The lead author of the study was Dr. Carolyn Beth Sufrin, MD, PhD, who is an Assistant Professor of Gynecology and Obstetrics at Johns Hopkins School of Medicine, with a joint appointment at the Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. She is also the author of the book "Jailcare: Finding the Safety Net for Women Behind Bars". "Currently, there are no mandatory standards for prenatal and pregnancy care for women in prisons,"
says Sufrin. "This study gives us insight into the actual numbers, which will help us better understand the scope of care needed by pregnant people behind bars. Having this information could also help inform policies to consider alternatives to incarceration for pregnant people".
The study was based on the only dataset available on the prevalence of pregnancy in US prisons, which was collected by the Bureau of Justice Statistics (BJS). Interestingly, all current national health statistics totally excluded data from prisons, thereby contributing to the paucity of information on maternal health and childbirths in US prisons. The major background information obtained from the BJS includes the following:
- In 2016, there were over 110,000 women in federal and state prisons across USA
- 75 percent of the above women were in the age group 18-44 years
- As per a 2004 BJS survey, 3 percent of women in federal prisons and 4 percent of women in state prisons were pregnant at the time of imprisonment
- The 2004 BJS survey data only took into consideration self-reported pregnancies
The study was aimed at reducing the above information gap by gathering data on pregnant women and pregnancy outcomes in 22 state and all federal prison systems across the US over a span of one year (2016-2017).
The study procedure involved the following steps:
- Prison administration was contacted for participating in the study
- Approval for the participation of federal prisons was granted by the US Department of Justice and the Federal Bureau of Prisons
- Approval for the participation of state prisons was granted by the US State Departments of Corrections
- A 'Site Reporter' was appointed for each prison to collect data on pregnant women and pregnancy outcomes on a monthly basis
- Information on the following parameters was collected:
- Monthly data were sent by site reporters to the Johns Hopkins researchers through a secure, web-based program called Research Electronic Data Capture (REDCap)
- Johns Hopkins research staff assessed the data for any inaccuracies and made the necessary corrections
- 43 percent of site reporters were interviewed by the researchers to cross-check the accuracy and quality of the submitted data
The major findings of the study are indicated below:
"We were very surprised by how willing and eager the prisons were to participate and to have better data to work with,"
- 1,396 pregnant women were imprisoned in 22 state and all federal prisons across the US during the study period (2016-2017)
- The above prisons contained 57 percent of all imprisoned women in the US
- During the women's incarceration, there were 753 live births
- 6 percent of live births were preterm (10% in the general population)
- 30 percent of live births were delivered by Cesarean section (31.9% in the general population)
- Statistics on other pregnancy outcomes include the following:
- Miscarriages - 46
- Abortions - 11
- Stillbirths - 4
- Newborn deaths - 3
- Maternal deaths - 0 (Annual national figures: >700 maternal deaths)
- Reasons for variation of preterm birth rates between prisons include the following:
- Pre-incarceration health conditions
- Access to prenatal care
- Availability of food and shelter
- Access to illegal drugs
- Access to quality healthcare varied between prisons. So, the data are not generalizable for states that didn't participate in the study
- Pregnancy outcomes varied widely between states
says Sufrin. "With the collective help of the prisons, our research team was able to take the initial steps to gather more systematic and standardized information."
She adds: "We know there are pregnant people in prison, and until now, it wasn't clear whether or not people wanted to pay attention to this particular population or do the adequate research needed to advance the quality of reproductive health care in prisons."
Information is lacking on the following important aspects:
- Stage of pregnancy at the time of imprisonment
- Size of the prisons
- Prison policies on pregnancy testing
- Type of hospital used for delivery of babies
- Quality of living conditions in prisons
- Pregnancy statistics from the other 28 state prison systems (including New York, Florida and California - the largest)
- Demographic data on age and ethnicity
The research team plans to gather demographic data, as well as information on patient experiences by conducting one-on-one interviews. They also plan to assess the quality of maternity care in prisons.
The research team is optimistic that this study will be instrumental in developing guidelines for tracking pregnant women and improving their antenatal healthcare in prisons across the US. "Our hope is for these findings to be used to advance national standards of care for imprisoned pregnant women,"
says Sufrin, "and to support those who advocate for policies and laws that guarantee acceptable and safe pregnancy care and childbirth, that consider alternatives to incarceration for pregnant people, uphold reproductive justice, and encourage more attention to the reproductive health needs of marginalized women and their families." References :
- Pregnancy Outcomes in US Prisons, 2016-2017 - (https://ajph.aphapublications.org/doi/10.2105/AJPH.2019.305006)