Pregnant Women in DOJ Custody: U.S. Marshals Service and Bureau of Prisons Should Better Align Policies with National Guidelines

What GAO Found

GAO analyses of available data show that from calendar year 2017 through 2019, there were at least 1,220 pregnant women in U.S. Marshals Service (USMS) custody and 524 pregnant women in Bureau of Prisons (BOP) custody.

Pregnant Women in USMS and BOP Custody: Number, Age, Race, and Length of Time in Custody from 2017 through 2019

aUSMS does not track pregnancy outcomes, so length of time in custody may include time when the women were not pregnant. For BOP, the length of time represents only the period of pregnancy.

GAO analyses also show that pregnant women were held at a variety of facility types from 2017 through 2019. For example, pregnant women spent 68 percent of their time in USMS custody in non-federal facilities where USMS has an intergovernmental agreement. BOP data show that pregnant women spent 21 percent of their time in BOP custody while pregnant at Carswell—BOP’s only female Federal Medical Center.

While USMS and BOP both have policies that address the treatment and care of pregnant women, not all policies fully align with national guidance recommendations on 16 pregnancy-related care topics. For example, national guidance recommends specialized nutrition and when needed, mental health care. USMS policies fully align on three of 16 care topics and BOP policies fully align on eight of 16. By taking steps to more closely align agency standards and policies with national guidance as feasible, USMS and BOP would be better positioned to help ensure the health of pregnant women in their custody.

Why GAO Did This Study

Policymakers and advocacy groups have raised questions about the treatment of incarcerated pregnant women, including the use of restrictive housing—removal from the general prisoner population with the inability to leave the cell for the majority of the day—and restraints. Within DOJ, USMS is responsible for prisoners awaiting trial or sentencing. BOP is responsible for sentenced prisoners. GAO was asked to review issues related to pregnant women in USMS and BOP custody.

This report examines (1) what DOJ data indicate about pregnant women in USMS and BOP custody; (2) the extent to which USMS and BOP policies align with national guidance on pregnancy-related care; and (3) what is known about the care provided and the extent to which USMS and BOP track when pregnant women are placed in restrictive housing or restraints. GAO analyzed available agency data from calendar years 2017 through 2019, which were the most recent data available; compared agency policies to relevant national guidance; and interviewed officials and a non-generalizable sample of prisoners who had been pregnant in USMS or BOP custody.

What GAO Recommends

GAO is making six recommendations, including that USMS and BOP take steps to more closely align their policies with national guidance on pregnancy-related care as feasible, and that USMS require facilities to collect data on and notify USMS when pregnant or postpartum women are placed in restrictive housing. DOJ concurred with our recommendations.

For more information, contact Gretta L. Goodwin at (202) 512-8777 or goodwing@gao.gov.

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    What GAO Found In its May 2021 report, GAO found that the Department of Defense (DOD) met a statutory requirement to collect and report data for incidents that it determined met its criteria for domestic abuse. In fiscal years 2015-2019, DOD determined that over 40,000 domestic abuse incidents met its criteria, of which 74 percent were physical abuse. However, DOD has not collected and reported accurate data for all domestic abuse allegations received, including those that did not meet DOD's criteria, as statutorily required. Thus, DOD is unable to assess the scope of alleged abuse and its rate of substantiation. In addition, despite a statutory requirement since 1999, DOD has not collected comprehensive data on the number of allegations of domestic violence—a subcategory of different types of domestic abuse that constitute offenses under the Uniform Code of Military Justice—and related actions taken by commanders. Improving collection of these data could enhance DOD's visibility over actions taken by commanders to address domestic violence. DOD and the military services have taken steps to implement and oversee domestic abuse prevention and response activities, but gaps exist in key areas, including creating awareness of domestic abuse reporting options and resources, allegation screening, and victim risk assessment. For example, while DOD and the military services have taken steps to promote awareness of reporting options and resources, DOD has not fully addressed challenges in doing so, and may miss opportunities to provide available resources to victims. In addition, the military services perform limited monitoring of installation incident-screening decisions and therefore lack reasonable assurance that all domestic abuse allegations are screened in accordance with DOD policy. DOD and the military services have developed risk assessment tools in accordance with DOD policy, but the Army, the Navy, and the Marine Corps have not ensured their consistent implementation across installations, and may therefore be limited in their ability to identify and convey the need for any critical safety measures for victims of domestic abuse. Finally, GAO found that the military services perform limited oversight of commanders' disposition of domestic violence incidents, referred to as command actions. These command actions can have significant implications, including for victims' eligibility for transitional compensation and Lautenberg Amendment restrictions to firearm possession for alleged abusers. DOD has not assessed the potential risks associated with its current disposition model for domestic violence incidents and the feasibility of potential alternatives that may respond to such risks. Performing such an assessment could provide the department and military services with a better understanding of such risks and their resulting potential impacts. Why GAO Did This Study This testimony summarizes the information contained in GAO's May 2021 report, entitled Domestic Abuse: Actions Needed to Enhance DOD's Prevention, Response, and Oversight (GAO-21-289). Specifically, this testimony discusses the extent to which 1) DOD has met statutory requirements to collect and report complete data on reports of domestic abuse and 2) DOD and the military services have implemented and overseen domestic abuse prevention and response activities, including commanders' disposition of incidents, in accordance with DOD policy.
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  • Secretary Antony J. Blinken at a Youth Moderated Discussion on Democracy and Human Rights
    In Crime Control and Security News
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  • Justice Department Announces Additional Distribution of more than $488 Million to Victims of Madoff Ponzi Scheme
    In Crime News
    The Department of Justice announced today that the Madoff Victim Fund (MVF) began its sixth distribution of approximately $488 million in funds forfeited to the U.S. Government in connection with the Bernard L. Madoff Investment Securities LLC (BLMIS) fraud scheme, bringing the total distributed to almost $3.2 billion to nearly 37,000 victims worldwide.
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  • ‘All too frequent tragedies demand action to improve judicial security,’ Judge tells Judicial Conference
    In U.S Courts
    “Four federal judges and three family members have been killed since 1979. These horrific tragedies must stop,” Judge David W. McKeague told the Judicial Conference of the United States today.
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  • Prescription Drugs: Medicare Spending on Drugs with Direct-to-Consumer Advertising
    In U.S GAO News
    What GAO Found Drug manufacturers spent $17.8 billion on direct-to-consumer advertising (DTCA) for 553 drugs from 2016 through 2018, and spending was relatively stable at about $6 billion each year. Almost half of this spending was for three therapeutic categories of drugs that treat chronic medical conditions, such as arthritis, diabetes, and depression. GAO also found that nearly all DTCA spending was on brand-name drugs, with about two-thirds concentrated on 39 drugs, about half of which entered the market from 2014 through 2017. Medicare Parts B and D and beneficiaries spent $560 billion on drugs from 2016 through 2018, $324 billion of which was spent on advertised drugs. Of the 553 advertised drugs, GAO found Medicare Parts B and D spending for 104 and 463 drugs, respectively. Among the drugs with the highest Medicare spending, some also had the highest DTCA spending. Specifically, among the top 10 drugs with the highest Medicare Parts B or D expenditures, four were also among the top 10 drugs in advertising spending in 2018: Eliquis (blood thinner), Humira (arthritis), Keytruda (cancer), and Lyrica (diabetic pain). Medicare Spending on Advertised Drugs, 2016 - 2018 GAO's review of four advertised drugs found that drug manufacturers changed their DTCA spending during key events, such as increasing spending when a drug was approved to treat additional conditions or decreasing spending following the approval of generic versions. GAO also found that DTCA may have contributed to increases in Medicare beneficiary use and spending among four selected drugs from 2010 through 2018. However, other factors likely contributed to a drug's Medicare beneficiary use and spending, making it difficult to isolate the relationship between drug advertising, use and spending. For example, GAO's review of four selected drugs showed that increases in unit prices were a factor, while stakeholders GAO interviewed cited other contributing factors such as doctors' prescribing decisions and manufacturers' drug promotions directed to doctors. Why GAO Did This Study Drug manufacturers use advertising on television and in other media to promote the use of their drugs to consumers and to encourage them to visit their doctors for more information. From 2016 through 2018, the Medicare program and beneficiaries spent $560 billion on drugs, and spending is projected to increase with the use of newer, more expensive drugs and an increase in beneficiaries. GAO was asked to examine DTCA and Medicare spending on advertised drugs. This report examines (1) drug manufacturer spending on DTCA; (2) Medicare spending on advertised drugs; and (3) changes in DTCA spending and Medicare use and spending for selected drugs. GAO analyzed DTCA spending data from Nielsen Media, and Medicare Parts B and D Drug Spending Dashboard data, from 2016 through 2018 (the most recent available data at the time of GAO's analysis). GAO also analyzed DTCA spending and Medicare data for a non-generalizable selection of four advertised drugs over a longer period—from 2010 through 2018. The four drugs were selected to reflect differences in DTCA and Medicare spending, beneficiary use, and medical conditions treated. GAO also interviewed or obtained information from officials representing 14 stakeholder groups (including research, trade, and physician organizations; and drug manufacturers of the four selected drugs) about DTCA spending and drug use and spending. The Department of Health and Human Services provided technical comments on a draft of this report, which GAO incorporated as appropriate. For more information, contact John Dicken at (202) 512-7114 or dickenj@gao.gov.
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    In Justice News
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