Last year, an enterprising advertising executive based in Boston, Massachusetts, had an idea: Instead of using his sophisticated mobile surveillance techniques to figure out which consumers might be interested in buying shoes, cars, or any of the other products typically advertised online, what if he used the same technology to figure out which women were potentially contemplating abortion, and send them ads on behalf of anti-choice organizations?

The executive—John Flynn, CEO of Copley Advertising—set to work. He put together PowerPoint presentations touting his capabilities, and sent them to groups he thought would be interested in reaching “abortion-minded women,” to use anti-choice parlance.

Before long, he’d been hired by RealOptions, a network of crisis pregnancy centers (CPCs) in Northern California, as well as by the evangelical adoption agency Bethany Christian Services.

Flynn’s endeavors quickly won him attention in the anti-choice world. He was invited to speak at the Family Research Council’s ProLifeCon Digital Action Summit in January this year, and he got a few write-ups in anti-choice press.

In an interview with Live Action News—the website for Live Action, the group run by anti-choice activist Lila Rose that is responsible for bogus attack videos against Planned Parenthood—Flynn gave some details about his strategy. He sends advertisements for his clients to women’s smartphones while they are sitting in Planned Parenthood clinics, using a technology known as “mobile geo-fencing.” He also planned to ping women at methadone clinics and other abortion facilities. His program for Bethany covered five cities: Columbus, Ohio; Pittsburgh, Pennsylvania; Richmond, Virginia; St. Louis, Missouri; and New York City.

“We are very excited to bring our mobile marketing capabilities to the pro-life community,” Flynn told Live Action News.

Anti-choice groups were tantalized by the ability to home in on the women they think will be most susceptible to their message.

“Marketing for pregnancy help centers has always been a needle in a haystack approach—cast a wide net and hope for the best,” said Bethany Regional Marketing Manager Jennie VanHorn, according to the report. “With geo fencing, we can reach women who we know are looking for or in need of someone to talk to.”

Flynn’s targeting of women seeking abortion presents a serious threat to the privacy and safety of women exercising their right to choose, as well as to abortion providers and their staff, a Rewire investigation has found. But due to weak and patchwork laws governing privacy and data collection in the United States, the conduct appears to be perfectly legal.

Women who have visited almost any abortion clinic in the United States have seen anti-choice protesters outside, wielding placards and chanting abuse. This technology, when deployed by anti-choice groups, allows them to send propaganda directly to a woman’s phone while she is in a clinic waiting room. It also has the capability to hand the names and addresses of women seeking abortion care, and those who provide it, over to anti-choice groups.

“It is incredibly unethical and creepy,” Brian Solis, a digital marketing expert, told Rewire, expressing a view that was unanimous among a dozen experts in digital security, privacy law, and online marketing we interviewed for this story.

Solis said this example was the inevitable application of a technology meant for one purpose—mass advertising campaigns that, while considered by many people to be unseemly and intrusive, do not generally amount to a threat—to a very different, and troubling, objective.

“You can grab an uncomfortable amount of information from someone’s device and the apps they use,” said Solis. “It’s unfortunate, but any woman who plans to visit an affected Planned Parenthood, or anyone who works for Planned Parenthood, should be afraid.”

When Ads Follow You Around

By now, most Americans have experienced the following phenomenon: You look at something online—a hotel, a flower delivery service, a course at a local college—and the next thing you know, ads for that thing follow you around the internet for the next week.

A watch you looked at now pops up next to your Facebook feed; an ad for a coffee machine you researched on Amazon now lurks on your favorite news sites. And maybe, after researching cars online, it seems that Toyota knows whenever you visit a lot, and sends ads to your phone as you walk through the dealership’s doors.

This is all part of the new landscape of digital advertising, where marketers can tailor their ads to very specific groups of consumers by compiling “personas” based on the thousands of shards of data we all create as we go about our activities online.

While theoretically anonymous, these marketing personas are surprisingly accurate. Marketers likely know your age, gender, occupation, education level, marital status, and—if you have GPS enabled on your phone and are logged into apps that track you—where you live, work, and travel.

What Flynn realized is that he could use the same technologies to infer that a woman might be seeking an abortion, and to target her for ads from anti-choice groups.

“We can reach every Planned Parenthood in the U.S.,” he wrote in a PowerPoint display sent to potential clients in February. The Powerpoint included a slide titled “Targets for Pro-Life,” in which Flynn said he could also reach abortion clinics, hospitals, doctors’ offices, colleges, and high schools in the United States and Canada, and then “[d]rill down to age and sex.”

“We can gather a tremendous amount of information from the [smartphone] ID,” he wrote. “Some of the break outs include: Gender, age, race, pet owners, Honda owners, online purchases and much more.”

Flynn explained that he would then use that data to send anti-choice ads to women “while they’re at the clinic.”

In his sales PowerPoint, Flynn said that he had already attempted to ping cellphones for RealOptions and Bethany nearly three million times, and had been able to steer thousands of women to their websites. The price tag for one of Copley’s campaigns, he said, was $8,000.

Flynn initially agreed to speak with Rewire for this story, but did not respond to multiple follow-up emails and phone calls. Much of this report is based on materials that he sent to people he believed to be potential clients. Numerous messages seeking comment from management for RealOptions went unanswered; Jennifer Gradnigo, a spokesperson for Bethany Christian Services, confirmed that they have used Copley’s services and “appreciate their ideas,” but declined to discuss specific campaigns.

Not everyone who received Flynn’s pitch emails was impressed. One recipient contacted Rewire after speaking with Flynn, and expressed horror at what Flynn told her he was able to do on behalf of anti-choice clients.

“I felt disgust, and I felt protective of these women who are going to seek sensitive medical services at a time when they’re vulnerable,” said the recipient, who is a social worker at a Northern California adoption agency. Rewire agreed to withhold her identity due to her fears of retaliation from anti-choice activists.

“They’re being spied on by this capitalist vulture who is literally trying to sell their fetuses,” she said. “To do this to women without consent is predatory and it’s an invasion of her privacy, and unethical.”

In emails and PowerPoint presentations sent in early March, Flynn claimed to have reached more than 800,000 18-to-24-year-old women on behalf of RealOptions, and to have sent more than 2,000 of those women to RealOption’s website.

Rewire obtained three examples of the ads that Flynn said he had sent to young women’s phones on RealOptions’ behalf.

The ads are typical of CPCs.

They ask, “Pregnant?” or “Abortion?” and then include statements like “It’s your choice. You have time… Be informed” and “Get the facts first.”

Like most CPCs, the claim that RealOptions provides “facts” about abortion is deceptive. While that language may lead women to believe they could obtain abortion care at RealOptions, in federal tax filings, the organization explains its mission as: “empowering and equipping women and men to choose life for their unborn children through the love of Jesus Christ in accordance with his word regarding the sanctity of human life.”

According to its website, RealOptions has received funding from the radical Christian group Focus on the Family. The organization was founded in 1981 by Marion and Tom Recine, fervent Christians who in a video posted to their website refer to the “many, many, many women who’ve come to Jesus because of the [RealOptions] centers.”

Flynn also says that he has targeted 140 abortion clinics on behalf of Bethany Christian Services over the past few months, and that 10,000 people clicked on the ads for Bethany that he sent to smartphones in those clinics, directing them to a “dedicated resource centers landing page.”

Bethany is the nation’s largest adoption agency, with assets of more than $45 million in 2014, according to the most recent available figures. The chain has faced accusations of pressuring birth moms to continue pregnancies against their will, of abandoning mothers who change their minds and decide not to go through with adoptions, and other abuses.

The social worker who received Flynn’s pitch deck told Rewire she was alarmed that Flynn had succeeded in reaching so many women on behalf of his anti-choice clients.

“He’s doing it and it’s working and it’s probably really impacting human trajectories,” she said. “It changes human lives to be funneled into a system like this.”

Advertising Is Now a System of Surveillance

Although it is now ubiquitous, mobile digital advertising is a relatively new phenomenon, only as old as the sophisticated smartphones on which it relies. As a result, laws and the regulators who enforce them are lagging behind when it comes to the many possible ways that bad actors can abuse smartphone advertising.

In terms of federal laws, many either don’t apply to Flynn’s conduct, or would allow it, according to Chris Hoofnagle, a professor at the University of California, Berkeley’s School of Law, and School of Information.

“Privacy law in the U.S. is technology- and context-dependent,” Hoofnagle said. “As an example, the medical information you relay to your physician is very highly protected, but if you go to a medical website and search for ‘HIV’ or ‘abortion,’ that information is not protected at all.”

In other words, it’s almost certain that the Health Insurance Portability and Accountability Act, known as HIPAA, would not apply.

The other limitations, such as they are, come from two sets of laws. The Federal Trade Commission (FTC) and state attorneys general can prevent advertisers from sending false and misleading ads; they can also stop advertisers from lying about what information they are tracking and what they plan to do with it once collected.

The FTC did not reply to Rewire’s questions in time for the publication of this story. However, the commission does not have jurisdiction over nonprofits, so it is highly unlikely that it could take action in this case.

The second set of laws concern user consent. Companies like Verizon and AT&T, known as carriers, are required to get affirmative consent before using “Customer Proprietary Network Information” gleaned through cellphone towers—including call records and location—for marketing. Apps don’t use network information, but rely instead on the GPS built into phones. They also need to obtain affirmative consent to collect and use information for marketing.

Obtaining that consent is easier than many consumers may think.

“The reality of this stuff is that no one’s asking what marketers will do with their information when they click, ‘I Agree,’ when an app asks if it can use their location,” Hoofnagle said. “If one consents to that tracking, and consents for it to be used for advertising purposes, that’s pretty much the end of the story.”

Certainly, most people wouldn’t imagine that by agreeing that, say, Yelp, Snapchat, Tinder, or the New York Times could use their location, that marketers could then use the same information for the very different purpose of figuring out whether they are seeking sensitive medical services.

Hoofnagle says that such use is perfectly legal, as long as companies don’t lie about what information they’re collecting—even if those disclosures are buried in fine print.

For his part, John Flynn is confident that his campaign is within legal bounds.

“I have worked with pharma, medical recruitment and many others where we mobile geo-fenced medical centers without a problem,” he wrote in an email to a potential client. “Bethany’s campaign targeted just medical centers and there was [sic] no issues. RealOptions in the San Jose area is presently targeting colleges and medical centers without issue.”

In the absence of robust legal limitations in the United States, advertisers have organized into self-regulatory bodies to police themselves, acutely conscious that examples of egregious privacy violations could spark a public backlash, and lead consumers to block ads and to opt out of targeted marketing.

Lindsay Hutter, a spokesperson from the Direct Marketing Association (DMA)—a New York-based group that represents direct marketers—said in an email statement to Rewire:

A key pillar of DMA’s work is to ensure that data-driven marketers conduct their work on an ethical basis, respecting the private information of consumers. This is particularly true for sensitive medical information about particular individuals, the use of which for marketing purposes without permission is against DMA’s Ethical Guidelines. Any location-based marketing should be opt-in, with the consumer notified that marketing offers are being presented due to their location.

Hutter did not provide a direct reply to our questions as to whether targeting women who might be seeking abortion care on behalf of anti-choice groups would be in violation of DMA’s guidelines.

It would, however, violate Facebook’s standards, according to Tom Channick, a company spokesperson.

“Our policies prohibit ads that make implications, directly or indirectly, about a user’s personal characteristics, including medical condition or pregnancy,” Channick said. “Deceptive or misleading advertisements are also prohibited.”

Flynn claims that he has a “relationship” with Facebook that allows him to “place mobile and digital ads in Facebook pages,” but Channick said the company could find no record of Flynn or his company ever using their platform.

Calling Flynn’s campaigns “really objectionable,” Hoofnagle said that these kinds of practices are toxic to the digital advertising industry, as well as the platforms—like Google and Facebook—that depend on advertising dollars.

He said this example drives home the fact that the nature of advertising has fundamentally transformed with the rise of the internet, and as smartphones have become ubiquitous.

“Advertising is a system of surveillance now,” Hoofnagle said. “It used to be billboards and television. Now it’s surveillance.”

Extremists Could Use Women’s Phones to Learn Their Names and Addresses

Surveillance has long played a central—and deadly—role in the efforts of anti-choice activists to intimidate women out of accessing abortion care, and to stop providers from making it available.

In the late 1990s, an anti-choice extremist created a website called the Nuremberg Files—in reference to Nazi Germany—which was a list of the names and addresses of doctors who provided abortions. Operation Rescue maintained a site called “Tiller Watch” that monitored the doctor’s whereabouts until he was murdered in the spring of 2009. Extremists have published “Wanted” signs with photographs of abortion providers. Activists in Texas stalk people entering local clinics, noting their physical appearance and license plates, hoping to determine which women went through with their abortion and whether anyone changed their mind, as well as to identify clinic workers. Many providers around the country report having been followed on their way to and from work.

Sasha Bruce, senior vice president of campaigns and strategy at NARAL Pro-Choice America, says that tagging the cellphones of women who go to abortion clinics falls within the pattern of intimidation.

“Intimidation frankly is the lowest threshold—that quickly turns to violence,” Bruce said. “That’s part of what’s troubling about this. There’s a real incitement that this information can contribute to.”

Bruce said she was alarmed in particular because Flynn was not just collecting information about what women looked at online, but also about their physical locations.

“If you have the smartphone ID, and then you can tie that to a location outside of the clinic, let’s say a home, that’s a real security threat,” Bruce told Rewire. “I worry about the extension of that—the desire of anti-choice activists to know who these staffers are, and who the women are.”

To be clear, there is no evidence to suggest that Flynn or his clients have or want to use geo-fencing to learn the real identities of women seeking abortion. But experts told Rewire that the potential for others to abuse the technology is a cause for alarm. In keeping with the view that transparency fosters security, Rewire has chosen to outline the ways this tracking could be misused.

In theory, when marketers gather information about individual smartphone users through methods like geo-location, that data is anonymized, meaning that it is not attached to a person’s name, but rather to a unique number known as an “advertising ID.” That is the number associated with the particular copy of the operating system that each of us has downloaded onto our smartphone. If you use a Google phone, your operating system is Android; for iPhone users, it’s your copy of iOS. Much of what you do on your phone can be associated with that advertising ID.

In most cases, marketers want to collect data from millions of potential customers, said John Deighton, a professor of marketing at Harvard Business School, in an interview with Rewire. The more data they have, the more ads they can send, which enhances their database.

“What your story is drawing to my attention is that these same surveillance technologies can be used at a much more micro scale,” he said. “You could imagine outright illegal use of geo-targeting: for example, geo-targeting a rich person’s house and getting an alert when they leave home.” That could, say, lead to high-tech burglary.

“Once you start realizing you can target desirable individuals, instead of being a big data function it becomes about tiny data,” Deighton said.

But if all of the data that marketers collect is supposed to be anonymized, how could bad actors—including anti-choice extremists—figure out the actual identities of the people they track?

The dirty secret of digital marketing is that it is in fact relatively easy to find out the real identities that are attached to our online IDs, according to experts who spoke with Rewire.

The most obvious way is simply to ask people for that information.

Both RealOptions and Bethany Christian Services require a person’s name and contact information in order to receive information online. Once a woman enters her name, email, home address, phone number, or ZIP code, that information is tied to her advertising ID, and Flynn could potentially marry that ID to all data associated with it and store it in what he calls his databank.

There are, however, plenty of less aboveboard methods to learn the name attached to an anonymous ID.

Any site or app that uses a profile with your name and any other information—Facebook, dating services, banking apps—can link your device, and your advertising ID, to the real you.

Legitimate services would not hand over personally identifying information willingly, but there are many instances of such information being made widely available. The cyber attack on Ashley Madison, the dating site for married people seeking extramarital partners, resulted in the release by hackers of the personal information of 32 million of the site’s users, revealing the potential for profile-based sites to be targeted.

Even without sophisticated hacks on established sites, bad actors can use techniques known as “social engineering” to learn the personal identities associated with advertising IDs.

For instance, if an anti-choice group wanted to learn the identity of women seeking abortions, instead of sending them ads for CPCs, they could send ads that seemed unrelated to abortion—for a competition to win $500, or for help with student loans—that tricked women into entering their names, email addresses, and any other information required by the form. Any woman who filled out the form would have unwittingly handed her name to anti-choice activists.

That would allow anti-choice groups to literally see women’s whereabouts in real time, said digital marketing experts who spoke with Rewire anonymously because they were not authorized to speak with the press. They described marketing software that allows them to see targeted individuals’ locations, the same way you can see yourself as a blue dot on a smartphone map. If certain people were seen at an abortion clinic regularly—say, during work hours—Flynn or his clients might even be able to infer that they work there.

“That’s what scares me about your story,” said Deighton. “Now we have an incentive to track people that isn’t the usual big data incentive.”

The question naturally arises: What can abortion providers and the women they serve do to fend off these digital affronts?

The simplest measure Planned Parenthood, or any other abortion provider, could take is to tell patients to leave their smartphones at home or in the car. If that isn’t possible or practical, the best advice is to turn off their GPS and log out of all apps before they come to a clinic.

It’s a simple step, but one that many people either won’t or don’t take, said Cooper Quintin, a technologist at the Electronic Frontier Foundation (EFF), a San Francisco-based organization dedicated to preserving fundamental rights in the age of technology.

“The way we need to fight back against this is by blocking these things that are tracking who we are and where we are and what things we’re looking at,” Quintin told Rewire. EFF considers location-based tracking to be a serious threat to privacy.

“Right now, there’s this big ideological debate about ad-blocking. What’s missing from that debate is the idea of blocking things that are tracking you. Tracking people and building up these databases of what they read online, where they go in the real world, linking their online behaviors to their offline purchases and real world behavior—these things can have real-world effects, and this is a horrific example of how this can affect people in a way that’s much more important than seeing some annoying or creepy ads that follow you around.”

Editor’s Note: Watch our video for info on how to avoid location-based tracking.

This is the second article in a two-part series on the effect Rep. Marsha Blackburn’s Select Investigative Panel on Infant Lives is having on the research community. You can read the first piece in the series here.

The anti-choice front group that triggered Rep. Marsha Blackburn (R-TN)’s investigation into widely discredited allegations of fetal tissue trafficking first revealed the identities of researchers who have used fetal tissue in their work more than a year ago.

In May 2015, the Center for Medical Progress (CMP) published unredacted documents naming the researchers that are identical to those used by the so-called Select Investigative Panel on Infant Lives, according to a publicly available online directory discovered by Rewire. In June 2016, CMP added to its database unredacted Planned Parenthood contracts, which appeared verbatim among the documents that Blackburn sent over to the Obama administration as part of her request for a federal abortion inquiry.

CMP’s heavily edited videos alleging that Planned Parenthood profited from fetal tissue donations led to three congressional investigations that yielded no evidence of wrongdoing and the creation of the current panel, seemingly intent on proving otherwise. David Daleiden, the group’s leader, remains under criminal indictment in Texas for fraud in connection with his production and release of the videos. This month, Arizona became the 13th state to find no substance to his allegations.

One of the at least 14 researchers named in the documents agreed to an interview with Rewire, some of which appeared in part one of this series, on the condition of anonymity. The researcher wasn’t aware that such a prominent anti-choice group had previously revealed the names and contact information for individuals typically found in laboratories, not abortion clinics. Neither did Eugene Gu, a second researcher that spoke with Rewire on the record. The select panel subpoenaed Gu’s company, Ganogen, Inc., in March.

Gu said that by releasing the names and delaying the redactions, Republicans on the U.S. House of Representatives select panel allowed anti-choice groups to get their hands on the researchers’ personal and professional information. The documents were available online for two days before the belated redactions. Links to the unredacted documents sent to reporters remained live for at least five days.

“I was actually hoping that they corrected it fast enough that it wouldn’t be re-circulated, but I guess that was just wishful thinking,” Gu said.

Relationship Raises Eyebrows on Capitol Hill

Gu didn’t realize that CMP had circulated the researchers’ names in 2015. No matter which came first, the underlying fact remains the same: CMP and Blackburn are using many of the same documents to try and prove the existence of fetal tissue trafficking.

Reports have previously linked the two: Media Matters for America reported that Blackburn’s exhibits at the panel’s April hearing on fetal tissue “pricing” closely mirrored those in the CMP attack videos. Screens showing select images from the same exhibits flanked Blackburn as she delivered a conservative call to action against “baby body parts” in June at the faith-based Road to Majority conference.

The connection, at a minimum, raises a chicken-or-egg scenario. Is CMP feeding information to Blackburn, is it the other way around—or is it a combination of the two?

Congressional Democrats have few doubts that it’s all of the above.

“That relationship is clearly very close,” Rep. Jan Schakowsky (D-IL), the panel’s ranking member, said in an interview with Rewire. “It certainly appears that the Republicans may be receiving documents and information directly from Daleiden or someone associated with him.”

Democrats on the panel have called on Blackburn to reevaluate the alleged relationship among repeated caucus-wide pleas to House Speaker Paul Ryan (R-WI) to shut down the investigation.

StemExpress, the tissue procurement company targeted in the CMP videos, raised the same objections over Blackburn’s exhibits for the hearing looking into the allegations of fetal tissue “pricing.”

“While some of these illegally obtained documents are posted to the CMP website, some of the Majority’s exhibits have never appeared publicly, suggesting that perhaps the Select Panel may be receiving so-called ‘evidence’ directly from Mr. Daleiden and/or his associates,” the company’s counsel wrote in a letter to the select panel.

Blackburn’s select panel did not respond for comment by publication time.

Researchers’ Ethics Counter Blackburn’s Allegations

Researchers’ concerns extend beyond their personal well-being to the chilling effect of the select panel’s investigation on scientific advancements. Blackburn has downplayed the importance of fetal tissue in research, which is legal and heavily regulated, amid other misconceptions about the ethics of “baby body parts.”

Fetal tissue research plays an important role in understanding the causes of diseases, particularly Zika and others that strike in utero, according to the researcher. Such research could also lead to major developments in the area of regenerative medicine, potentially replacing lost neurons as a result of Parkinson’s disease and spinal cord injuries.

The researcher that requested anonymity sought to correct the record on Blackburn’s assertions about the processes governing such research.

“It’s important for the public to understand the way research works,” the researcher said. Biologists “will do absolutely everything that they can” in the initial stages to use human cultured cells or animal models, turning to fetal tissue specimens only for final, confirmatory experiments. The researcher described a multistep process that involved senior-level reviews to determine whether experiments had advanced to that stage and, if so, establish reputable sources from which to place orders.

“I would want to reassure people who don’t support the use of fetal tissue for research that researchers take the weight of the responsibility of using this material very seriously,” the researcher said. The research community approaches fetal tissue “with the utmost respect” and reserves use “for the most important experiments when there is no other possible scientifically valid way to address the question that needs to be addressed.”

Frustrations, Fears Run High Amid Slowing Research

Gu echoed similar ethical considerations in his use of fetal tissue. Through Ganogen, he’s set an ambitious goal: End the organ donor shortage, starting with pediatric patients, by growing human fetal organs in animals. He credits fetal tissue with the potential to greatly accelerate the clinical trial process.

“There’s no alternative to having human tissue, and this is human tissue that would be incinerated and thrown away. We’re not encouraging abortions in any shape or form,” Gu said. “A transplant surgeon doesn’t encourage traffic fatalities so they have organs to transplant into their patients.”

The research community, nevertheless, is suffering as a direct result of the investigation and the anti-choice sentiment fueling it. The New York Times reported a downturn in the availability of fetal tissue for research and the willingness of institutions to proceed with what remains. One neurologist delayed his multiple sclerosis research until 2019, according to the Washington Post.

Separately, the reproductive health-care community is facing its own set of consequences—in the form of unprecedented violence that researchers fear could head their way and ultimately, dissuade them from participating in fetal tissue research.

The researcher that requested anonymity recognized the cessation of research as the investigation’s “intended,” if misguided, goal.

“To my mind, it doesn’t help the overall cause of improving humanity by curing disease, and finding new remedies for conditions that plague all of us, to intimidate researchers in this way, especially in an instance like this where it is not the researchers themselves that are accused of doing anything wrong,” the researcher said.

The way Gu sees it, the select panel isn’t just putting his own life, and research, at risk. It’s endangering widespread medical advancements. And it’s frustrating for him.

“That’s why we went to medical school in the first place—to help patients, not to be subpoenaed by Congress,” Gu said.

“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.

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.”