Ashley Denney was about seven months pregnant in 2022 when police handcuffed her during an arrest in Carroll County, Georgia. Officers shackled her even though the state bans the use of restraints on pregnant women in custody beginning at the second trimester.

In early July, she said, it happened again.

"I asked the officer, 'Please, pull over. I'm not supposed to be handcuffed. I'm pregnant,'" said Denney. At the time, she was near the end of her first trimester, though she believed her pregnancy was more advanced. Arresting officers did not know she was pregnant, said an official with the Carrollton Police Department who reviewed video footage of that arrest. 

Medical groups, such as the American College of Obstetricians and Gynecologists, widely condemn shackling pregnant people, which they argue is unethical and unsafe because it increases the risk of falls, hinders physicians' care, and endangers the fetus.

About 40 states, including Georgia, have passed laws limiting the use of restraints such as handcuffs, leg restraints, and belly chains on pregnant people in law enforcement custody, according to a Johns Hopkins University research group. Laws that seek to improve treatment of pregnant women in jails and prisons have drawn bipartisan support, including the First Step Act, which was passed in 2018 and limits the use of restraints on pregnant people in federal custody. Yet advocates say they continue logging reports of law enforcement agencies and hospital staffers ignoring such prohibitions and allowing pregnant people to be chained, handcuffed, or otherwise restrained.

Confusion over the laws, lack of sanctions for violations, and wide loopholes are contributing to the continued shackling of pregnant women in custody. But it's nearly impossible to get an accurate picture of the prevalence because of limited data collection and little independent oversight.

"People see laws like these, and they say 'check.' They don't know how they are being implemented and if they are creating the outcomes intended," said Ashley Lovell, co-director of the Alabama Prison Birth Project, a group that works with pregnant prisoners. Without oversight, these laws "are words on paper," she said. "They don't mean anything."

More than 55,000 pregnant women enter U.S. jails and prisons each year, according to estimates based on 2017 data from research led by Carolyn Sufrin, a gynecology and obstetrics associate professor at Johns Hopkins University who researches pregnancy care in jails and prisons. "The fact that we don't know what is happening is part of the story itself," she said.

Yet reports of shackling continue to surface, often making local headlines.

In January, a Georgia woman, 32 weeks pregnant, was shackled for hours while waiting for a medical appointment and during transport, according to Pamela Winn, founder of RestoreHER US.America, a group that works with people entangled in the criminal justice system. The woman did not want to be identified because she is in state custody and fears retaliation. She said her handcuffs were removed only after a request from medical staffers.

Her experience was echoed by women nationwide in law enforcement custody.

Minnesota passed an anti-shackling bill in 2014, but six years later a suburban Minneapolis woman sued Hennepin County after a wrongful arrest during which she was shackled while in active labor — an incident first reported by local media.

And despite Texas' shackling ban, in August 2022 an officer in Harris County, which includes Houston, chained Amy Growcock's ankle to a bench in a courthouse holding area for hours.

"It was pretty painful," said Growcock, who was eight months pregnant and worried about circulation being cut off in her swollen leg.

Prohibitions on shackling have run into the realities of the country's complicated web of penal institutions. Millions of people are held in a system that includes thousands of county jails, state and federal prisons, and private facilities with varying policies. Facilities often operate with little or no independent oversight, said Corene Kendrick, deputy director of the ACLU National Prison Project.

Some ACLU chapters have been logging complaints about violations of state bans on shackling pregnant people in jails and prisons. It appears, from complaints and oversight reports, that officials are usually left to interpret the law and police their own behavior, said Kendrick.

The Georgia law bans restraining pregnant women in their second and third trimesters and allows restraints in certain circumstances immediately postpartum. The state Department of Corrections maintains an anti-shackling policy for pregnant people in state custody and requires violations to be reported. But agency officials, in response to records requests from KFF Health News, said there were no incident reports regarding shackling in 2022 and through late October. 

The Georgia Sheriffs' Association asks county jails to voluntarily submit data on shackling, but only 74 of the 142 jails sent reports in 2022. Those jails reported holding 1,016 pregnant women but only two who were restrained in the immediate postpartum period.

Association officials contend that shackling is rare. "Our jail people have a lot of common sense and compassion and do not do something to intentionally hurt somebody," said Bill Hallsworth, director of jail and court services for the association. Many rural jails don't have medical staffers to immediately verify a pregnancy, he added.

The Carrollton Police Department, whose officers handcuffed Denney, maintain that the law didn't apply during her arrest, before her booking into a facility, according to public information officer Sgt. Meredith Hoyle Browning. 

"It sounds like, to me, that there has been wide interpretation of this bill by the people we are asking to enforce it," said Georgia state Rep. Sharon Cooper, a Republican who authored the state's bill. Cooper said she hadn't been notified of any incidents but added that if pregnant incarcerated women are still being shackled, legislators may need to revise the law.

In addition, some incidents in which jailors shackle pregnant people fall into legal loopholes. In Texas, as in many other states, officers can make exceptions when they feel threatened or perceive a flight risk. Last year 111 pregnant women reported being restrained in jail, according to a Texas Commission on Jail Standards report in April. In more than half the cases, women were shackled during transport even though that's when they are most likely to fall.

The Texas commission has sent memos to jails that violate the shackling policy, but documents reviewed by KFF Health News show the agency stopped short of issuing sanctions.

Most states don't allocate funding to educate correctional officers and hospital staff members on the laws. More than 80% of perinatal nurses reported that the pregnant prisoners they care for were sometimes or always shackled, and the vast majority were unaware of laws around the use of restraints, as well as of a nurses association's position against their use, according to a 2019 study.

Even when medical professionals object to restraints, they generally defer to law enforcement officials.

Southern Regional Medical Center, just south of Atlanta, handles pregnant incarcerated patients from the Georgia Department of Corrections, the Clayton County Jail, and other facilities, said Kimberly Golden-Benner, the hospital's director of business development, marketing, and communications. She said clinicians request that officers remove restraints when pregnant incarcerated patients arrive at the center for labor and delivery. But it's still at the officers' discretion, she said.

The Clayton County Sheriff's Office didn't return a request for comment. The state Department of Corrections maintains a policy of limiting the use of restraints on pregnant incarcerated people to only extreme cases, such as when there is an imminent escape risk, said Joan Heath, public affairs director. All staff members at facilities for women are required to complete an annual training course that outlines the policy, she said.

Strengthening the laws will require funding for implementation, such as creating model policies for hospitals and law enforcement staffs; continuous training; tighter reporting requirements; and sanctions for violations, advocates say.

"The laws are a necessary step and draw attention to the issue," said Sufrin, the Johns Hopkins professor. They are "by no means enough to ensure the practice doesn't happen."

Winn wants states to allow pregnant women to bond out of jail immediately and defer sentences until after they give birth. In Colorado a law took effect in August that encourages courts to consider alternative sentences for pregnant defendants. Florida lawmakers considered but did not pass a similar measure this year.

The use of restraints is a window into mistreatment that pregnant women face in jails and prisons.

Denney said that in August she was mistakenly given medication for depression and anxiety instead of nausea; her morning sickness worsened, and she missed a meal. 

The medical staff doesn't have a record of Denney being given the wrong medication, said Brad Robinson, chief deputy of the Carroll County Sheriff's Office.

"They don't take you seriously," Denney said of the pregnancy care she has received while incarcerated. "They should at least make sure the babies are all right."

Growcock said her initial shackling in Houston was the first sign that officers weren't equipped to handle pregnant people. She gave birth in a jail cell and nearly lost her son less than two weeks after her arrest. The Texas Commission on Jail Standards acknowledged that Growcock, who photographed her ankle in restraints, had been shackled. But the jail overseer admitted no other wrongdoing in her case, according to a memo the commission sent to the Harris County Jail.

"I felt like if I wasn't getting treated right already, then the whole experience was going to be bad," she said. "And it was."

KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.