The harms described in this book are born of structurally instituted bias, neoliberal disinvestment in social support, and the building of an enormous carceral system. When individuals like Stephen Lloyd recommend that a person seeking treatment commit a misdemeanor to get access to drug court; when Cindy Jones reports her own child to the police in order to get him access to what little drug treatment exists in her own community; and when Nikki Brown is grateful for the drug court that gave her access to the support she needed, they are all three making choices within a set of systems defined by structural subordination. They are choosing in a context in which, all too often, care is more easily accessible proximate to or inside punishment systems, with all the risks and harms associated with that criminalization of care. Moreover, these structural realities are, as this book has argued, deeply intertwined with intersectional forms of bias.

About a year and a half into gathering the data for this book, I hired a law student to assist in data analysis. She was in law school at the time but had worked as a labor and delivery nurse at a local hospital for many years. She was, to say the least, an ideal candidate for the research team. One of the first assignments I gave her drew on her medical and practice knowledge. I asked her to go through the criminal court files for the women who were prosecuted and look specifically at the allegations contained in the charging document. Her task was to determine whether or not the public criminal allegations against the fetal assault defendants included information obtained by health care providers in the health care setting. Several days later she stopped by my office visibly upset. As it turned out nearly every file contained such information.