When Mia T. first arrived at Pittsburgh’s Allegheny County Jail in May 2016, she suspected she was pregnant, but wasn’t sure. During the jail’s two-day intake process, she asked for a pregnancy test. She was given one, but no one told her the results until she was about to walk to her assigned pod, or housing unit. “They told me, ‘Put your bed roll down. You’re going to the hospital,'” she told Rewire.

Jail staff handcuffed her and drove her to the hospital, where a second test confirmed her pregnancy. She was kept overnight, she says, with her feet shackled the entire time. “It was hard to sleep, it was so uncomfortable,” recalled Mia, who asked that Rewire not use her last name.

That was only the first of many uncomfortable nights. As Mia recounts, she had brought the prescribed medications she’d been taking for seizures, depression, and bipolar disorder. Jail rules prohibit people from keeping their medication on their person, but no one one at the institution noticed that she had the pills until she attempted to give them to an officer. She was charged with possession of contraband and placed on Disciplinary Housing Unit (DHU) status, where she was locked alone in a cell for seven days pending a hearing. She says that she was only allowed to shower twice during that time.

In addition, she says, was not given the meals designated for pregnant women, a problem that was to occur repeatedly during the following six months. According to Mia, when a pregnant woman is moved from one housing unit to another, her designated meals don’t automatically follow. “They’re always two weeks behind,” she remembered. After seven days, she was finally granted a hearing; since the pills were her own prescription medications, she was released from DHU.

Now out of jail, Mia is one of five plaintiffs in a class-action lawsuit on behalf of pregnant and postpartum women held at the Allegheny County Jail in Pennsylvania. The suit was filed on Monday, December 19, by the Abolitionist Law Center, the Pennsylvania Institutional Law Project, the ACLU of Pennsylvania and the Reed Smith Centre, and charges the jail with the “cruel, unusual and inhumane practice” of placing pregnant women in solitary confinement. Given that as many as 81 percent of the jail’s population are held while awaiting trial and have not been convicted, the suit also charges that placing women in solitary without a hearing to determine whether they’ve broken a rule violates their right to due process under the 14th Amendment. Finally, it charges that the jail provides an inadequate diet, inadequate nutrition, and inadequate nutritional supplements for pregnant women in custody.

The lawsuit seeks to prohibit the placement of pregnant women in isolation as well as to have the jail institute meaningful and enforceable safeguards to protect the health of pregnant women, provide nutritious pregnancy meals, and hold hearings before enforcing punishments such as solitary confinement. Though the suit only encompasses pregnant and postpartum women at the jail now or in the future, Bret Grote, the legal director of the Abolitionist Law Center and one of the attorneys representing the plaintiffs, noted to Rewire that the solitary confinement aspect “would have ramifications throughout the entire jail.”

The Allegheny County Jail holds more than 2,200 people. In October of this year, 34 were pregnant. That number was sufficient to be of concern to the Allegheny County Jail Oversight Board, which conducted an unannounced inspection that month. In its subsequent report, board members noted their “continued concern that too many pregnant women are being housed in the jail as opposed to alternative facilities.” They did not, however, recommend alternatives or note the punishment policy for pregnant women.

According to Grote, four of the suit’s plaintiffs were placed in DHU for periods of time varying from six to 22 days.

Mia, for example, was placed in isolation three more times before her release from jail. The second time, she spent 22 days locked in her cell for drug allegations while jail officials investigated whether she had actually broken a rule.

According to Mia, she had two showers during that time; she was also not given her pregnancy meals. To make matters worse, she didn’t know how long she’d remain in DHU. “I felt like I was going to be in there forever,” she recalled. She filed a grievance (or complaint) with the warden, informing him that she’d voluntarily taken a drug test that had come up negative, she was in solitary without a hearing, and that she was experiencing serious psychological stress, pain, and anxiety. She asked if she could at least be permitted to sit in the jail’s gym for a while. “I’m closterphobic [sic] and it’s getting to me,” she wrote.

The reply was scribbled at the bottom of the form: “If this is a problem don’t come to jail.”

In November, Mia was placed in isolation a third time after an officer noticed that she had three pairs of shoes as well as her engagement ring, which staff had not taken from her upon arrival. Jail rules allow detainees to have only one pair of shoes; Mia says it’s fairly common for anyone who has been at the jail for any length of time to wind up with more. Pregnancy had made her feet swell, leaving her unable to fit into the shoes she had worn when arrested. Someone gave her another pair that fit. Then, when her cellmate was transferred to prison, she left Mia her pair. The officer confiscated two pairs of shoes and the engagement ring, then placed Mia in DHU. As the complaint notes, “individuals on solitary confinement status may share a cell with another individual on solitary confinement status due to space constraints.” This time, Mia had a roommate during her 24-hour lockdown. The other woman was also pregnant and, since both women had been assigned to the lower bunk, Mia was forced to sleep on a mattress on the floor.

Mia recalls that the one hour of recreation was offered between 11 p.m. and 3 a.m., an offer that she found absurd. “Who wants to be in the gym by themselves in the middle of the night?” she said. She spent 11 days in DHU; once again, she says, she did not receive pregnancy meals.

The dangers of extreme isolation have been well documented. The risks include a plethora of mental health problems, including anxiety, panic, insomnia, paranoia, aggression, and depression. Dr. Carolyn Sufrin, an OB-GYN who has worked with incarcerated women for a decade, notes that incarcerated women have higher rates of mental illness than women who are not incarcerated as well as incarcerated men. “Placing them in solitary confinement makes these conditions worse,” she told Rewire.

Being locked into a cell nearly 24 hours a day also heightens physical and mental health risks for pregnant women. Sufrin noted that incarceration during pregnancy can be a stressful and isolating experience, which is worsened by solitary. Furthermore, engaging in moderate exercise is important to ensure adequate blood flow to the placenta and fetus. Being locked in a cell 23 to 24 hours each day strips a woman of the ability to exercise, increasing the risk of developing deep vein thrombosis or blood clots in the veins. “Pregnant women are at increased risk of blood clots, so forcing them to be immobilized can increase that risk,” she explained. Conversely, moving around can lessen the likelihood of blood clots forming.

Sufrin also noted concerns that appropriate and timely medical care is not easily accessed in isolation. For instance, vaginal bleeding during pregnancy may be a sign of preterm labor or labor and must be immediately evaluated by medical staff. But people locked in their cells may not be able to quickly flag the attention of jail staff.

The United Nation Rules for the Treatment of Women Prisoners and Non-Custodial Measures for Women Offenders, popularly known as the Bangkok Rules, recommend that pregnant and postpartum women not be placed in isolation, especially given their susceptibility to isolation’s harmful psychological effects. So does the National Commission on Correctional Health Care and the U.S. Department of Justice.

Even out of isolation, say the plaintiffs, jail conditions in Allegheny are far from optimal for a healthy pregnancy. According to the suit, when those behind bars do receive “pregnancy meals,” they consist of two slices of bread, a thin hamburger with no toppings, less than half a cup of canned fruit, less than half a cup of canned vegetables, and a half pint of milk. Another meal might be sausage, less than half a cup of canned fruit, lettuce and no other vegetables. “Each meal is supposed to have portions essentially identical to this,” says the suit.

Medical experts note that fruits and vegetables are a crucial component of prenatal nutrition, recommending at least three servings of fresh fruits and vegetables each day. But, despite repeated requests, Mia doesn’t recall receiving fresh fruit for the first four months. Not until she was six months pregnant did that change: One afternoon, mandarins were on her lunch tray.

Still, Mia recounts constantly being hungry. She’s not alone. During its surprise inspection, Jail Oversight Board members noted that pregnant women had concerns about food and were requesting more fruits, vegetables, and whole grains. Though the jail provides a pregnancy snack at night, usually a peanut butter and jelly or egg salad sandwich, Grote said that every pregnant woman he talked with told him the same. “The women say they’re hungry all the time,” he told Rewire. “They all have to supplement their meals with [foods from] commissary,” or jail store. But, he points out, women must have money in order to buy from the commissary. And those who are confined within the infirmary—either for medical or punitive reasons—or DHU are not allowed to order from the commissary or to take their already-purchased items with them.

The scarcity of nutrient-rich food can be supplemented by vitamins. The jail gives pregnant women four different pills—a multivitamin and supplements for folic acid, iron, and calcium. But, both Mia and Grote told Rewire, at times the jail would run out. Then, women would have to wait until the following Thursday, the one day that the OB-GYN was at the jail, for a new prescription.

When asked about the allegations in the complaint, the warden’s office at the Allegheny County Jail referred Rewire to Amie M. Downs, the county’s director of communications. While the county does not comment on lawsuits, Downs sent the jail’s current policy, which states, “Pregnant inmates that commit minor infractions will receive an informal resolution or misconduct, but may only be segregated from the general population following clearance from medical personnel.”

Women with more serious rule violations—such as hiding pills in their cheeks rather than swallowing them, fighting, and possessing serious contraband like drugs—are transferred to the infirmary.

In addition to not being able to order from the commissary, jail policy prohibits people in DHU or the infirmary from using the telephone or receiving visits. Downs also said the policy includes a recreation plan to ensure adequate out-of-cell time.

The jail is currently not accredited by the National Commission for Correctional Health Care, which sets the standards for health care in jails, prisons, and juvenile detention facilities, and which recommends that pregnant women be excluded from solitary confinement for any length of time.

For her part, Mia says the only time she was placed in the infirmary was during the first week of what became her 22-day DHU status: She was given a urine test and, a week later, returned to her cell, where she spent another two weeks locked in without access to her belongings or commissary. She questions how she could have been medically cleared for segregation, noting that she did not see medical staff before being isolated or, with the exception of the weekly OB-GYN visits, during her time in DHU.

Mia spent the last two days of her stay at Allegheny in DHU a fourth time, for passing a book to another woman. Now out of jail and preparing for the birth of her baby, Mia is determined not to allow the jail to continue the practices she experienced. “The treatment I had, no one deserves to go through it,” she reflected. “Whatever I can do, I will do.”