(AP) - The number of women in America's state prisons has reached a record high, yet many states have inadequate policies for dealing with the large portion of them who have children or are pregnant, according to a new 50-state survey.
The report, being released Thursday by the National Women's Law Center and the Rebecca Project for Human Rights, analyzes policies in three areas -- prenatal care, shackling of pregnant women during childbirth, and community-based alternatives to incarceration enabling mothers to be with their children.
Only one state, Pennsylvania, received an A.
"It's shameful that so many states fail to have laws and policies to protect this vulnerable population of unseen and largely forgotten women," said Jill Morrison, a co-author of the report and senior counsel at the law center.
As a backdrop to its findings, the report noted the number of women in prison -- more than 115,000 as of 2009 -- has risen at a higher rate than that of men since the introduction of mandatory sentencing policies for many drug offenses. It said most of the women are nonviolent, first-time offenders, and about two-thirds have at least one child under 18.
According to the report, pregnant women entering prison often have high-risk pregnancies, yet many states lack comprehensive policies to ensure they receive essential prenatal care. The report said a majority of states do not require medical examinations as a component of prenatal care, and do not offer pregnant women screening for HIV/AIDS.
The report also said most states have failed to implement strict limits on the use of shackles or other restraints on mothers during labor and delivery. Morrison said the actual use of shackles during childbirth has likely declined in recent years, but she complained that many states lacked firm, clear-cut regulations governing the practice.
The report also urged continued expansion of community-based alternative sentencing programs, including drug-treatment programs, for women who have children and were convicted of nonviolent offenses.
"These treatment programs permit mothers and children to heal together in community-based facilities and consistently show successful outcomes for children's health and stability," the report said.
Some of the states that received low grades in the survey disagreed with how they were characterized -- notably in regard to F's given for prenatal care.
Mississippi's corrections department said all incarcerated pregnant women in its custody receive prenatal care from qualified physicians. Anne Cybulski-Sandlian, health services program manager for Wyoming's corrections department, said the private company running the state prison for women was required to meet national standards for its medical program, including prenatal care.
According to the report, Wyoming is one of 16 states that do not provide alternative community-based sentencing enabling some mothers to be with their children.
"The department is poised and ready to move forward if that is something that is legislatively changed," Cybulski-Sandlian said.
South Carolina, which received an 'F' grade overall, vigorously defended its policies on prenatal care and shackling, saying there were misrepresented in the report.
"When the S.C. Department of Corrections receives a pregnant inmate through our courts, she is afforded complete medical and prenatal care," department spokesman Josh Gelinas said in an e-mail. He said pregnant women past the 20th week of pregnancy are not restrained except for specific security reasons.
Morrison said a primary purpose of the report was to encourage greater accountability and consistency in how incarcerated mothers are treated.
"We know some states that are doing the right thing that don't have policies, and some states that have good policies that aren't doing the right thing," she said. "We want prisoners and their families to know what they're entitled to." Morrison said the use of shackles during childbirth has abated in part because of individual women who've taken a stand against the practice after enduring it.
Among them is Shawanna Nelson, 37, of Little Rock, Ark., who was shackled to a hospital bed while giving birth to her son in 2003 when she was serving time for credit card fraud.
Released in 2004, Nelson sued the state prison system, saying that the shackling -- while she was experiencing severe contractions -- caused lasting hip and back injuries.
In July, a federal jury found that Nelson's civil rights has been violated and awarded her $1. Nelson, who works for a nonprofit that helps grandparent caregivers, says her son, Jordan, is thriving and she is proud of pursuing the lawsuit despite the nominal award.
"The case was never about money," she said. "It helped bring attention to the situation."
Malika Saada Saar, executive director of the Rebecca Project and co-author of the new report, said further reforms in the treatment of imprisoned mothers could have far-reaching impact.
Better-designed programs "will offer incarcerated mothers and their families a meaningful chance to break the cycle of generational addiction, incarceration and poverty and achieve family stability," Saar said.
AP writers Mead Gruver in Cheyenne, Wyo., and Shelia Hardwell in Jackson, Miss., contributed to this story.