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This first-of-its-kind federal civil rights lawsuit against the Etowah County Detention Center seeks unspecified damages

NEW YORK — Today, Pregnancy Justice along with co-counsel Southern Poverty Law Center and Sullivan & Cromwell LLP filed a federal civil rights lawsuit in Alabama on behalf of a woman whose constitutional rights were violated when a notorious jail treated her with cruel indifference, first restricting her access to necessary medical care during her high-risk pregnancy and then ignoring her pleas for help as she delivered her baby alone in a filthy jail shower — almost losing her life. 

Ashley Caswell was two months into her high-risk pregnancy when she was detained at the Etowah County Detention Center (ECDC) in Gadsden, Alabama, in March 2021. Citing her pregnancy, the jail denied her use of her lawfully prescribed psychiatric medication and later restricted her access to recommended regular prenatal visits, despite her high blood pressure. The jail also denied her basic accommodations, even forcing her to sleep on a thin mat on a concrete floor.

In October 2021, Ms. Caswell’s water broke, but her cries to be taken to a hospital were ignored. During nearly 12 hours of labor, medical staff only gave Ms. Caswell Tylenol for her pain as she lost amniotic fluid and blood. Ms. Caswell was eventually taken to the jail showers, where she delivered alone while standing on the concrete floor. She suffered excruciating pain and experienced a life-threatening placental abruption, which almost caused her to bleed to death. 

She handed her newborn to staff before passing out, naked and terrified on the shower floor. Instead of offering aid, staff took pictures with her newborn without her consent, despite the fact that the baby was still attached to her body via the umbilical cord.

“Giving birth to my son without any medical help in the jail shower was one of the most terrifying experiences of my life. My body was falling apart, and no one would listen to me. No one cared,” said Ms. Caswell. “I thought I’d lose my baby, my life, and never see my other kids again.” 

“Ashley is the latest victim of the Etowah County Jail, which consistently punishes pregnant women in the name of protecting ‘unborn children’ while simultaneously endangering their lives,” said Pregnancy Justice Senior Staff Attorney Emma Roth.They stripped her of her dignity, violated her constitutional rights, and again showed their callous disregard for mothers and children. The abuses and violations are numerous, and there is simply no word to describe what she endured other than ‘torture.'”

“We cannot continue disappearing people into prisons and jails, where we ignore their rights and needs and subject them to unspeakable cruelty,” said Southern Poverty Law Center Senior Staff Attorney Rebecca Ramaswamy. “Like all those incarcerated, Ashley is a human being worthy of compassion and entitled to life and health. And she nearly died giving birth alone in a shower while jail officials stood around and took photos.”

“The mistreatment Ashley experienced in the Etowah County Jail is shocking and unacceptable,” said Sharon Cohen Levin, a partner in Sullivan & Cromwell LLP’s litigation group. “Incarcerated women who are pregnant and postpartum should not have to beg for — and still be denied — basic medical care, but that is the unfortunate reality at the jail. This lawsuit sheds light on the horrible conditions Ashley faced as a pregnant and postpartum woman at the Etowah County Jail. The jail continuously violated Ashley’s constitutional rights, and she deserves justice.”

This first-of-its-kind federal civil rights lawsuit against Etowah County seeks unspecified damages for the jail’s deliberate indifference to Ms. Caswell’s medical needs, a constitutional rights violation, among other claims.

Ms. Caswell’s case is part of a disturbing pattern of inhumane treatment at the jail, where most women are held on Chemical Endangerment of a Child charges for alleged drug use during pregnancy. Our investigation has revealed that many women who were jailed while pregnant or shortly after giving birth have faced brutal and dehumanizing treatment, including:

  • In 2018, ECDC staff refused to take a woman in labor to the hospital for hours on end as she suffered through severely painful contractions, even after her water broke and she experienced vaginal bleeding.
  • In 2019, ECDC staff refused to take a pregnant woman to the hospital for five days after her water broke prematurely, and she experienced vaginal bleeding and lost amniotic fluid. She later experienced a stillbirth.
  • In 2019, the ECDC forced a woman who had recently delivered her baby via cesarean surgery to sleep on a concrete floor without a mat for nine days and denied her access to her prescribed pain medication despite her excruciating pain.
  • In 2020, yet another woman was forced to labor and give birth alone without medical assistance or pain medication in an ECDC jail cell. 

Alabama leads the nation in pregnancy criminalization, and Etowah County is the epicenter, targeting at least 257 pregnant women and new mothers, according to local reports, in recent years. The state consistently ranks near the bottom for maternal and fetal outcomes, in large part because criminalization deters pregnant women who use substances from seeking necessary medical care. As a result, the Alabama Maternal Mortality Review Committee recommends that “punitive measures for pregnant women with mental health and substance use disorders must be eliminated in order to create an environment that encourages them to seek assistance during pregnancy.”


Pregnancy Justice works to ensure that no one loses their rights because of their capacity for pregnancy or pregnancy outcome, focusing on people who are most at risk of state control and criminalization: those who are low-income, of color, or use drugs.