The Reproductive and Carceral Politics of Ambiguity

Jailcare: Finding the Safety Net for Women behind Bars

Carolyn Sufrin

University of California Press, 2017, 311 pages.


Jailcare sheds light on a dark place. The ethnography exposes how care emerges and is nurtured in spaces, like jail, that are not intuitively caring. Sufrin develops the concept of jailcare as a way to understand how jail, a violent and disciplinary space, can in fact offer complicated forms of care. The book draws on feminist and anthropological theories to develop a distinct and slightly unsettling concept of care. Jailcareis unsettling because it is inherently ambiguous and ambivalent (p.35); it is not either/or, but rather both/and. As a book, Jailcare embodies the idea that the world is not just good or bad, black or white, caring or not caring, but instead complexly ambiguous. This might seem like an obvious starting point for an anthropological analysis, but the book investigates the ambiguity of jailcare from a rare perspective. As both a medical doctor at the jail clinic and an anthropologist doing fieldwork, the author brings the reader across the boundaries of the carceral walls and into confidential spaces like staff meetings with guards, deputies, and nurses, and clinical encounters with pregnant inmates; spaces which no other anthropologists has had the position or access to explore.

The book is not an easy critique of structures or institutions, nor is it an exotification of individual and marginalized experiences. Loyal to the ambiguity of jailcare,the book portrays the guards, clinicians, and inmates in an indefinite light. There are no overdetermined statements about the agents and systems. For instance, the staff, guards, and deputies’ attitudes towards the inmates can be both violent and caring; the pregnant women who suffer from addiction can be both prisoners and caring mothers; Sufrin’s own role as a medical doctor can be both authoritative and compassionate; and, the carceral system can be both the materialization of racist, political, and economic inequalities and a social safety net.

To understand this dynamic of both/and, or as Sufrin describes it the “ambiguity of jailcare” (p.24), each chapter examines different aspects of jail and women’s experiences in jail.

The book is organized into two distinct parts. Part One is composed of four chapters that explore the historical, bureaucratic, and institutional apparatuses of jail and mass incarceration. Part Two also has four chapters that examine pregnancy and motherhood in jail. The author gestures towards the ethnographic narratives of women’s experiences in the first part, which then get taken up in more depth in the second part, thus providing a connective tissue throughout the book. Each part employs different anthropological analyses. Whereas part one examines technologies of bureaucracies and cultures of institutions (Gordillo 2006; Das 2004; Riles 2001), part two draws from a rich feminist tradition of storytelling through the narratives of women’s lives (Knight 2015; Rapp 2001).

For instance, Chapter Three analyzes the specific forms that document and organize inmates’ medical needs, desires, and refusals of care. Sufrin insightfully notes that the ways in which “patient-prisoners and nurses engaged with MCRs [Medical Care Requests] made the forms a nexus of the desire to be cared for and the state’s carceral burden to care” (p. 90). The analysis of the forms represents the ambiguous ways in which care manifests. This approach brings nuance to understanding the form as not just a technical medical apparatus, but also a materio-semiotic representation of jailcare. Chapter Four also brings a unique perspective to the ambiguity of jailcare by exploring the twenty-four-hour routine of the jail from the perspectives of the guards, nurses, and clinicians. The clinic routine intersects with guards and prisoners’ schedules. Tracing this routine reveals moments of contact and mundane conversations that illuminate contradictions of care. Sufrin finds that the technical and routine practices of the jail are not only bureaucratic but they also offer up forms of intimate care. She argues that “they allow an ethos of compassionate care not to contradict an ethos of punitive discipline, but to form within it” (p. 116).

The second part of the book narrates women’s experiences of being pregnant and cared for by Sufrin and the rest of the medical staff at the San Francisco jail. Chapter Five examines the contradictions of being pregnant and in jail by highlighting how some judges frame pregnant, poor, and addicted women as “safer” in jail, while other guards and deputies state that jail is “no place for a pregnant woman” (p. 121). The contradictions continue to unfold as Sufrin traces different women’s experiences and treatments, like the woman who had a miscarriage and received empathetic gestures from the guards. The chapter also explores the conundrum of handcuffing pregnant women’s hands and feet while they walk, which some guards thought was routine and others thought was dangerous. At the core of jailcare is the issue of who or what the state is obligated to take care of – the woman, the fetus, and/or both?

Whereas Chapter 5 focuses on what it means to be pregnant and in jail, Chapter Six, focuses on how jail shapes motherhood. Kima is one of Sufrin’s patients and an incarcerated women who agreed to participate in the ethnography. Through Kima’s experience of giving birth in jail, the reader is exposed to the intimate ways in which high rates of recidivism and addiction are connected to the desire for redemption and rescue, all of which are facilitated by and through the carceral process. In jail, women are able to connect with the identity of being a mother without actually having custody, access, or contact with their children. Tracing Kima’s story of getting out of jail after she had her baby, but then returning a few months later, and losing custody of her child reflects how the lack of a social safety net makes jail the only place for women like Kima to reset, recalibrate, and try again.

Chapters 7 and 8 are compelling illustrations of different contradictions and ambiguities related to custody, intimacy, and home. In Chapter seven, Sufrin examines the concept of custody as a goal, and a process that anchors the ambiguity of jailcare. Custody, as Sufrin explains, can be disciplinary, punitive, and it can mean safety and medical care. Drawing from Foucault, Sufrin shows how jailcare is a form of pastoral care that both watches over and protects inmates, and also controls their bodies and behaviors. The author argues that jailcare is a conceptual link across pastoral care and the multiple facets of carceral custody.

In Chapter Eight, the author slightly diverges from the well-developed framework of jailcare, to conceptualize jail as home for the inmates. Drawing from Heiddeger’s concept of dwelling, Sufrin shows how jail acts as a home, refuge, or in the words of the inmates and guards, a place to “refuel.” This is evidenced by Kima, who states “we actually live here and survive out there” (p. 222). Framing jail as home reveals a different motivation and rational for the high rates of recidivism that stands apart from conservative or traditional explanations. From Sufrin’s analysis, recidivism appears like a reasonable choice. Inmates who return are not always or only “irrational” in their behavior, nor are they predisposed biologically to repeat offenses (as some scientific studies suggest). Jailcare shows how the decision to violate parole is about finding refuge from the streets. Poor women of color who are exposed to intergenerational violence find care in punitive and violent spaces like jail. Recidivism from this perspective is not so much about behaving within the law or not, but rather, a question of which violent space, either the streets or jail, is tolerable and livable.

A strength of the book is the intersubjective, material, and experiential analysis of the key organizing concept of jailcare. In addition, Sufrin shows us the value of ethnography and how it is a tool for understanding the disturbing reality that jail has come to supplement the lack of a reliable safety net. The ethnography balances the structural and individual dynamics to make the case that power relations are not unilateral, but complexly ambiguous. The book is relevant to graduate students and professors in the anthropologies of biomedicine, reproduction, and institutions. Selections of the book could also be used to teach undergraduate classes on the politics of reproduction and ethnographic methods.

However, I also found that the book missed the opportunity to engage substantially with the reproductive justice (RJ) framework, and affect theory as it relates to emotional labor. Sufrin references the reproductive justice framework superficially but could have explored the intersections of jailcare with RJ more thoroughly. For instance, what kinds of ambiguities overlap across RJ and jailcare? What are productive ways to think with reproductive justice and mass incarceration? I also wondered what the limits of jailcare are in relation to emotional labor. For instance, how do the guards, clinicians, and inmates emotionally sustain the unresolvable ambiguity of jailcare?  Put another way, what are the limits of co-producing care in a disciplinary and violent context? Is jailcare inexhaustible? Thinking across jailcare and emotional labor, might have provided an interesting space to explore politics of affect, with long standing feminist concerns of labor, that engage not just individuals but also institutions.

Nevertheless, with eight substantial chapters that draw heavily from ethnographic analysis, the book is an ambitious and laborious undertaking; one that required a long-term commitment to building and maintaining relationships. One of Sufrin’s patients and key figures in the book even named her child after the author. Sufrin worked at the jail for over five years before starting her fieldwork. This kind of dedication and training is difficult to reproduce – especially in an economic and political climate set on dismantling not only the social safety net but also higher education as an institution. The time and labor invested into developing and executing Jailcare might not be feasible for current and future anthropologists.

To conclude, Sufrin makes clear the political stakes involved in addressing mass incarceration in the US. As others have noted mass incarceration is challenging to resolve because it is perpetuated and entangled with racism and wealth inequalities (Institute for Policy Studies 2015). Being pregnant and in jail represents the intergenerational perpetuation of mass incarceration that disproportionately affects families and communities of color.   The book ends with a sobering critique of the new administration’s social, judicial, and economic policies and its potential effects on mass incarceration. Readers might be disheartened, or they might draw inspiration from the key argument of the book – care can emerge in the most unlikely spaces.


Natali Valdez is an Assistant Professor in the Department of Women’s and Gender Studies at Wellesley College. Her book project, Weighing the Future, ethnographically explores the clinical translation of epigenetics in and through pregnant bodies. Valdez has recently published on the environment of epigenetics in prenatal interventions in Medical Anthropology Quarterly.  Her work lies at the intersection of medical anthropology, reproductive anthropology, and feminist science and technology studies.


Works Cited

Das, Veena.  2004. “The signature of the State: The Paradox of Illegibility.” In Anthropology in the Margins of the State, ed. Veena Das, and Deborah Poole. Santa Fe: School of American Research.

Gordillio, Gaston 2006. “The Crucible of Citizenship: ID-paper Fetishism in the Argentinean Chaco.” American Ethnologist 33 (2):162-76.

Knight, Kelly. 2015. Addicted. pregnant.poor. Durham, NC: Duke University Press.

Karen Dolan and Jodi L.Carr. 2015. The Poor Get Prison. Institute for Policy Studies.

Riles, Annalise, ed. 2001. Documents: Artifacts of Modern Knowledge. Ann Arbor: University of Michigan Press.

Rapp, Rayna. 2001. “Gender, Body, Biomedicine: How Some Feminist Concerns Dragged Reproduction to the Center of Social Theory.” Medical Anthropology Quarterly 15(4):466-77.