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Motherhood in Captivity: Investigating Ambiguity in Carceral Institutions

How does the ambiguity of jailcare, or healthcare in jail, affect everyday interactions in carceral institutions? Despite seeming like a strictly punitive institution at first glance, jail is an integral part of the safety net for many women. Jailcare is ambiguous, as it exists at the crux of the punitive, correctional nature of jail and empathetic nature of healthcare. In her “ethnography of the obvious”, Carolyn Sufrin explores the inherent ambiguity and tensions present in jailcare (Sufrin 2017, 33). Through her unique perspective as both an anthropologist and obstetrician in the San Francisco Jail, Sufrin examines the ambiguity between deservingness and necessity of care that emerges when care is administered in a primarily punitive institution. She contextualizes her position as an anthropologist and obstetrician, mentioning how she found it difficult to separate her roles as she conducted fieldwork (Sufrin 2017, 234). Sufrin assumes a perspective as a figure who administers care while simultaneously having the authority to scold or punish a patient-prisoner. Her investigation of ambiguity in jailcare extends beyond her own lens to those of female patient-prisoners, courts, jail nurses, guards, and other jail clinicians. In this review, I will summarize and critically analyze Jailcare: Finding the Safety Net for Women Behind Bars by Carolyn Sufrin.

In her fieldwork, Sufrin analyzes the fundamental ambiguity of jailcare through patient-prisoners’ poignant anecdotes of health, addiction, recidivism, intergenerational trauma, and pregnancy, bringing readers to forge a connection with those women. This connection emboldens readers to question the United States’ current status quo of mass incarceration, a diminishing safety net, alarming rates of recidivism, and intergenerational patterns of structural inequality that plague communities. Despite engaging in thorough fieldwork and conveying a detailed analysis of ambiguity and deservingness in jailcare, Sufrin leaves readers searching for the answers to mend our broken criminal justice system.

Jailcare is organized into two main parts. Part I contextualizes the carceral system’s position at the crossroads of structural inequality, mass incarceration, and care. Sufrin coins the term “jailcare”, which she defines as “the disturbing entanglement of carcerality and care” (Sufrin 2017, 6). These explanations remain integral to understanding the rest of the ethnography. Part I focuses on everyday interactions between patient-prisoners and authority figures such as guards, clinicians, and nurses. In Part I, Sufrin approaches the ambiguity of jailcare through an interpretive anthropological approach, analyzing rituals and daily interactions in jail. Part II, in contrast, centers around pregnancy in jail specifically. She analyzes the liminal state of pregnancy and gestation, amplified by the ambiguity of jailcare itself. She delves into the hypermedicalization of pregnancy, enforced intimacy, and jail as a safe space for women without access to consistent healthcare.

Jailcare’s organization caters to an audience with minimal knowledge on the current status quo of our criminal justice system. Sufrin builds from the bottom-up, explaining recidivism, mass incarceration, deservingness of care, and other common themes of the system. These factors contextualize the lives of incarcerated women, as well as the reason jailcare is so ambiguous in the first place. Next, she chronologically explores the daily schedule in jail, with a focus on ambiguous interactions and rituals. She develops readers’ familiarity with the structure and everyday dynamics of jailcare. Sufrin hones in on pregnant women in Part II. The inherent liminal nature of gestation and pregnancy magnifies her claim that jailcare is fundamentally ambiguous in nature. With this particular organization, Sufrin ensures her readers understand her claims despite the complexity of the criminal justice system, which has heavily impacted the women in her fieldwork, who are integral to her analysis of ambiguity in jailcare.

Sufrin uses anecdotal evidence, interpretive anthropology, interviews, policy descriptions, personal experience, and thorough fieldwork to support her claims. Part I’s interpretive anthropological approach suggests she expects her readers to understand basic anthropology. This first part describes ambiguous rituals of care within daily life in jail. Sufrin points to daily dilemmas such as “everyday ethics”, in which jail nurses’ ideals are constantly questioned and articulated through reflections on their patient interactions. Despite brief moments of reflection following patient interactions, which engender ambivalence, nurses fall back into their rituals of care. Rituals serve as the foundations of her discussion of jailcare, so she assumes readers understand them (Sufrin 2017, 82). Furthermore, Sufrin uses terms such as “liminal” to describe pregnancy as an ambiguous state (Sufrin 2017, 131). From an anthropological viewpoint, liminality describes a transitional period. In order to fully understand this liminal state, one must understand this anthropological background of the term. Another example of Sufrin’s expectation that readers have a basic anthropological understanding is the way she describes hypermedicalization. Rather than explaining the concept of medicalization, she delves right into the meaning and reasons behind the hypermedicalization of pregnancy in everyday life.

An aspect of Jailcare that frustrates me is repetition. Although some repetition strengthens connections between concepts throughout the book, Sufrin often reiterates points without bringing in fresh perspectives. For example, she mentions “the familiarity that can be engendered in jail” due to the “flow of bodies between jail and the community” several times throughout the book in great detail (Sufrin 2017, 17). Oftentimes, she alludes to this using the same perspectives and examples. With access to so many different viewpoints such as female patient-prisoners, guards, policy-makers, and jail medical workers, Sufrin has the opportunity to introduce new insights through repetition. Chapter after chapter, the repetition made me feel as though I had traveled back to a part I had already read. She could have instead included more contextual information regarding the safety net and justice system and their effect on jailcare.

Sufrin’s on-and-off references to courts, policies, and Medicaid assumes readers to have prior knowledge about the safety net. As someone whose knowledge on jailcare policies and Medicaid is relatively basic, I found her claims on the topic difficult to understand. For example, she claims “San Francisco’s jailcare can be found not only in the ambivalent relationships of care inside the jail, but also at the policy level”, but she does not explain how Medicaid and other safety net programs specifically work. Readers like me are left wondering which medical services courts deem “necessary” for patient-prisoners. What quality of care do they “deserve”? Further details about jailcare policies would qualify readers’ understanding of the relationship between patient-prisoners’ “deservingness” and policy-dependent necessity of care. Despite these disappointments, Sufrin is thought-provoking and humanizing in her investigation.

Sufrin maintains a non-judgemental tone when discussing her patients’ choices, assuming her role as an objective physician-anthropologist in her analysis. Even while describing the frustrating, hopeless event of finding her pregnant patient homeless and high, she maintains a relatively objective, analytical tone. Besides mentioning that finding her patient in that state was “hard” and made her feel disappointed, angry, and concerned, she “[contextualizes] behaviors understood to be unhealthy within the larger structural forces of inequality that created conditions for pregnant women’s addictions” (Sufrin 2017, 234). I find this perspective-taking incredibly impressive. Sufrin descriptively analyzes the systemic factors that put her patients into that position, rather than placing the blame entirely on her patients.

Jailcare was eye-opening. Mass incarceration is a term we hear so often now. Previously, I had understood the gravity of this issue in the context of numbers and statistics to back up my high school debate cases in order to win against my opponents. I had almost been desensitized to what mass incarceration and the failing safety net in our country truly mean in real people’s lives. In Jailcare, Sufrin effectively and poignantly contextualizes what mass incarceration means in terms of intergenerational addiction and recidivism, gaping holes in our country’s safety net, questions of “deservingness” in healthcare, and the effects of our broken system on the lives of real women in the real world. Her personal recounting of experiences with patient-prisoners humanizes the women, presenting them in the ambivalent light of the term “patient-prisoner”. Despite now better understanding the importance of “jailcare”, I find myself questioning why jailcare even needs to close the gaps in our safety net. Why is lowering recidivism rates not a priority? Why are the holes in our safety net getting larger? Should we not be progressively stitching them together as years pass? Though the repetitive nature of Jailcare frustrated me, it occurred to me that the reason Sufrin may have repeated certain ideas such as relapsing, recidivism, and “deservingness” of care so many times is because she felt as though she herself had to circle back to these ideas as her patients kept falling into the same cycles. I recommend Jailcare to anyone interested in learning about women’s health, structural inequality, mass incarceration, and the nature of care.

Carolyn Sufrin’s thorough and humanizing “ethnography of the obvious” comes at a time when the entire country actively questions our gendered and deeply racially encoded criminal justice system (Sufrin 2017, 235). Jailcare opened my eyes to these issues and furthered my understanding of the fundamental ambivalence of jailcare and its roots in deservingness, race politics, and everyday jail interactions.

Sufrin, Carolyn. 2017. Jailcare: Finding the Safety Net for Women Behind Bars. Oakland, CA: University of California Press.

Hi! My name is Sravani Sunkara, and I am a freshman at Michigan State University studying human biology and bioethics. In my free time, I run, bake, hammock, and volunteer as a junior EMT at my local rescue station.
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