Mental health conditions, including deaths by suicide and overdose, are among the leading causes of pregnancy-related deaths in the United States. These are not mystifying realities but preventable tragedies: foreseeable outcomes of laws and policies that prioritize harm and punishment over compassion and support. For millions of people with mental health conditions, jails and prisons have become de facto “treatment” centers. Pregnant people living with a mental health condition, particularly a substance use disorder, are trapped in a Catch-22. Those who would have chosen to terminate a pregnancy cannot access that care due to laws criminalizing abortion providers in several states. Those who choose to remain pregnant with hopes of parenting often cannot because many state criminal and family policing systems punish them for existing. The problem is a patchwork of regimes that criminalize either choice, instead of supporting the choices that further pregnant people’s dreams and their rights to safety, dignity, and the pursuit of happiness.

This Article traces how (1) civil confinement regimes, (2) “child” abuse registries, (3) family separation policies, (4) criminal prosecutions, and (5) abortion bans construct a different legal universe for pregnant people living with mental health conditions—one in which they are denied care, criminalized, and rendered expendable—and argues that our collective liberation depends on abandoning these carceral reflexes in favor of abolitionist, health-equity approaches that center support, dignity, and care.