- A new study has been carried out on almost 1,400 pregnant women in 22 state and all federal prisons across the US
- The study focuses on the frequency of pregnancy and pregnancy outcomes
- It aims to improve maternal health and the health of newborns in US prisons
A first-of-its-kind study on pregnant women in prisons across the US has been carried out by a research team at the Johns Hopkins School of Medicine. The study looks at the frequency of pregnancy and its outcomes in almost 1,400 imprisoned women in 22 state and all federal prisons across the US. Pregnancy outcomes revealed that there were a maximal number of live births with no maternal deaths.
The findings have been published in the American Journal of Public Health (AJPH), a publication of the American Public Health Association (APHA).
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".
Study BackgroundThe 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
Study ObjectiveThe 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).
Study ProcedureThe 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
Study FindingsThe major findings of the study are indicated below:
- 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
Study LimitationsInformation 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
Future PlansThe 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.
Concluding RemarksThe 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."
- Pregnancy Outcomes in US Prisons, 2016-2017 - (https://ajph.aphapublications.org/doi/10.2105/AJPH.2019.305006)