One year ago today, I was thrilled to have a front-row seat when the Massachusetts governor signed the pregnancy care and anti-shackling bill into law. Twelve months later, my mood is tempered by the mixed picture we see around the state, from full compliance with the law on paper to violations of the law in practice.

The Massachusetts law is unusual because it takes a comprehensive approach to pregnant women’s health, combining strict limits on the use of restraints with minimum standards of health care, nutrition, and other conditions of confinement, including guarantees of safe transportation and appropriate clothing.

Prisoners’ Legal Services and the Prison Birth Project are monitoring how the law is working, including collecting information from women about their experiences (I am partnering with them in this work).  “Implementation has been uneven and inconsistent across the state,” explained Lauren Petit, staff attorney at Prisoners’ Legal Services. “While some sheriffs have shown commitment to complying with the law, others have issued policies that do not comply; moreover, we have evidence that, regardless of law or policy, some prisons and jails have continued to use prohibited restraints on pregnant and postpartum women.”

The law absolutely prohibits the shackling of women in labor. And yet a woman in labor was recently handcuffed on the way to the hospital: “It was really hard. I couldn’t move like I needed to—couldn’t hold my stomach or push up to move myself around. The metal would dig into me every time I did try to grab my stomach during a contraction. It was incredibly lonely going through that experience by myself, and being cuffed during that labor felt dehumanizing.”

Another woman said, “I took a shower after the birth and they put me back in bed and shackled me to the bed by my left ankle. I said it was against the law, but the female C.O. [corrections officer] said she had never heard of that. She called the jail and whoever she talked to also said they never heard of it. So I stayed shackled to the bed.”

As this example illustrates, even when women know their rights, they can’t enforce them on their own. It’s especially unnerving to learn about women being shackled in labor or shackled to the hospital bed, because so much of the public debate about the need for a law focused on preventing precisely these kinds of inhumane treatment. As Harvard Law School professor Nancy Gertner observed in The Boston Globe, for some women, it’s as if the law doesn’t exist.

“The legislature passed this law unanimously and considered it important enough to put into effect immediately,” remarked Marianne Bullock, program director at the Prison Birth Project. “Yet a year after its passage, women tell us all the time that they are hungry and many report other persistent problems.”

Not only are some women hungry, but they question the nutritional value of the food they are given. As one woman said, “It’s like that show Punk’d on TV, they put up signs in the kitchen about how many fresh fruits and vegetables we should eat every day… then serve us food that doesn’t have any of that!”

Another problem is that prisons and jails don’t provide maternity clothing, instead leaving women to struggle with clothes that are either too small for their growing bodies or too big: “About a month ago I needed new clothes because I still had what I first got when I came in, I asked a few times and finally was given clothes that are an XL, I am about a size 4 in women’s. I fold the pants over so many times they are short on me but it’s still like I am swimming.”

Forcing pregnant women to wear pants that are too long is not only uncomfortable, but unsafe—it’s easy to trip over pants that drag on the floor. Women in prison are not allowed to have belts to keep their pants up.

Safety underpins a unique provision of the law—the requirement that prison and jail personnel use a vehicle with a seatbelt to drive women who are pregnant or in post-partum recovery to court appearances and medical appointments. As the death of Freddie Gray in Baltimore makes all too clear, being tossed around in the back of a van, especially while handcuffed and unable to hold onto the seat or brace oneself, can be very dangerous. But women report that they still endure this situation: “You’d slide everywhere, it was a very bumpy ride. It was scary.”

In other instances, prison and jail officials know that they shouldn’t subject women to these conditions, and don’t take them to their court dates. As one woman explained: “I should have had a hearing two weeks ago, but when I got down for transport they never sent a van with a seatbelt. A white shirt was there and told us ‘pregnant girls can’t go today,’ they know the law—now they just have to make it right.”

Massachusetts isn’t unique in falling short on implementation. But because the law is more holistic than in other states, even more is at stake for the women who need its protections.

To commemorate this first anniversary, more than a dozen organizations joined with Prisoners’ Legal Services and the Prison Birth Project to call for full enforcement of the law. It’s time to make it right and deliver on the promise made to pregnant women in prison that we care about their health and safety.