Could Rising Maternal Death Rates in California Signal a Broader Trend?

Nathanael Johnson

Evidence suggests that maternal mortality rates in the U.S. may be increasing. They have spiked in California where it's now more dangerous to give birth than it is in Kuwait or Bosnia.

This post was orginally published on California Watch, a project of The Center for Investigative Reporting

The mortality rate of California women who die from causes directly
related to pregnancy has nearly tripled in the past decade, prompting
doctors to worry about the dangers of obesity in expectant mothers and
about medical complications of cesarean sections.

For the past seven months, the state Department of Public Health declined to release a report outlining the trend.  

California Watch spoke with investigators who wrote the report and
they confirmed the most significant spike in pregnancy-related deaths
since the 1930s. Although the number of deaths is relatively small,
it’s more dangerous to give birth in California than it is in Kuwait or
Bosnia.

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“The issue is how rapidly this rate has worsened,” said Debra Bingham, executive director of the California Maternal Quality Care Collaborative, the public-private task force investigating the problem for the state. “That’s what’s shocking.”

The problem may be occurring nationwide. The Joint Commission, the
leading health care accreditation and standards group in the United
States, issued a “Sentinel Event Alert
to hospitals on Jan. 26, stating: “Unfortunately, current trends and
evidence suggest that maternal mortality rates may be increasing in the
U.S.”  

The alert asked doctors to consider morbid obesity, high blood
pressure and diabetes, along with hemorrhaging from C-sections, as
contributing factors.

In 2007, the U.S. Centers for Disease Control and Prevention reported that the national maternal mortality rate had risen, but experts such as Dr. Jeffrey C. King,
who leads a special inquiry into maternal mortality for the American
College of Obstetricians and Gynecologists, chalked up the change to
better counting of deaths. His opinion hasn’t changed.

“I would be surprised if there was a significant increase of
maternal deaths,” said King, who has not seen the California report.

But Shabbir Ahmad, a scientist in California’s Department of Public
Health, decided to look closer. He organized academics, state
researchers and hospitals to conduct a systematic review of every
maternal death in California. It’s the largest state review ever
conducted. The group’s initial findings provide the first strong
evidence that there is a true increase in deaths – not just the number
of reported deaths.

Changes in the population – obese mothers, older mothers and
fertility treatments – cannot completely account for the rise in deaths
in California, said Dr. Elliott Main, the principal investigator for the task force.  

“What I call the usual suspects are certainly there,” he said.
“However, when we looked at those factors and the data analyzed so far,
those only account for a modest amount of the increase.”

Main said scientists have started to ask what doctors are doing
differently. And, he added, it’s hard to ignore the fact that
C-sections have increased 50 percent in the same decade that maternal
mortality increased. The task force has found that changing clinical
practice could prevent a significant number of these deaths.

One maternity expert who was not involved in the report, Dr. Thomas R. Moore,
chair of the Department of Reproductive Medicine at UC San Diego, said
about the data: "This could be a sentinel finding, and I could see
other states taking a closer look and finding the same thing."

Low numbers, high consequences

Despite the increase in the mortality rate, pregnancy is still safe for the vast majority of women.

In 2006, 95 California women died from causes directly related to
their pregnancies – out of more than 500,000 live births. That’s a
small number by public health standards. If California had met the goal
set by the U.S. Department of Health and Human Services
to bring the state’s maternal mortality rate down to a level achieved
by other countries, the number of dead would be closer to 28.

It’s not clear who is most at risk, but researchers have long known
that African-American mothers are between three and four times more
likely to die from pregnancy-related causes than the rest of the
population. That racial association is not stratified by socio-economic
status: Even high-income black women are at a greater risk.

While the maternal mortality rate among black women is rising, the
task force found a more dramatic increase in deaths among white,
non-Hispanic mothers. There is not yet enough data to show if the risk
of death is associated with poverty.

maternal deaths California Watch

Tatia Oden French

What’s certain is that each maternal death shatters families. That cold sum – 95 dead – represents 95 stories of people such as Tatia Oden French.
In 2001, she was newly wed and had just finished her doctorate in
psychology. She was about to have a baby girl she would name Zorah
Allie Mae French.

“She’s the type of person that just walked into the room and lit it up,” said her mother, Maddy Oden.

During the labor, Maddy Oden was at home in Oakland, waiting for a
call announcing the birth of her granddaughter. Instead, she needed an
emergency C-section. “I woke up at 4 in the morning, and I knew that
something was wrong,” Oden said.

Then the phone rang. French was in trouble. Powerful contractions
had forced amniotic fluid into her bloodstream, stopping her heart and
killing the baby. When Oden got to her daughter at an Oakland hospital
there was only one thing she could do: “We said a prayer,” Oden said,
“and I closed her eyes.”  

The subsequent lawsuit was dismissed: The doctor had not deviated from the standard of care.

Rather than track down the cause of every death and assign blame,
the California task force is focused on finding solutions. And Bingham
and Main have found that doctors and nurses are eager to help after
seeing the numbers.

In 1996, the maternal death rate in California was 5.6 per 100,000
live births, not far from the national goal of 4.3 per 100,000. Between
1998 and 1999, the World Health Organization changed its coding system,
which may have increased reporting of deaths. The California rate was
6.7 in 1998 and 7.7 in 1999. Because the number of mothers who die is
small, the rate tends to fluctuate from year to year.   

In 2003, when California revised its death certificate, the rate
jumped to 14.6. And in 2006, the last year for which data is available,
the rate stood at 16.9.  

The best estimates show that less than 30 percent of the increase is
attributable to better reporting on death certificates. Even accounting
for these reporting and classification changes, the maternal death rate
between 1996 and 2006 has more than doubled, Main said.

Not yet public

When researchers unveiled their initial findings to a conference of
the American College of Obstetricians and Gynecologists in 2007, there
were gasps from the audience, according to participants at the San
Diego event. The idea that California was moving backward even in an
era of high-tech birthing was implausible to some. Confirmation of the
trend was noted in the 2008 report written by 27 doctors and
researchers. The report was described in detail to California Watch.

The state of California has yet to share the report with the public.
Researchers say that, after reviewing the report in 2008, officials in
the Department of Public Health asked for technical clarifications.
Revisions were complete and approved in the first half of 2009,
according to Ahmad.  

Al Lundeen, the department’s director of public affairs said, “There
was no effort to hold that report back. It just needed some more
revisions.”

Researchers say that it is important for the public to be aware now
that these trends are worsening. Diane Ashton, the deputy medical
director for the March of Dimes, has seen the numbers. She says they demand a concerted response.  

“Even though they tend to be small numbers in terms of maternal
mortality, it is important – it’s very important – that these trends be
looked at,” she said. “And efforts need to be made to try and reverse
them when they are going in the wrong direction.”

Rising C-section birth rate

Nearly one in three babies is now born by C-section. Many scientists
have acknowledged that at some point, as the number of surgeries spiral
upward, the risks will outweigh the benefits. But the C-section remains
a useful tool, and in the middle of labor, doctors say, it’s hard to
balance the potential long-term harm against immediate crisis.

Today, doctors face a condition called placenta accreta,
where the placenta grows into the scar left by a previous C-section. In
surgery, doctors must find and suture a web of twisted placental
vessels snaking into the patient’s abdomen, which can hemorrhage
alarming amounts of blood. Often, doctors must remove the uterus.

Main said this complication from C-sections has increased
eight-to-10 fold in the past decade. Nonetheless, most women survive
the ordeal. The point, says Catherine Camacho, deputy director of the
state’s Center for Family Health, is that the rise in deaths is indicative of a larger problem.  

“For every maternal death, there are 10 near misses; for every near
miss, there are 10 severe morbidity cases (such as hysterectomy,
hemorrhage, or infection), and for every severe morbidity case, there
is another 10 morbidity cases related to childbirth,” Camacho wrote in
an e-mail.  

Other factors are contributing to the rise in deaths, but the
researchers in California are most interested in the areas where they
have control, such as the high C-section birth rate: It’s easier for
doctors to improve medical care than to fix more intractable problems
like poverty and obesity.

Inducing labor before term more common

In 2002, Dr. David Lagrew,
the medical director of the Women’s Hospital at Saddleback Memorial
Medical Center in Orange County, noticed that a lot of women were
having their labor induced before term without a medical reason. And he
knew that having an induction doubled the chances of a C-section.

So he set a rule: no elective inductions before 41 weeks of
pregnancy, with only a few exceptions. As a result, Lagrew said, the
operating room schedules opened up, and the hospital saw fewer babies
admitted to the neonatal intensive care unit, fewer hemorrhages and
fewer hysterectomies.  

All this, however, came at a cost: The hospital had to take a cut in
revenue for reducing the procedures it performed. Lagrew doubts that
any hospital has increased its C-section rate in pursuit of profit, but
he does note that the first hospitals to adopt controls on early
elective inductions have been nonprofits.  

According to a report issued by the advocacy group Childbirth Connection,
“Six of the 10 most common procedures billed to Medicaid and to private
insurers in 2005 were maternity related.” On average, a C-section
brings in twice the revenue of a vaginal birth. Today, the C-section is
the single most common surgical procedure performed in the United
States.

“If all these guys were losing money on every C-section, well,
what’s the old saying? Whenever they tell you it’s not about the money,
it’s about the money,” Lagrew said.

The California task force isn’t waiting to determine the ultimate
cause of these deaths. It has started pilot projects to improve the way
hospitals respond to hemorrhages, to better track women’s medical
conditions and to reduce inductions – as Lagrew did at Memorial Care.

Although the state hasn’t released the task force’s report, the
researchers and doctors involved forwarded data to the national Joint
Commission, which issued incentives for hospitals to reduce inductions
and fight what it called “the cesarean section epidemic.”  

“You don’t have to be a public health whiz to know that we are facing a big problem here,” Bingham said.

Commentary Politics

No, Republicans, Porn Is Still Not a Public Health Crisis

Martha Kempner

The news of the last few weeks has been full of public health crises—gun violence, Zika virus, and the rise of syphilis, to name a few—and yet, on Monday, Republicans focused on the perceived dangers of pornography.

The news of the last few weeks has been full of public health crises—gun violence, the Zika virus, and the rise of syphilis, to name a few—and yet, on Monday, Republicans focused on the perceived dangers of pornography. Without much debate, a subcommittee of Republican delegates agreed to add to a draft of the party’s 2016 platform an amendment declaring pornography is endangering our children and destroying lives. As Rewire argued when Utah passed a resolution with similar language, pornography is neither dangerous nor a public health crisis.

According to CNN, the amendment to the platform reads:

The internet must not become a safe haven for predators. Pornography, with its harmful effects, especially on children, has become a public health crisis that is destroying the life [sic] of millions. We encourage states to continue to fight this public menace and pledge our commitment to children’s safety and well-being. We applaud the social networking sites that bar sex offenders from participation. We urge energetic prosecution of child pornography which [is] closely linked to human trafficking.

Mary Frances Forrester, a delegate from North Carolina, told Yahoo News in an interview that she had worked with conservative Christian group Concerned Women for America (CWA) on the amendment’s language. On its website, CWA explains that its mission is “to protect and promote Biblical values among all citizens—first through prayer, then education, and finally by influencing our society—thereby reversing the decline in moral values in our nation.”

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The amendment does not elaborate on the ways in which this internet monster is supposedly harmful to children. Forrester, however, told Yahoo News that she worries that pornography is addictive: “It’s such an insidious epidemic and there are no rules for our children. It seems … [young people] do not have the discernment and so they become addicted before they have the maturity to understand the consequences.”

“Biological” porn addiction was one of the 18 “points of fact” that were included in a Utah Senate resolution that was ultimately signed by Gov. Gary Herbert (R) in April. As Rewire explained when the resolution first passed out of committee in February, none of these “facts” are supported by scientific research.

The myth of porn addiction typically suggests that young people who view pornography and enjoy it will be hard-wired to need more and more pornography, in much the same way that a drug addict needs their next fix. The myth goes on to allege that porn addicts will not just need more porn but will need more explicit or violent porn in order to get off. This will prevent them from having healthy sexual relationships in real life, and might even lead them to become sexually violent as well.

This is a scary story, for sure, but it is not supported by research. Yes, porn does activate the same pleasure centers in the brain that are activated by, for example, cocaine or heroin. But as Nicole Prause, a researcher at the University of California, Los Angeles, told Rewire back in February, so does looking at pictures of “chocolate, cheese, or puppies playing.” Prause went on to explain: “Sex film viewing does not lead to loss of control, erectile dysfunction, enhanced cue (sex image) reactivity, or withdrawal.” Without these symptoms, she said, we can assume “sex films are not addicting.”

Though the GOP’s draft platform amendment is far less explicit about why porn is harmful than Utah’s resolution, the Republicans on the subcommittee clearly want to evoke fears of child pornography, sexual predators, and trafficking. It is as though they want us to believe that pornography on the internet is the exclusive domain of those wishing to molest or exploit our children.

Child pornography is certainly an issue, as are sexual predators and human trafficking. But conflating all those problems and treating all porn as if it worsens them across the board does nothing to solve them, and diverts attention from actual potential solutions.

David Ley, a clinical psychologist, told Rewire in a recent email that the majority of porn on the internet depicts adults. Equating all internet porn with child pornography and molestation is dangerous, Ley wrote, not just because it vilifies a perfectly healthy sexual behavior but because it takes focus away from the real dangers to children: “The modern dialogue about child porn is just a version of the stranger danger stories of men in trenchcoats in alleys—it tells kids to fear the unknown, the stranger, when in fact, 90 percent of sexual abuse of children occurs at hands of people known to the victim—relatives, wrestling coaches, teachers, pastors, and priests.” He added: “By blaming porn, they put the problem external, when in fact, it is something internal which we need to address.”

The Republican platform amendment, by using words like “public health crisis,” “public menace” “predators” and “destroying the life,” seems designed to make us afraid, but it does nothing to actually make us safer.

If Republicans were truly interested in making us safer and healthier, they could focus on real public health crises like the rise of STIs; the imminent threat of antibiotic-resistant gonorrhea; the looming risk of the Zika virus; and, of course, the ever-present hazards of gun violence. But the GOP does not seem interested in solving real problems—it spearheaded the prohibition against research into gun violence that continues today, it has cut funding for the public health infrastructure to prevent and treat STIs, and it is working to cut Title X contraception funding despite the emergence of Zika, which can be sexually transmitted and causes birth defects that can only be prevented by preventing pregnancy.

This amendment is not about public health; it is about imposing conservative values on our sexual behavior, relationships, and gender expression. This is evident in other elements of the draft platform, which uphold that marriage is between a man and a women; ask the U.S. Supreme Court to overturn its ruling affirming the right to same-sex marriage; declare dangerous the Obama administration’s rule that schools allow transgender students to use the bathroom and locker room of their gender identity; and support conversion therapy, a highly criticized practice that attempts to change a person’s sexual orientation and has been deemed ineffective and harmful by the American Psychological Association.

Americans like porn. Happy, well-adjusted adults like porn. Republicans like porn. In 2015, there were 21.2 billion visits to the popular website PornHub. The site’s analytics suggest that visitors around the world spent a total of 4,392,486,580 hours watching the site’s adult entertainment. Remember, this is only one way that web users access internet porn—so it doesn’t capture all of the visits or hours spent on what may have trumped baseball as America’s favorite pastime.

As Rewire covered in February, porn is not a perfect art form for many reasons; it is not, however, an epidemic. And Concerned Women for America, Mary Frances Forrester, and the Republican subcommittee may not like how often Americans turn on their laptops and stick their hands down their pants, but that doesn’t make it a public health crisis.

Party platforms are often eclipsed by the rest of what happens at the convention, which will take place next week. Given the spectacle that a convention headlined by presumptive nominee (and seasoned reality television star) Donald Trump is bound to be, this amendment may not be discussed after next week. But that doesn’t mean that it is unimportant or will not have an effect on Republican lawmakers. Attempts to codify strict sexual mores are a dangerous part of our history—Anthony Comstock’s crusade against pornography ultimately extended to laws that made contraception illegal—that we cannot afford to repeat.

Culture & Conversation Human Rights

The Prison Overcrowding Problems on ‘Orange Is the New Black’ Reflect a Real-Life Crisis

Victoria Law

In both the Netflix series and real life, overcrowding has serious ramifications for those behind bars. But the issue isn't limited to privately run institutions; public prisons have been overflowing in many states for years.

“I’ve been in Litchfield for a while now,” says Piper Chapman (actress Taylor Schilling) in the latest season of Orange Is the New Black, “and I’ve started to feel unsafe lately.”

Season four of OITNB has taken on prison overcrowding. Viewers may recall that, in the last season, the fictional Litchfield Penitentiary was taken over by a corporation, transforming it from an already underfunded state prison to a private facility whose sole purpose is the bottom line. That means each woman inside Litchfield has become a commodity—and the more commodities locked inside, the more profit the corporation receives.

In both the Netflix series and real life, overcrowding has serious ramifications for those behind bars. But the issue isn’t limited to privately run institutions; public prisons have been overflowing in many states for years.

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In the latest season of OITNB, viewers see some of the potential consequences of prison overcrowding: It is accompanied by increased threats of violence and abuse, as people, packed like sardines, step on each other, jostle each other, and can’t get away from each other. Supplies, such as soap, sanitary napkins, and toilet paper, are never in abundance in a prison setting; they become even more scarce as the number of people clamoring for them soar. Even food, which prisons are required to provide in the form of regular meals, becomes in short supply.

A scarcity of resources isn’t the only problem in Litchfield. Again and again, we see long lines for the bathrooms and showers. When the prison installs “porta potties” in the yard, there are long lines for those as well. “Too many people in here, everybody getting on each other’s nerves,” remarks Poussey Washington (Samira Wiley), another of the show’s long-term characters. Conflicts emerge as women struggle to navigate daily living in a narrow room with multiple other women. Some of these may seem small, like the nightly snoring of a new bunkmate keeping another one awake all night. But these seemingly inconsequential issues lead to larger ones, such as sleep deprivation. In the show, women resort to comic measures; but these conflicts, especially in a closed and cramped environment, can quickly erupt into violence.

This is the case in Litchfield as well. Conflicts quickly turn into threats or actual attacks. While prison socializing has always been racially segregated, some of it now becomes racialized and racist. Some of the new white women, noting that they are in the minority among the large numbers of Latina and Black women being shuttled in, are unwittingly pushed by Piper to form a white power group. They hurl racist epithets at the women of color and, when they spot a lone Dominican woman on the stairs, move together to attack her.

Prison staff perpetuate the violence, using their authority to do so. They begin their own version of “stop and frisk” in the prison’s hallways, targeting the growing Latina population. While the body searches in and of themselves are humiliating, the (male) guards also take advantage of the additional security measure to grope and further abuse the women. They even force women into fighting, which they then bet on—a nod to the actual allegations of guard-instigated gladiator fights in California’s prisons and the San Francisco County Jail.

Although not everything in OITNB is realistic, the problems the show portrays in this respect reflect the frequent results of overcrowding—and some of its causes. As OITNB notes repeatedly throughout the season, private prisons receive money per person, so it’s in the company’s interest to lock up as many people as possible.

In 2014, for example, private prison contractor GEO Group contracted with the California Department of Corrections and Rehabilitation (CDCR) to open and operate a women’s prison north of Bakersfield, California. Under the terms of the contract, California pays GEO Group $94.50 per person per day for the first 260 women sent to that prison. The contract also includes an opportunity for the company to expand its prison by another 260 beds—although, if it does that, the state only pays $86.95 per person per day. But even at that lower rate, doubling the occupancy increases the private prison’s overall four-year revenue from roughly $38 million to $66 million. (As of June 8, 2016, that prison held 223 people.)

But prison overcrowding isn’t limited to private prisons. In some states, the “tough on crime” laws passed in the 1980s and 1990s are still leading to crammed public prisons today.

California, for instance, is one of the most egregious examples of such legislation leading to prison overcrowding. Years of extreme overcrowding ultimately led to Brown v. Plata, a class-action lawsuit charging that the state’s severely crowded prisons prevented it from providing adequate medical and mental health care, thus violating the Eighth Amendment’s prohibition on cruel and unusual punishment. In 2011, the U.S. Supreme Court agreed and ordered California to decrease its state prison population from 180 to 137.5 percent capacity.

To do so, the CDCR took several actions: It began shipping thousands of men to private prisons in Arizona, Mississippi, and Oklahoma. In addition, it converted Valley State Prison for Women, one of its three women’s prisons, into a men’s prison, and transferred the approximately 1,000 women there from Valley State Prison for Women to two other prisons—the Central California Women’s Facility (CCWF) and the California Institution for Women (CIW). It also opened the 523-bed Folsom Women’s Facility in January 2013.

Despite these efforts, overcrowding continues to plague California’s prisons. As of June 8, CCWF was at 143.6 percent capacity; while CIW was at 129 percent capacity.

Even before the influx of women from Valley State Prison, though, the numbers of people packed into CIW had led to reports of violence from inside. In 2012, Jane, who has been incarcerated at CIW for several years, wrote in a letter that was later reprinted in Tenacious, “When eight women of widely disparate ages, social backgrounds, ethnicities and interests share a 246-square foot cell, there are bound to be conflicts, and there is little tolerance for any behaviors that are different.” She recounted a woman named Anna who spoke little English and was mentally ill.

“Little Anna has spent the last several weeks being alternately beaten up by her cellmates, who don’t understand her behaviors, or drugged into a drooling stupor in the Specialty Care Unit,” Jane wrote. According to Jane, housing staff ignored the violence. When Anna tried to complain to a higher-ranking staff member, Jane said that correctional officers, “angry at her inability to follow directions, threw her to the floor, cuffed her hands behind her back and twisted her arms until she screamed in pain.”

Two years later, after women from Valley State Prison were moved to CIW, Jane wrote in a second letter published in Tenacious, “What this overcrowding has created in terms of living conditions is continued horrendous health care and failed mental health care.”

The situation seems to have persisted. As noted earlier, women have also reported a pervading sense of hopelessness, exacerbated in part by the inability to access mental health care. CIW has a suicide rate that reportedly is eight times the national rate for women behind bars. In 2015, it had two suicides and 35 attempts. As of June 16, 2016, there have been two successful suicides and nine attempts. “A lot of us are only hanging on by hope alone. In a hopeless place, most don’t make it,” one woman told Rewire one month before her friend’s suicide this past April.

In many men’s prisons, overcrowding is even more severe. Valley State Prison, now a men’s prison, is currently at 172 percent capacity. The vast majority of the state’s other male prisons operate at over 100 percent capacity.

But it’s not just California that suffers from prison overcrowding. Oklahoma, which has especially harsh sentencing laws—particularly for drug offenses—has the country’s highest rate of incarceration for women. And the number of those behind bars continues to rise: In 2014, the state imprisoned 2,979 women, a 9.3 percent increase from the 2,702 women imprisoned the year before.

Mary Fish has been incarcerated at Oklahoma’s Mabel Bassett Correctional Center (MBCC) for the past 15 years. She told Rewire that prison administrators recently added 40 more beds to each unit, increasing its capacity from 1,055 to 1,291. (As of June 13, 1,250 women were incarcerated at MBCC.) This has led to competition, even for state-guaranteed items like cafeteria food (especially fresh fruit, which is infrequent in many prisons). “This overcrowding is all about who can get up there and bull dog [sic] their way to the front of the line,” she wrote in a letter to Rewire. She said that two days earlier, the prison’s cafeteria was serving bananas with lunch. But, even though each woman only received one banana, by the time she reached the window, all of the bananas were gone.

“It really gives new meaning to overcrowded,” Fish reflected. “Bodies rubbing in passing, kind of space-less, boundary-less environment. I’ve never had so much human contact in the 15 years I’ve been incarcerated.”

The state’s medium-security women’s prison, the Eddie Warrior Correctional Center (capacity 988) currently holds 1,010 women. “There are huge overcrowded dorms crammed with bunk beds and steel lockers,” wrote “Gillian” in a letter to Rewire, later printed in Tenacious, shortly after being transferred from MBCC to Eddie Warrior. “The population is young, transient and the majority are disrespectful. They have no clue how to live successfully in a crowded communal environment. The dorms are filthy, loud and chaotic for the most part. There is no peace.”

The situations in Oklahoma and California are only two examples of how state prison overcrowding affects those locked up inside. Institutions in other states, including Alabama, North Dakota, and Nebraska, have also long been overcrowded.

On OITNB, the private corporation in charge plans to bring even more women to Litchfield to increase revenue. But in real life, as state budgets grow leaner and prison justice advocates continue to press for change, local legislators are beginning to rethink their incarceration policies. In California, a recently proposed ballot measure would change parole requirements and allow for early release for those with nonviolent convictions if they enroll in prison education programs or earn good behavior credits. If the ballot garners at least 585,407 voter signatures, it will be added to the state’s November ballot.

In Oklahoma, meanwhile, where the state now spends $500 million a year on incarceration, former Republican house speaker and leader of the coalition Oklahomans for Criminal Justice Reform Kris Steele is pushing for two ballot measures—one that allows reclassifying offenses like drug possession from felonies to misdemeanors, and another that sets up a new fund that would redirect the money spent on incarceration for low-level offenses back to community programs focused on rehabilitation and treating the root causes of crime.

Still, these changes have been slow in coming. In the meantime, individuals continue to be sent to prison, even if it means more bunk beds and less space to move (not to mention the devastation caused by breaking up families). “Last week, Oklahoma County brought a whole big RV-looking bus to deliver a bunch of women here to [Assessment and Reception],” Fish, at MBCC, noted in a May 2016 letter to Rewire.

The following week, she told Rewire, “They keep crowding us. There’s no room to even walk on the sidewalks.” Fish regularly reads the local newspapers in the hopes of learning about pending legislation to ease overcrowding and allow for early release. Though the senate recently passed four bills that may reduce the number of people being sent to prison, she feels that the new laws won’t help those currently trapped inside. “It’s getting pretty awful, and it looks like no bills passed to help us so there’s NO END IN SIGHT.”