In March 2021, sheriffs in Etowah county, Alabama, arrested Ashley Caswell on accusations that she’d tested positive for methamphetamine while pregnant and was “endangering” her fetus.
Caswell, who was two months pregnant at the time, became one of a growing number of women imprisoned in the county in the name of protecting their “unborn children”.
But over the next seven months of incarceration for “chemical endangerment” in the Etowah county detention center (ECDC), Caswell was denied regular access to prenatal visits, even as officials were aware her pregnancy was high-risk due to her hypertension and abnormal pap smears, according to a lawsuit filed on Friday against the county and the sheriff’s department. She was also denied her prescribed psychiatric medication and slept on a thin mat on the concrete floor of the detention center for her entire pregnancy.
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In October, when her water broke and she pleaded to be taken to a hospital, her lawyer says, officials told her to “sleep it off” and “wait until Monday” to deliver – two days away.
During nearly 12 hours of labor, staff gave her only Tylenol for her pain, the suit says, allegedly telling her to “stop screaming”, to “deal with the pain” and that she was “not in full labor”. Caswell lost amniotic fluid and blood and was alone and standing up in a jail shower when she ultimately delivered her child, according to the complaint and her medical records. She nearly bled to death, her lawyers say.
After she was taken to a hospital, she was diagnosed with placental abruption, a condition in which the placenta separates from the wall of the uterus and the fetus is deprived of oxygen, meaning there was a risk of stillbirth. The baby survived, but Caswell was immediately separated from her newborn.
“Giving birth to my son without any medical help in the jail shower was one of the most terrifying experiences of my life. My body was falling apart, and no one would listen to me. No one cared,” Caswell said in a statement. “I thought I’d lose my baby, my life, and never see my other kids again.”
The lawsuit, filed by the non-profit groups Pregnancy Justice and the Southern Poverty Law Center, is the first case to challenge the conditions for jailed pregnant women in Etowah county, which advocates say is ramping up its prosecutions. Data suggests the county is the national leader in arresting women under the guise of protecting their fetuses.
“The sheer level of callousness here and complete disregard for human suffering is part of a broader scheme to criminalize and incarcerate as many pregnant women as possible in a way that is unprecedented across the country,” said Emma Roth, senior staff attorney at Pregnancy Justice.
Ashley Caswell. Photograph: Courtesy Ashley Caswell
Caswell’s experience, advocates say, shines a light on the life-threatening mistreatment and neglect that pregnant women can face behind bars. And, they argue, it exposes the consequences of the “fetal personhood movement”, which seeks to legally define fertilized eggs, embryos and fetuses as people. The concept, enshrined in expanding anti-abortion laws, has led to increased surveillance and criminalization of pregnant people, with women punished for the outcomes of their pregnancies or other actions that police claim endangered their fetuses.
After Caswell delivered her baby alone and lost consciousness, staff still refused to render aid and instead took photos of her baby without her consent, her lawyers allege. When she returned to the jail from the hospital, staff denied her access to her prescribed breast pump and ibuprofen.
“Etowah county claims they prosecute women to protect their fetus, or what they refer to as the ‘unborn child’, from harm. This case shows they’re doing precisely the opposite,” said Roth, who said the abuses Caswell endured were tantamount to “torture”. “Once [women like Caswell are] in jail, they’re deprived of the most basic prenatal care and humane living conditions.”
Caswell, who has faced several chemical endangerment charges over the years, is now in state prison, serving a 15-year sentence. She was convicted of a “Class C” felony endangerment, which doesn’t require evidence that the fetus was harmed, but merely exposed to substances.
Pregnancy Justice reported this year that Alabama had the highest number of pregnancy criminalization cases in the country from 2006 to 2022, the year Roe v Wade was overturned. The group logged 649 cases in which women in the state were arrested or faced other criminal consequences in the name of protecting their fetuses or to punish actions that authorities said endangered their pregnancies. Etowah county has the highest rate of these arrests in the state, the Alabama news site AL.com recently reported, citing 257 arrests of pregnant women and new mothers from 2015 to 2023.
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The suit also cites past cases of alleged neglect of pregnant women in the ECDC jail. In 2019, staff refused to take a woman to the hospital for five days after her water broke prematurely, and she later lost her baby, the complaint says. And in 2020, another woman was allegedly forced to give birth alone without medical assistance or pain medication.
Etowah county faced national scrutiny last year when a 23-year-old woman was arrested during a traffic stop after she disclosed to officers that she’d smoked marijuana two days earlier, the day she learned she was pregnant. And a separate lawsuit last year alleged that Etowah county had arrested a woman for “chemical endangerment”, alleging she was exposing her fetus to drugs, only to discover she wasn’t pregnant.
The prosecutions fall under an Alabama law adopted in 2006 with the intent to protect children from the hazards of meth labs.
Women across the country have increasingly been jailed for pregnancy outcomes, including miscarriages and stillbirths.
The crackdown has occurred despite research showing that policies that punish drug use during pregnancy can result in worse birth outcomes in part because people avoid getting addiction treatment and prenatal care out of fear of arrest. Physician experts have also testified that these prosecutions can be rooted in “medical misinformation”, with law enforcement linking certain pregnancy outcomes to drug exposure without evidence.
The Etowah county sheriff’s department did not immediately respond to requests for comment on Friday.
Jody Willoughby, the Etowah county district attorney, did not comment on his office’s policy of prosecuting “chemical endangerment” cases or Caswell’s lawsuit. But he said in an email that Caswell’s 15-year sentence included an initial “community corrections” placement, meaning an alternative program outside of jail, but that she was sent to state prison after her probation was revoked. Records show officials moved to have her complete her sentence in prison after a positive drug test.