Criminalization of infant mortality

Criminalization of infant mortality is the process by which an unexpected infant death becomes grounds to suspect and prosecute a mother, sometimes without reliable evidence that a crime occurred. The book shows how grief, poverty, gaps in medical care, and uncertain forensic judgments can be recast as signs of guilt. Its cases range from capital-murder charges after stillbirths to prosecutions of women whose children were alleged to have been endangered before birth, revealing how the criminal system can treat maternal hardship as evidence of criminality rather than as a reason to offer care.

From unexplained death to accusation

The account of Marsha Colbey shows how suspicion can take shape before a medical examination establishes what happened. After Colbey’s baby was stillborn, Debbie Cook noticed that Colbey was no longer pregnant and had no baby. Cook, who worked at the elementary school attended by Colbey’s children, prompted a cafeteria worker to contact police. Colbey, still grieving and angered by the questioning, initially tried to protect her privacy. When an officer saw a marked grave beside the family’s home, she explained that it held her recently delivered stillborn son.

The state summoned forensic pathologist Kathleen Enstice to exhume the body. Before conducting an examination, Enstice told an investigator she believed the baby had been born alive; she later acknowledged that she had no basis for that conclusion at the time and that an autopsy and tests were necessary. Her subsequent autopsy nevertheless concluded that the baby had been born alive and would have survived with medical attention. The book emphasizes the limits of that claim: forensic pathologists primarily examine the dead, and most experts do not consider them qualified to estimate a newborn’s chances of survival.

The prosecution proceeded despite the weakness of the underlying scientific claim. Just weeks after the stillbirth, Colbey was arrested and charged with capital murder. At trial, Enstice called her conclusion a diagnosis of exclusion: she had found no evidence that the baby was stillborn and no alternative explanation for the death. The state’s own expert, obstetrician-gynecologist Dennis McNally, testified that Colbey’s pregnancy carried a high risk of unexplained fetal death because of her age and lack of prenatal care. Werner Spitz, whose medical treatise Enstice had relied on in her training, testified for the defense that he would not declare a live birth or a homicide under the circumstances.

With no credible scientific evidence that a crime had occurred, the prosecution also presented photographs of an unflushed toilet and a beer can on Colbey’s floor. Those ordinary household details were used to imply neglect and bad parenting, while Colbey’s poverty and prior drug use were placed before the jury. She consistently maintained that her baby had been stillborn and had never breathed, despite her efforts to revive him. She rejected an offer to plead guilty and serve eighteen years because she insisted she had done nothing wrong.

Unequal vulnerability and failed safeguards

Colbey’s case was part of a broader pattern in which poverty and limited access to care could be transformed into suspicion. The book notes that the United States has long had higher infant-mortality rates than most developed countries, while many poor women have been unable to obtain adequate prenatal and post-partum health care. Against that background, an unexplained death does not itself establish that a mother committed a crime. Yet the absence of medical care, which can make a pregnancy and its outcome more dangerous and harder to assess, may be used to make a woman appear culpable.

The account places Colbey alongside Bridget Lee, a thirty-four-year-old mother of two and church pianist in Pickens County, Alabama. After becoming pregnant through an affair, Lee hid the pregnancy and hoped to arrange an adoption. She went into labor five weeks before her due date, and the baby was stillborn. The circumstances of the pregnancy helped shape suspicion: the pathologist who performed the autopsy concluded that the baby had been born alive and suffocated by Lee. Months after Lee was charged with capital murder, six other pathologists examined the body and unanimously concluded that neonatal pneumonia had caused the death. They identified it as a stillbirth with common features. The prosecutor then dropped the charges, avoiding a capital trial and the possibility of a death sentence.

That reversal exposes how much can depend on whether an accused woman receives independent forensic scrutiny. Lee’s charges were dismissed after six pathologists supplied the evidence the original investigation had failed to establish. The book warns that hundreds of other falsely accused women never received the forensic assistance needed to challenge a prosecution. Where access to expert review is unequal, an initial unsupported conclusion may acquire the authority of a criminal case before a mother has a meaningful opportunity to contest it.

Victoria Banks’s case makes the danger still more stark. Banks was an intellectually disabled Black woman in Choctaw County, Alabama. Police accused her of killing a newborn after she allegedly told a deputy she was pregnant to avoid jail on an unrelated matter; months later, officers saw her without a child. Without adequate legal assistance, Banks and her sister, Diane Tucker, pleaded guilty to killing a child who had never existed. Banks accepted a twenty-year prison sentence while facing capital-murder charges and a possible death sentence. Officials declined to investigate her innocence before sending her to prison. Her freedom was won only after it was established that a tubal ligation five years earlier made it biologically impossible for her to have conceived or given birth.

Media, motherhood, and presumed guilt

The book connects these prosecutions to a public appetite for stories about dangerous mothers. Colbey’s case attracted press attention and was sensationalized as a story of a mother who had harmed a defenseless infant. The broader media climate made allegations of mothers killing children national spectacles: the book refers to the cases of Andrea Yates and Susan Smith and later to the extensive coverage of Casey Anthony’s trial. Such attention could distort judgment. A tragic death and a mother’s conduct became a compelling crime narrative even when the underlying medical facts were uncertain.

The book does not minimize the horror of a parent killing a child. It argues, instead, that emotionally charged cases can produce bias and a presumption of guilt, particularly against poor women in difficult circumstances. The spectacle of the supposedly bad mother can displace the harder questions: whether the infant was born alive, whether a death was preventable, what medical care was available, and whether investigators have sufficient evidence to allege homicide. In Colbey’s prosecution, objects photographed in her home and gaps in prenatal care could be made to carry persuasive force even as the medical basis for a crime remained disputed.

Expansion from infant death to pregnancy

The same punitive logic extends beyond deaths after birth. Alabama passed a child chemical endangerment law in 2006, ostensibly to protect children living in homes with methamphetamine laboratories or drug-trafficking operations. The law was applied much more broadly, putting thousands of mothers in poor communities affected by drugs and addiction at risk of prosecution. The Alabama Supreme Court interpreted environment to include the womb and child to include a fetus. As a result, pregnant women could face years in prison for evidence that they had used drugs at any point during pregnancy.

The book presents this expansion as part of the criminalization of infant mortality and pregnancy: instead of meeting addiction and health risks with help, the state can treat pregnancy itself as a basis for punishment. Dozens of women had been imprisoned under the law, the account says, rather than receiving the assistance they needed. Together, the stillbirth prosecutions and pregnancy-related cases show how criminal liability can move backward from an infant’s death into a woman’s pregnancy, making poverty, inadequate care, and substance use grounds for surveillance and incarceration.

Significance

The cases expose a gap between the certainty required to accuse someone of a grave crime and the uncertainty that often surrounds infant death. Colbey’s initial forensic conclusion preceded an examination; Lee’s charges ended after six pathologists contradicted the original finding; and Banks was convicted of killing a child who had never existed. These reversals are not interchangeable, but each demonstrates the consequences of allowing suspicion to outrun medical evidence and of failing to provide accused women with the means to challenge official claims.

The pattern also distinguishes public concern for victims from equal treatment of families and women affected by tragedy. The book’s central concern is not that infant deaths should go uninvestigated, but that grief, poverty, disability, and lack of health care must not substitute for proof. When a stillbirth is treated as a homicide before reliable evidence supports that conclusion, the state turns a medical and personal tragedy into a criminal accusation—and may punish the very people who needed care, support, and a fair investigation.