Have you experienced or witnessed issues related to pregnancy or any medical care in a Texas county jail? Send tips to reporter Alex Nguyen at alex.nguyen@texastribune.org or via a message on Signal at @alexnguyen.23.
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In May 2018, Ruby McPeters was eight months pregnant when she was booked into Hood County jail on a probation violation. Just a month later, the 33-year-old North Texas woman was dead.
According to her custodial death report, McPeters was sent back to jail after delivering her baby by C-section at a local hospital. But the jail had to again transport her to the hospital a few days later, after she developed an infection from the procedure. That led to sepsis, according to the report, which was sent to the Texas attorney general’s office nearly five years late because the sheriff thought the investigating agency had submitted it.
In subsequent years, other stories would come out about babies dying after their mothers gave birth alone in custody and women miscarrying due to alleged medical neglect. There have also been at least six federal lawsuits filed in the past decade alleging mistreatment of pregnant jail inmates in Texas, according to a recent NBC and Bloomberg Law investigation.
But these harrowing reports capture just a small slice of the issue, advocates said.
The state has for years tracked the number of pregnant people in county jails and incidents of restraints — but now, Texas is also collecting information about their prenatal care, mental health indicators, pregnancy outcomes and more. Advocates hope this effort will provide more accountability to a system that incarcerates hundreds of pregnant people each month. They also believe it will help demonstrate that the harm to the health of these mothers — many of whom are arrested on non-violent or low-level charges — is preventable in the first place.
“We’re hoping lawmakers will see that there is nothing to be gained by locking up this population and causing generational trauma,” said Krish Gundu, executive director of the Texas Jail Project, a key advocacy organization pushing for this work.
The Texas Jail Association said it has no comment at this time.
The study comes from a rider in last year’s budget that appropriated $15,000 for the Texas Commission on Jail Standards to produce a report on maternal health and mortality. Authored by Democratic state Rep. Mary González of Clint, the provision mandates the agency to pull together information based on data collected by individual jails.
So far, broad figures from the commission show that county jails across Texas held on average around 430 pregnant inmates each month between September and November 2025 — a statistics that has previously been tracked. What’s new information is that there were a total of 42 deliveries, 28 miscarriages and one ectopic pregnancy in this period, according to Kaitlin Hickner, a TCJS program specialist.
Other data prescribed in the rider are not yet publicly available. The commission is expected to submit a full report to the state Legislature by December.
And while this one-time study will only last a year, it already makes Texas one of the few places in the country that have this level of data collection on pregnancy in jails, according to a leading national expert on the issue.
“What it symbolizes is that women who don’t count, don’t get counted,” said Carolyn Sufrin, a fellow of the American College of Obstetricians and Gynecologists who also serves on the board of the National Commission on Correctional Health Care, “and women who don’t get counted, don’t count.”
“A lot of moms are impacted”
According to Hickner, all deliveries in the study’s first three months happened in hospitals except for two cases, one of which happened in an ambulance. The other occurred in Johnson County jail in September.
KERA News reported that a 27-year-old woman, who was serving 30 days for failure to complete community service, gave birth in her cell at the North Texas lockup at the time. Jail staff had refused to send her to the hospital, according to the report.
Lt. Keven George told The Texas Tribune that the Johnson County sheriff’s office can confirm that a birth took place at its jail, but it cannot share any additional details due to health privacy laws.
“If it was someone who’s reporting contractions for a while and she wasn’t taken to the hospital, that’s pretty concerning,” said Sufrin. “These outliers are instances where more detail is needed.”
Sufrin also said more information is required to properly assess the outcomes for pregnant women in Texas jails. For instance, she questions how many of the 42 reported deliveries were pre-term, which is the leading contributor to developmental problems and baby death after delivery. Similarly, she wonders how many of the recorded 28 miscarriages happened in the second trimester, which is less common and more concerning than pregnancy losses in the first trimester.
This kind of data also matter because in a 2020 study of pregnant people in six large U.S. jails including in Dallas and Harris counties, Sufrin noted that this population often face additional issues that can create risks for their pregnancies such as a lack of access to medical care in the community, insecure housing, systemic racism as well as higher prevalence of trauma and mental illness.
These nuances, she said, show the need for more specialized care for pregnant inmates as well as collaboration with local health authorities.
Still, “what’s striking is just the absolute numbers,” said Sufrin. “A lot of moms are impacted by the criminal justice system.”
Gundu is also similarly focused on the total number of pregnant jail inmates in Texas.
“If we claim that we’re a right-to-life state and if we are, then what are we doing to protect that?” she said.
Meanwhile, when asked about the available figures so far, González said she prefers to wait for the full findings to avoid politicizing the data.
“It’s really important for us as legislators to use data to make sure that the agencies and the institutions that are part of our ecosystem are treating people with respect and compassion,” the lawmaker added. “I’m really grateful that we’ve had the opportunity to work on this issue and look forward to continuing to work on this issue because it’s very critical that we take care of our families.”
A near decade of advocacy
For Gundu, this initiative is the culmination of nearly a decade of her organization’s work.
The Texas Jail project launched in 2006, after environment activist Diane Wilson shared what she saw during her incarceration in Victoria County’s lockup including the mistreatment of a pregnant woman. Gundu said they had initially thought this case was an outlier, but then received a flood of similar anecdotes when they shared that story.
Then, the group brought these testimonies to the state Legislature. In Texas, there was no tracking of pregnant inmates in county jails and no established health care standards for this population until House Bill 3654’s passage in 2009. Lawmakers also passed House Bill 3563 that same year to largely ban jails from using restraints on pregnant inmates during their labor and recovery.
“When we got the data for the first time, we could say, ‘You’re actually are booking a lot of pregnant women in jails,” Gundu said. “This population literally did not count, so we’ve come a long way.”
More guardrails arrived in subsequent sessions, such as House Bill 1651 from 2019 mandating obstetrical and gynecological care for pregnant people in jails. Still, the advocate said horror stories continued to come out, eventually prompting the push for the current rider.
“There were so many cases,” she said. “But Ruby [McPeters]’ case is definitely one of the main driving forces because I don’t know of any other post-delivery deaths.”
In the meantime, Gundu said she is thankful for the commission’s work and hopes that the final report will show lawmakers the importance of making this data collection permanent.
One piece that won’t be included in that report, however, is data on inmates who delivered shortly before entering jail. She said a report about maternal health and mortality should cover this population as they navigate a critical period that accounts for most of the country’s pregnancy-related deaths. There could be health complications, such as in the case of McPeters who developed an infection after giving birth. There could also be new mental health risks, such as postpartum depression and psychosis.
And this should include people who have given birth within a year before entering custody, according to advocates.
“The postpartum period is defined as up to 12 months after delivery,” Sufrin said. “It’s not just the first two days after someone delivers or even the first six weeks, and that’s because of the physiology of pregnancy. It takes a long time for someone’s body to restore to the non-pregnant state.”
Hickner acknowledged the push for this postpartum data-tracking, but said it would have not been feasible for the length of this study.
“There are thousands and thousands of women that come into the county jails each year,” she said. “And then to collect that information on top of all the pregnant inmate information, it would be extremely difficult and very also hard on the jails.”
González’s office confirmed that postpartum care is not part of the rider, but signaled openness to consider the issue in the future.
Have you experienced or witnessed issues related to pregnancy or any medical care in a Texas county jail? Send tips to reporter Alex Nguyen at alex.nguyen@texastribune.org or via a message on Signal at @alexnguyen.23.