP currently does not offer programs geared toward pregnant women, but does offer parenting classes.

The Chesterfield jail does not provide prenatal care, so pregnant inmates are sent to Riverside in Prince George County. Riverside had 475 pregnant inmates in a little over eight years, according to the jail.

HARP predates the Opioid Abatement Authority, an organization created by the General Assembly in 2021 to handle incoming opioid lawsuit settlement money. Virginia is beginning to receive millions of what will be an estimated $1.1 billion, according to the OAA.

“One of the rules for the use of the funds, which we disagree with very much, is that the funds cannot be used for any existing programs,” Sheriff Leonard said.

A locality cannot use OAA money to supplant existing expenditures but can receive funding if they expand existing programs or implement new programs, according to its website.

Support for Incarcerated Pregnant Women

Many women do not even know they are pregnant when they enter jail, according to Henrico County West Jail Capt. Pamela Dismuke. Female inmates are required to take a pregnancy test when they enter.

“I like to say a lot of the time jail kinda saved them, because had she not known she was pregnant she’d probably still be doing drugs and hurting the baby even more, Capt. Dismuke said.

Capt. Dismuke started a program for preg-nant inmates two years ago. She contacted someone who works for the Department of Corrections and is a doula, or a person who provides guidance and support to a pregnant woman during labor.

Incarcerated pregnant women need specific food, supplements, exercise and even postpartum help that is not common practice throughout the system.

The nonprofit Virginia Prison Birth Project pairs pregnant women in the Henrico jail with a doula and also shares nutritional food and information on a baby’s development and care, in addition to a weekly yoga class.

Doulas also offer support by delivering breastmilk to the baby’s caretaker.

The organization provided the first doula-supported birth for a pregnant inmate in Virginia in 2019, according to its website.

Many women learn through the program how drugs hurt their babies, and it helps them take better care of themselves, Capt. Dismuke said.

Bobbie Jo Lashway, a pregnant inmate at Henrico County West Jail, said there are few programs aimed at her subgroup, despite large numbers of incarcerated pregnant women.

Ms. Lashway enjoys the yoga program and is thankful people take time out of their day to share experiences.

“It’s good on a human connection level that we don’t get in here,” Ms. Lashway said.

Funding Efforts to Combat the Epidemic

The OAA distributes 55% of incoming settlement funds to state agencies and localities that apply for funding, according to OAA director of finance Adam Rosatelli. A grants committee decides how to distribute the funds, in line with opioid abatement efforts and Virginia code.

The OAA has not funded any programs related to incarcerated pregnant or parenting women, but has funded jail programs, according to Rosatelli.

“It was a pretty powerful thing to observe about the work we do and it being put into action,” Mr. Rosatelli said, about a visit last year to an OAA-funded recovery center for women in Washington County.

The OAA has distributed about $34 million, which has been used for initiatives such as recovery homes, education and prevention efforts and marketing campaigns, according to Rosatelli.

VCU InSight journalist Jimmy Sidney contributed to this report. Capital News Service is a program of Virginia Commonwealth University’s Robertson School of Media and Culture.