give birth every year. Incarcerated women already tend to have more high-risk pregnancies, due to possible complications by drug and alcohol abuse and STIs, histories of victimization and abuse, and poor support networks, so they are particularly in need of quality prenatal care as compared to non-incarcerated women. Studies have found mixed results when it comes to the effects of incarceration on pregnancy outcomes. Some studies have found that incarceration correlates to lower birth weight, and an increased chance of complications in the pregnancy; others have found the opposite: that incarceration is associated with higher birth weight and a decreased likelihood of premature delivery. However, the latter finding may simply speak to the low level of medical care available to women in poverty in the free world. A 1996 study conducted by the National Council on Crime and Delinquency (NCCD) on women in California, Connecticut, and Florida state prisons found a lack of adequate prenatal and postnatal medical care, prenatal nutrition, level of methadone maintenance for opiate-dependent pregnant inmates, education regarding childbirth and parenting, and preparation for the mother's separation from her child. Often, inmates report receiving no regular pelvic exams or sonograms, and little to no information about proper prenatal care and nutrition. Prison diets often lack proper nutrition, particularly for the changing and special dietary needs of pregnant women, and many women prisoners report not being allowed to alter their diets during their pregnancy. Despite the lack or low quality of prenatal care in most institutions, many correctional facilities have made strides to provide adequate care. For example, Washington State has a program called the Birth Attendants Prison Doula project, which provides support to incarcerated pregnant and postpartum women. When asked about her prison's response to pregnancy, Boo, an inmate in an Arizona correctional facility, said: In general, pregnant inmates are transported to outside medical facilities to give birth, because most correctional facilities are not medically equipped to provide such services. These transports often result in complications due to the risk of injury to both the mother and the child, and due to the additional stress. The practice of shackling inmates, both in transit to the hospital and during labor, is also common at many facilities. Forty-one states permit the use of restraints during transport to the hospital, and twenty-three states and the federal government permit the use of restraints during labor. These restraints may include belly chains,