Incarceration, maternal hardship, and perinatal health behaviors

The impact of social-environmental factors on IQ in syndromic intellectual developmental disabilities

Despite having the same underlying genetic etiology, individuals with the same syndromic form of intellectual developmental disability (IDD) show a large degree of interindividual differences in cognition and IQ. Research indicates that up to 80% of the variation in IQ scores among individuals with syndromic IDDs is attributable to nongenetic effects, including social-environmental factors. In this narrative review, we summarize evidence of the influence that factors related to economic stability (focused on due to its prevalence in existing literature) have on IQ in individuals with syndromic IDDs. We also highlight the pathways through which economic stability is hypothesized to impact cognitive development and drive individual differences in IQ among individuals with syndromic IDDs. We also identify broader social-environmental factors (e.g., social determinants of health) that warrant consideration in future research, but that have not yet been explored in syndromic IDDs. We conclude by making recommendations to address the urgent need for further research into other salient factors associated with heterogeneity in IQ. These recommendations ultimately may shape individual- and community-level interventions and may inform systems-level public policy efforts to promote the cognitive development of and improve the lived experiences of individuals with syndromic IDDs.

Biopsychosocial contexts of timely and adequate prenatal care utilization among women with criminal legal involvement and opioid use disorder

OBJECTIVE

Pregnant women with criminal legal involvement and opioid use disorder (CL-OUD) living in non-urban regions may be at risk for complex biomedical, psychological, and social barriers to prenatal care and healthy pregnancy. Yet, limited research has explored prenatal care utilization patterns among this subpopulation. This study describes the biopsychosocial factors of pregnant women with a history of criminal legal involvement and opioid use disorder (CL-OUD) associated with timely prenatal care initiation and adequate prenatal care utilization (APNCU).

METHODS

Analyses were conducted on a subsample of medical record data from an observational comparative effectiveness study of medication treatment models for pregnant women with diagnosed opioid use disorder (OUD) who received prenatal care in Northern New England between 2015 and 2022. The subsample included women aged ≥ 16 years with documented criminal legal involvement. Analyses included χ2, Fisher exact tests, and multiple logistic regression to assess differences in timely prenatal care and APNCU associated with biopsychosocial factors selected by backwards stepwise regression.

RESULTS

Among 317 women with CL-OUD, 203 (64.0%) received timely prenatal care and 174 (54.9%) received adequate care. Timely prenatal care was associated with having two or three prior pregnancies (aOR 2.37, 95% CI 1.07-5.20), receiving buprenorphine at care initiation (aOR 1.85, 95% CI 1.01-3.41), having stable housing (aOR 2.49, 95% CI 1.41-4.41), and being mandated to court diversion (aOR 4.06, 95% CI 1.54-10.7) or community supervision (aOR 2.05, 95% CI 1.16-3.63). APNCU was associated with having a pregnancy-related medical condition (aOR 2.17, 95% CI 1.27-3.71), receiving MOUD throughout the entire prenatal care period (aOR 3.40, 95% CI 1.45-7.94), having a higher number of psychiatric diagnoses (aOR 1.35, 95% CI 1.07-1.70), attending a rurally-located prenatal care practice (aOR 2.14, 95% CI 1.22-3.76), having stable housing (aOR 1.94, 95% CI 1.06-3.54), and being mandated to court diversion (aOR 3.11, 95% CI 1.19-8.15).

CONCLUSION

While not causal, results suggest that timely and adequate prenatal care among women with CL-OUD may be supported by OUD treatment, comorbid indications for care, stable access to social resources, and maintained residence in the community (i.e., community-based alternatives to incarceration).

Entwined life events: The effect of parental incarceration timing on children's academic achievement

Parental incarceration has negative effects on children's educational outcomes. Past studies have only analyzed, and therefore only treated as consequential, parental incarceration that occurs during childhood rather than prenatally. Such analyses that emphasize the importance only of events that occur during one's lifetime are common in life course studies. This paper introduces an "entwined life events" perspective, which argues that certain events are so consequential to multiple persons' lives that they should be analyzed as events within multiple independent life courses; parental incarceration, whenever it occurs, is entwined across and shapes both parents' and children's lives. Drawing on data from the Panel Study of Income Dynamics and the Fragile Families and Child Wellbeing Study, we find that parental incarceration, both prenatal and during childhood, significantly influences children's academic ability measures and years of completed schooling. Our results show heterogeneous effects by children's race. We find that the absolute magnitude of parental incarceration effect estimates is largest for White children relative to estimates for Black and Hispanic children. At the same time, outcome levels tend to be poorer for Black and Hispanic children with parental incarceration experience. We explain this racial heterogeneity as confounded by the many other social disadvantages that non-White children encounter, resulting in the individual effect of parental incarceration not being extremely disruptive to their academic growth.

Recent Incarceration Exposure Among Parents of Live-Born Infants and Maternal and Child Health

OBJECTIVE

Women who have direct exposure to incarceration or indirect exposure through their partner are at high risk for poor health behaviors and outcomes, which may have lasting impacts on their children. The objectives of this study were to estimate the prevalence of recent incarceration exposure among women with a recent live birth and assess the relationship between incarceration exposure and maternal and child health.

METHODS

We used data from the Pregnancy Risk Assessment Monitoring System (36 states and New York City, 2012-2015; N = 146 329) to estimate the prevalence of women reporting that they or their husband/partner spent time in jail during the 12 months before giving birth. We used multivariable logistic regression to assess associations between incarceration exposure and maternal and infant health conditions.

RESULTS

The prevalence of incarceration exposure shortly before or during pregnancy was 3.7% (95% CI, 3.6%-3.9%). Women with incarceration exposure had increased odds of prepregnancy hypertension (adjusted odds ratio [aOR] = 1.51; 95% CI, 1.26-1.81), prepregnancy and postpartum depressive symptoms (aOR = 1.95 [95% CI, 1.73-2.19] and 1.49 [95% CI, 1.32-1.67], respectively), and having an infant admitted to the neonatal intensive care unit (aOR = 1.18; 95% CI, 1.04-1.33).

CONCLUSION

Because a parent's incarceration exposure is an adverse childhood experience with the potential to disrupt important developmental periods and have negative impacts on the socioemotional and health outcomes of children, it is critical for researchers and health care providers to better understand its impact on maternal and infant health. Prenatal and postnatal care may provide opportunities to address incarceration-related health risks.

Promotion, protection and support for breastfeeding in prisons: a scoping review

This article aims to identify and map the actions to promote, protect and support breastfeeding that are carried out within the prison system. Scope review, whose searches were performed in the Latin American and Caribbean Health Sciences Literature and Nursing databases, Virtual Health Library, Medical Literature, Analysis, and Retrieval System Online, via PubMed, Scientific Electronic Library Online and the Capes Periodicals Portal. A total of 465 studies were obtained, 177 duplicates and 175 by title exclusion were removed, 56 articles were eliminated by abstract, and eight articles were not found. After selection and reading by the review team, 16 articles were removed, thus constituting ten articles with relevant results for breastfeeding promotion in prison, 13 articles with important results for breastfeeding protection in prison, and ten articles with potential findings for breastfeeding support in prison. It is necessary to promote breastfeeding in prison with promotion, protection and support actions, because many children are still prevented from being breastfed soon after birth, which characterizes inequality in relation to the population in freedom.

Incarceration exposure and prescription opioid use during pregnancy

BACKGROUND

Prior research demonstrates a high prevalence of substance use, including opioid use, among those who have had personal or vicarious contact with the correctional system. Relatedly, alongside patterns of rising opioid use in general, opioid use during pregnancy is becoming a growing public health concern. Still, risk factors for prescription opioid use during pregnancy remain understudied. This study is the first to assess the connection between a women's personal or vicarious exposure to incarceration in the 12 months prior to birth and patterns of prenatal opioid use.

METHODS

Data are from the Pregnancy Risk Assessment Monitoring System (PRAMS) in 2019 (N = 17,551 mothers). Logistic and multinomial logistic regression are used to assess the association between incarceration exposure and patterns of opioid use during pregnancy.

RESULTS

Incarceration-exposed women were more likely to use all eight types of prescription opioids assessed in this study (Hydrocodone, Codeine, Oxycodone, Tramadol, Hydromorphone/Meperidine, Oxymorphone, Morphine, and Fentanyl). After adjustment for control variables, incarceration-exposed women were significantly more likely to report any prescription opioid use during pregnancy (OR = 1.745, 95% CI = 1.194, 2.554). Furthermore, relative to no opioid use, incarceration exposure was also associated with illicit prescription opioid use (RRR = 2.979, 1.533, 5.791).

CONCLUSIONS

Incarceration exposure in the year prior to birth is associated with higher odds of prescription opioid use. These findings add to the burgeoning literature that details a women's exposure to incarceration is a risk marker for substance use and engagement in health risk behaviors that can jeopardize maternal and infant wellbeing.

Incarceration exposure during pregnancy and maternal disability: findings from the Pregnancy Risk Assessment Monitoring System

BACKGROUND

Extant research reveals that currently and formerly incarcerated individuals exhibit higher rates of disability. Moreover, recent research highlights that women exposed to incarceration during pregnancy -either personally or vicariously through a partner- face poorer health. However, prior research has not detailed the connection between incarceration exposure and risk for maternal disability.

METHODS

The aim of this study is to evaluate the association between a women's exposure to incarceration during pregnancy and disability including difficulty with: communication, hearing, remembering, seeing, self-care, or walking. Data are from Pregnancy Risk Assessment Monitoring System (PRAMS), 2019 (N = 12,712). Logistic and negative binomial regression were used to assess the relationship between incarceration exposure and maternal disability.

RESULTS

Among the sample of women who delivered a recent live birth, approximately 3.3% of the sample indicated they were personally or vicariously exposed to incarceration in the 12 months before birth. Compared to those who did not have incarceration exposure, women with incarceration exposure have elevated odds of several disabilities, including difficulty remembering (Adjusted Odds Ratio [AOR] = 1.971; 95% Confidence Interval [CI] = 1.429, 2.718), difficulty seeing (AOR = 1.642, 95% CI = 1.179, 2.288), difficulty walking (AOR = 1.896, 95% CI = 1.413, 2.544), and a greater number of cumulative disabilities (Incidence Risk Ratio [IRR] = 1.483; 95% CI = 1.271, 1.731).

CONCLUSIONS

Women personally or vicariously exposed to incarceration during pregnancy endure greater odds of having a disability. Considering both incarceration and disability are important public health issues with implications for maternal and child well-being, these findings highlight the need for further research that can better understand the connection between incarceration and disability.

The Risk of Family Violence After Incarceration: An Integrative Review

Despite the importance of understanding the prevalence, causes, and consequences of conflict and violence within families, the specific risk of violence following a family member's release from incarceration has been hard to ascertain. Research indicates that a significant percentage of persons released from incarceration will experience involvement in family violence in their life, yet it remains unclear whether this heightened risk exists due to larger family or structural contexts or whether incarceration itself leads to heightened risk of family violence after release. Using an integrative review methodology that combines results from both qualitative and quantitative studies, we review existing studies of family violence after incarceration to explore (1) the prevalence, (2) variation in measurement, (3) risk factors, and (4) protective factors for family violence after a family member's incarceration. Through a search of three separate databases for peer-reviewed and gray literature, we analyzed 26 studies that estimated any form of physical family violence after any family member had been incarcerated. Where reported, intimate partner violence occurs in almost a quarter of cases, although only four studies examine the prevalence of violence perpetrated against children by parents. Family violence history, weakened family support during incarceration, and substance use after release all emerged as persistent risk factors. Directions and opportunities for future research are discussed.

Severe maternal hardships are associated with food insecurity among low-income/lower-income women during pregnancy: results from the 2012–2014 California maternal infant health assessment

Background

Assess the associations between ten severe maternal hardships and food insecurity experienced during pregnancy.

Methods

Data on 14,274 low-income/lower-income women (below 400% of the income to federal poverty guideline ratio) from the statewide-representative 2010–2012 California Maternal and Infant Health Assessment were used to estimate food security status prevalence. Prevalence of severe maternal hardships by food security status was estimated. Multinomial logistic regression was used to assess the associations between severe maternal hardship and food security status, adjusting for sociodemographic characteristics.

Results

Food insecurity was common among low- and lower-income pregnant women in California; 23.4% food insecure and an additional 11.5% marginally secure. In adjusted analysis, nine of ten hardships were associated with food security status. Only the respondent or someone close to the respondent having a problem with alcohol or drugs was not associated with food security status after adjusting for socioeconomic factors. Husband/partner losing a job, depressive symptoms, not having practical support and intimate partner violence were consistently associated with marginal, low and very low food security status. Each additional severe maternal hardship a woman experienced during pregnancy was associated with a 36% greater risk of reporting marginal food security (Relative Risk Ratio 1.36, 95% CI: 1.27, 1.47), 54% for low food security (Relative Risk Ratio 1.54, 95% CI: 1.44, 1.64), and 99% for very low food security (Relative Risk Ratio 1.99, 95% CI: 1.83, 2.15).

Conclusions

Food security status was strongly linked with several maternal hardships that could jeopardize maternal and/or infant health.

Services—including prenatal care and nutritional assistance—for a large proportion of pregnant women should address a wide range of serious unmet social needs including food insecurity.

Promotion, protection and support for breastfeeding in prisons: a scoping review

Abstract This article aims to identify and map the actions to promote, protect and support breastfeeding that are carried out within the prison system. Scope review, whose searches were performed in the Latin American and Caribbean Health Sciences Literature and Nursing databases, Virtual Health Library, Medical Literature, Analysis, and Retrieval System Online, via PubMed, Scientific Electronic Library Online and the Capes Periodicals Portal. A total of 465 studies were obtained, 177 duplicates and 175 by title exclusion were removed, 56 articles were eliminated by abstract, and eight articles were not found. After selection and reading by the review team, 16 articles were removed, thus constituting ten articles with relevant results for breastfeeding promotion in prison, 13 articles with important results for breastfeeding protection in prison, and ten articles with potential findings for breastfeeding support in prison. It is necessary to promote breastfeeding in prison with promotion, protection and support actions, because many children are still prevented from being breastfed soon after birth, which characterizes inequality in relation to the population in freedom.

"Here Comes the Junkies," Opioid Replacement Therapy in Rural Australia

BACKGROUND

Opioid replacement therapy (ORT) offers a harm minimization approach and is the mainstay treatment option for opioid dependence in Australia. Recovery is known to be complicated because of service access, cost, workforce availability, privacy, stigma, and discrimination. Rural living is considered to magnify each complication of recovery, yet little is understood about how opioid dependence recovery is experienced in rural Australia. This study aimed to explore the lived experience of people receiving ORT in rural Australia and describe impediments to recovery.

METHODS

In this qualitative study design, all outpatients enrolled in ORT at two rural Australian sites were invited to participate. Six volunteers from each site participated in a semistructured interview (eight men, four women; mean age = 44.8 years).

RESULTS

The participants had completed 3 years of secondary school education on average. Four major themes emerged: reinvention, restriction, employment, and reconnection. Small communities increased the likelihood of ORT participants knowing people both directly and indirectly, affecting their ability to reconstruct an identity. Lived distance from prescribers and dosing points dictated daily activity, including opportunities to seek and maintain employment. Rural ORT treatment seekers indicated that geographical displacement and separation from family, the people they needed to reconnect with, were challenging.

CONCLUSION

Rural people engaged in ORT require positive reinforcement from service providers, enabling identity reinvention and disconnection from the drug-seeking world. Acknowledging underlying trauma and supporting reconnection with loved ones may foster positive social connectedness.

Women's Health in the Era of Mass Incarceration

Dramatic increases in criminal justice contact in the United States have rendered prison and jail incarceration common for US men and their loved ones, with possible implications for women's health. This review provides the most expansive critical discussion of research on family member incarceration and women's health in five stages. First, we provide new estimates showing how common family member incarceration is for US women by race/ethnicity and level of education. Second, we discuss the precursors to family member incarceration. Third, we discuss mechanisms through which family member incarceration may have no effect on women's health, a positive effect on women's health, and a negative effect on women's health. Fourth, we review existing research on how family member incarceration is associated with women's health. Fifth, we continue our discussion of the limitations of existing research and provide some recommendations for future research.

Paternal Jail Incarceration and Birth Outcomes: Evidence from New York City, 2010-2016

OBJECTIVES

To examine population-level associations between paternal jail incarceration during pregnancy and infant birth outcomes using objective measures of health and incarceration.

METHODS

We use multivariate logistic regression models and linked records on all births and jail incarcerations in New York City between 2010 and 2016.

RESULTS

0.8% of live births were exposed to paternal incarceration during pregnancy or at the time of birth. After accounting for parental sociodemographic characteristics, maternal health behaviors, and maternal health care access, paternal incarceration during pregnancy remains associated with late preterm birth (OR = 1.34, 95% CI = 1.21, 1.48), low birthweight (OR = 1.39, 95% CI = 1.27, 1.53), small size for gestational age (OR = 1.35, 95% CI = 1.17, 1.57), and NICU admission (OR = 1.14, 95% CI = 1.05, 1.24).

CONCLUSIONS

We found strong positive baseline associations (p < 0.001) between paternal jail incarceration during pregnancy with probabilities of all adverse outcomes examined. These associations did not appear to be driven purely by duration or frequency of paternal incarceration. These associations were partially explained by parental characteristics, maternal health behavior, and health care. These results indicate the need to consider paternal incarceration as a potential stressor and source of trauma for pregnant women and infants.

Incarceration exposure and electronic cigarette use during pregnancy: Findings from the pregnancy risk assessment monitoring system, 2016-2018

Smoking during pregnancy is a serious public health concern that poses risks for maternal and infant health. Considering the rise of electronic cigarette use in recent years, there is also growing concern about electronic cigarette use during pregnancy. Recent research has begun to explore correlates of electronic cigarette use among pregnant women. While research has revealed a strong connection between incarceration and smoking, scholars have yet to examine the connection between a woman's exposure to incarceration in the year prior to birth - either personally or vicariously through her husband or partner - and prenatal electronic cigarette use. The current study uses data from 74,554 recent mothers from the 2016-2018 Pregnancy Risk Assessment Monitoring System. Logistic regression and multinomial logistic regression models were used to assess the association between incarceration exposure and electronic cigarette use. The findings indicate a robust association between incarceration exposure and electronic cigarette use during pregnancy. Specifically, analyses demonstrate that incarceration-exposed women were approximately 2.7 times (AOR = 2.699, 95% CI = 1.939, 3.755) as likely to use electronic cigarettes after adjusting for a host of demographic, economic, health, and pregnancy related characteristics. Additional analyses reveal this association remains after accounting for conventional cigarette use during pregnancy. Considering the potential harmful health ramifications for electronic cigarette use during pregnancy, these findings suggest a need for interventions targeting electronic cigarette use among incarceration-exposed populations and point to electronic cigarette use among pregnant women in particular as an important area of focus for both criminal justice and public health practitioners.

Barriers to Prenatal Care Among Food-Insufficient Women: Findings from the Pregnancy Risk Assessment Monitoring System

Background: This study examines the relationship among food insufficiency, adequacy of prenatal care, and barriers to prenatal care. Materials and Methods: Using data from the Pregnancy Risk Assessment Monitoring System (PRAMS), 2009-2016, negative binomial and logistic regression models were used to assess the association among food insufficiency during pregnancy, late onset of prenatal care, the number of prental care visits, as well as barriers to prenatal care. Results: Findings indicate that food insufficiency is associated with not initiating prenatal care during the first trimester and having fewer overall visits. In addition, food insufficiency is associated with more overall barriers to prenatal care, and this association operates through several specific barriers, including not having enough money, lacking transportation to get to the clinic or doctor's office, not being able to get time off work, not having a Medicaid card, having too many other things going on, and having no one to take care of children. Conclusion: Considering the adverse consequences of both food insufficiency and a lack of sufficient prenatal care for maternal and child health, study findings suggest a need to develop targeted interventions that expand access and remove barriers to prenatal care among food-insufficient women.

Incarceration Exposure and Barriers to Prenatal Care in the United States: Findings from the Pregnancy Risk Assessment Monitoring System

Previous research demonstrates that exposure to incarceration during pregnancy - either personally or vicariously through a partner - worsens parental care. However, little is known about the specific barriers to parental care that are associated with incarceration exposure. Using data from the Pregnancy Risk Assessment Monitoring System (years 2009-2016), the current study examines the relationship between exposure to incarceration during pregnancy and barriers to prenatal care in the United States. Negative binomial and logistic regression models were used to assess the association between the recent incarceration of a woman or her partner (i.e., incarceration that occurred in the 12 months prior to the focal birth) and several barriers to prenatal care. Findings indicate that exposure to incarceration, either personally or vicariously through a partner, increases the overall number of barriers to prenatal care and this association operates through several specific barriers including a lack of transportation to doctor's appointments, having difficulty finding someone to take care of her children, being too busy, keeping pregnancy a secret, and a woman not knowing she was pregnant. Policies designed to help incarceration exposed women overcome these barriers can potentially yield benefits for enhancing access to parental care.

Paternal violent criminality and preterm birth: a Swedish national cohort study

Background

Fathers may affect expectant mothers’ daily living situations, which in turn might influence pregnancy outcomes. We investigated the association between paternal violent criminality and risk of preterm birth (≤36 weeks).

Methods

We conducted a register-based study with all live singleton births in the Swedish Medical Birth Register from 1992 to 2012, linked with records of paternal violent crime convictions from the National Crime Register from 1973 to 2012.

Results

Paternal violent criminality was associated with increased risk of preterm birth and lower gestational age. The association was especially pronounced among infants of reoffenders: men convicted of three or more violent crimes (adjusted odds ratio [aOR] 1.23 [95% CI 1.17, 1.29]). Maternal half sibling-comparisons, an analytic approach controlling for maternal factors stable across pregnancies, also suggested increased risk of preterm birth and lower gestational age when exposed to a violently reoffending father compared to a father without violent criminal convictions (aOR 1.30 [0.99, 1.72], adjusted mean difference − 1.07 [− 1.78, − 0.36]).

Conclusions

Persistent paternal violent criminality was associated with increased risk of preterm birth, even after controlling for maternal characteristics that did not change between pregnancies.

County-level jail incarceration and preterm birth among non-Hispanic Black and white U.S. women, 1999-2015

Jail incarceration is widely prevalent in the United States, with disproportionate impacts on communities of color, yet little research has quantified its health consequences for communities. We assess county-level jail incarceration as a contextual stressor for individual-level preterm birth among non-Hispanic Black and White U.S. women, the vast majority (>99%) of whom were not incarcerated, between 1999 and 2015. We linked county jail incarceration rates to birth certificate data for all births to resident non-Hispanic Black and White U.S. women (N = 41, 911, 094). Using multilevel logistic regression models, we estimated the association between quintiles of county jail incarceration rates and the odds of preterm birth, adjusting for maternal- and county-level covariates and state fixed effects. Women living in counties in the highest quintile of jail incarceration rates had 1.08 (95% Confidence Interval (CI): 1.07-1.09) times greater odds of preterm birth, adjusting for covariates, compared to women living in counties with the lowest quintile of jail incarceration rates. Taken together with other research, these findings suggest policies to lower jail incarceration rates could potentially help prevent preterm birth and other adverse population health consequences of mass incarceration.

Incarceration as a unique social stressor during pregnancy: Implications for maternal and newborn health

RATIONALE

Exposure to incarceration during pregnancy is a stressful life event that poses risk for both maternal and newborn health.

OBJECTIVE

We conducted a pooled, cross-sectional analysis of the link between incarceration exposure of mothers during pregnancy - personally or vicariously through a romantic partner - and maternal and newborn health using data from the Pregnancy Risk Assessment Monitoring System from years 2012-2015.

METHOD

We applied a novel approach that compares mothers who were exposed to incarceration to the strategic comparison group of mothers who were not exposed to incarceration, but experienced varying numbers of stressors.

RESULTS

The initial findings indicated that respondents exposed to incarceration exhibited reductions in maternal and newborn health relative to respondents not exposed to incarceration. However, these differences were substantially attenuated when comparing the incarceration-exposed group to a more comparable stressor-exposed reference group.

CONCLUSIONS

While incarceration exposure has adverse consequences for health outcomes of mothers and newborns, incarceration exposure may not carry unique implications for maternal and newborn wellbeing beyond the clustering of other stressful life events. Policies targeting incarceration exposure as a means of promoting health must also provide adequate attention to co-occurring stressors.

Reproductive justice for incarcerated mothers and advocacy for their infants and young children

The United States has seen unprecedented growth in the number of incarcerated women, most of whom are mothers with minor children. Major public health concerns relate to the reproductive health of women in prisons and jails and the well-being of their infants and young children. In the current article, we use a reproductive justice framework to examine the intersection of incarceration and maternal and child health. We review (a) current research on the reproductive health of incarcerated women, (b) characteristics and experiences of pregnant incarcerated women, (c) outcomes of infants and young children with incarcerated parents, (d) implications of research findings for policy and practice, and (e) the need for increased research, public education, and advocacy. We strongly recommend that correctional policies and practices be updated to address the common misconceptions and biases as well as the unique vulnerabilities and health needs of incarcerated women and their young children.

Structural Racism and Severe Maternal Morbidity in New York State

Objective:

We examined the association between county-level structural racism indicators and the odds of severe maternal morbidity (SMM) in New York State.

Design:

We merged individual-level hospitalization data from the New York State Department of Health Statewide Planning and Research Cooperative System (SPARCS) with county-level data from the American Community Survey and the Vera Institute of Justice from 2011 to 2013 (n = 244 854). Structural racism in each county included in our sample was constructed as the racial inequity (ratio of black to white population) in female educational attainment, female employment, and incarceration.

Results:

Multilevel logistic regression analysis estimated the association between each of these structural racism indicators and SMM, accounting for individual- and hospital-level characteristics and clustering in facilities. In the models adjusted for individual- and hospital-level factors, county-level racial inequity in female educational attainment was associated with small but statistically significant higher odds of SMM (odds ratio [OR] = 1.17, 95% confidence interval [CI] = 1.47, 1.85). County-level structural racism indicators of female employment inequity and incarceration inequity were not statistically significant. Interaction terms examining potential effect measure modification by race with each structural racism indicator also indicated no statistical difference.

Conclusions:

Studies of maternal disparities should consider multiple dimensions of structural racism as a contributing cause to SMM and as an additional area for potential intervention.

Outcomes among pregnant recently incarcerated women attending a reentry transitions clinic

This mixed methods retrospective case series and qualitative descriptive study describes pregnancy outcomes during the postincarceration period. A retrospective case series via electronic medical record chart review from a subset of women attending a postincarceration primary care clinic with a condition of interest (pregnancy) described demographics, substance use, diagnoses, and pregnancy outcomes. We compared 27 pregnant to 79 nonpregnant women and contextualized quantitative data with qualitative descriptive vignettes. Twenty-seven women completed 29 pregnancies (2 women with 2 deliveries each), all of which were unplanned; there were 11 live births, 8 pregnant at study closure, 7 miscarriages, and 3 terminations. Although substance use history was high, rates were higher among nonpregnant women (92% vs 74%). Among the 5 births, 4 tested positive for substance use during pregnancy. All 11 infants had pregnancy or delivery complications. Although 7 of the 10 pregnant women with live births had prior pregnancy complications, only 4 were placed in a special care obstetrics clinic. Although unplanned pregnancies were common, most births did not demonstrate maternal substance use. All live births had pregnancy or delivery complications, but few were accepted to specialist prenatal care, suggesting potential considerations for recently incarcerated women.

Latinos' Connections to Immigrants: How Knowing a Deportee Impacts Latino Health

This manuscript examines how personally knowing a deportee and/or undocumented immigrant affects the mental health of Latina/o adults. Utilizing a new survey sponsored by the Robert Wood Johnson Foundation Center for Health Policy at the University of New Mexico (n=1,493), we estimate a series of logistic regressions to understand how personal connections to immigrants are affecting the mental health of Latinos using stress process theory. Our modeling approach takes into consideration the socio-political, familial, cultural, and personal contexts that make up the Latina/o experience, which is widely overlooked in data-sets that treat Latinos as a homogeneous ethnic group. Our findings suggest that knowing a deportee increases the odds of having to seek help for mental health problems. The significance of this work has tremendous implications for policy makers, health service providers, and researchers interested in reducing health disparities among minority populations especially under a new administration, which has adopted more punitive immigration policies and enforcement.

Parental Incarceration and Child Health in the United States

Mass incarceration has profoundly restructured the life courses of not only marginalized adult men for whom this event is now so prevalent but also their families. We examined research published from 2000 to 2017 on the consequences of parental incarceration for child health in the United States. In addition to focusing on specific health outcomes, we also considered broader indicators of child well-being because there has been little research on the association between parental incarceration and objectively measured child health outcomes. Our findings support 4 conclusions. First, paternal incarceration is negatively associated-possibly causally so-with a range of child health and well-being indicators. Second, although some research has suggested a negative association between maternal incarceration and child health, the evidence on this front is mixed. Third, although the evidence for average effects of paternal incarceration on child health and well-being is strong, research has also suggested that some key factors moderate the association between paternal incarceration and child health and well-being. Finally, because of the unequal concentration of parental incarceration and the negative consequences this event has for children, mass incarceration has increased both intracountry inequality in child health in the United States and intercountry inequality in child health between the United States and other developed democracies. In light of these important findings, investment in data infrastructure-with emphasis on data sets that include reliable measures of parental incarceration and child health and data sets that facilitate causal inferences-is needed to understand the child health effects of parental incarceration.

Pregnant in prison: An integrative literature review

BACKGROUND

Pregnant women in prisons are recognised as a marginalised group. However, there is a limited understanding of the women's unique maternity needs and how correctional institutions and maternity service providers respond to these needs.

AIM

The aims of the review are threefold.

METHOD

An integrative literature review was undertaken. A comprehensive search strategy using seven electronic databases resulted in the retrieval of 363 articles. Of them, 32 peer-reviewed studies met the final selection criteria and were included in this review which utilised the Critical Appraisal Skills Program tools and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart. Thematic analysis identified universal themes.

FINDINGS

Three dominant themes emerged related to the experience of pregnant women in prison: (1) risks and vulnerability factors; (2) prison enablers and supports; and (3) prison barriers. Extant research on risks and vulnerability factors is disproportionate to research examining how prisons can enable or obstruct responding to the women's perinatal needs. Limited research on the midwifery support available to the women in prison is available. Significantly, only two out of 32 reviewed papers include research directly conducted with the pregnant women in prison.

CONCLUSION

Pregnant women in prisons have complex needs. More research is required to understand how prisons can enhance the pregnancy experience by engaging pregnant women in prisons as research participants.

Impact of parental incarceration on neonatal outcomes and newborn home environments: a case-control study

OBJECTIVES

Parental incarceration (PI) is a prevalent adverse childhood experience (ACE) that has been linked to numerous social, emotional, and health problems in childhood and adulthood. A growing body of research has emphasized the importance of the timing of parent's incarceration on developmental outcomes.

STUDY DESIGN

The present study uses case-control matching to examine the impact of recent PI on newborn health and home safety outcomes.

METHODS

Neonatal health and newborn sleep and home safety data, including rates of premature birth, low birth weight (LBW), neonatal intensive care unit admittance, breastfeeding initiation, safe sleep, and home environment (e.g. working smoke alarm, proper firearm storage), were collected from 108 women who completed the Virginia Pregnancy Risk Assessment Monitoring survey. Half of these women (n = 54) had experienced the incarceration of themselves or their partner during the previous 12 months. Participants were matched by age, race, income, and the education level with those of 54 women who completed the survey and who had not experienced incarceration in the previous year.

RESULTS

Controlling for nicotine and alcohol consumption during pregnancy and other stressors, path analyses show that the women who experienced incarceration of themselves or their husband/partner were significantly less likely to deliver an LBW infant and more likely to live in a home with a loaded firearm in the home. No other significant differences emerged between the two matched groups among neonatal health or newborn sleep and home safety outcomes.

CONCLUSIONS

This result is considered from a public health perspective, as PI is an ACE which can be impacted by policy, particularly policies that promote practices that healthcare workers can use in correctional and other environments to encourage healthy pregnancies and home environments for newborns.

Conditions and Dynamics That Impact Maternal Health Literacy among High Risk Prenatal-Interconceptional Women

The purpose of the study was to describe conditions and dynamics in the lives of high-risk, low-income, Southern United States prenatal-interconceptional women (n = 37) in a home visiting program that promoted maternal health literacy progression. In the Life Course Health Development (LCHD) Model, conditions were risk and protective factors that impacted health. Dynamics drove the complex, epigenetic relationships between risk and protective factors. Maternal health literacy promotion helped participants address conditions and dynamics to create positive life changes. This research was a retrospective, mixed methods study of women's service records documenting care from prenatal admission to 24 months post-delivery. The Life Skills Progression Instrument (LSP) was scored to measure maternal health literacy progression. Ethnographic content analysis of visit notes triangulated with quantitative data enabled specificity of critical data elements. Subsequently, a complementary focus group was conducted with the Registered Nurse Case Managers (RNCM). Severe social conditions included devastating poverty, low educational achievement, transient housing, unstable relationships, incarceration, lack of continuous health insurance, and shortage of health care providers. Dynamics included severe psycho-social stressors, domestic violence, lack of employment, low income, low self-esteem and self-expectations, and social/family restraints upon women's intended positive changes. An important protective factor was the consistent, stable, evidence-informed relationship with the RNCM. Findings from the focus group discussion supported content analysis results.

Intention and Initiation of Breastfeeding Among Women Who Are Incarcerated

The Baby-Friendly Hospital Initiative recommends that all mothers be shown how to breastfeed, even when mothers and newborns are separated. Most incarcerated women are separated from their infants after the postpartum hospital stay, creating barriers to breastfeeding. We examined breastfeeding among a sample of women participating in a prison-based pregnancy program. Quantitative data indicated that women who discussed breastfeeding with their doulas were more likely to initiate breastfeeding. Three qualitative themes were identified: Benefits of Breastfeeding, Barriers to Breastfeeding, and Role of the Doula. We identified incongruence between the expected standard of breastfeeding support and the care incarcerated women received. Findings suggest that prison-based doula care might be an effective intervention for supporting breastfeeding among incarcerated women and highlight the importance of education for perinatal nurses about breastfeeding support of incarcerated women.

From the Ground Up: Improving Pregnancy and Birth Experiences Through the Provision of Extraordinary Learning Opportunities in Australia

A collaborative project formally titled "Working together to improve pregnancy and birth experiences for women and provide extraordinary learning opportunities for midwifery students" was launched in April 2017, after several years of consultation and planning. The opportunity to adopt an integrated response to the needs of incarcerated pregnant women and the learning needs of midwifery students was identified and supported by the university offering a graduate-entry midwifery program, a women's correctional center, and a health service in a regional area of Australia. Incarcerated women who are pregnant require pregnancy, birth, and postnatal support distinct from their clinical care, while at the same time, midwifery students need to recruit pregnant women for continuity-of-care experiences. This article presents an overview of the implementation of the pilot project. It also discusses the project team and the challenges and successes of and unanticipated opportunities for practice modification and change.

Social determinants of adult sex ratios and racial/ethnic disparities in transmission of HIV and other sexually transmitted infections in the USA

In Black population centres in the USA, adult sex ratios (ASRs) are strongly female-biased primarily due to high male incarceration and early mortality rates. I explore the system of social determinants that shape these ASRs, and describe their apparent consequences. Evidence suggests that female-biased ASRs play a role, along with racial residential segregation, to increase mixing between core and peripheral members of sexual networks, facilitating transmission of human immunodeficiency virus and other sexually transmitted infections. Unique historical factors underlie Black male incarceration and mortality rates in the USA, making comparisons with other groups or other countries challenging.This article is part of the themed issue 'Adult sex ratios and reproductive decisions: a critical re-examination of sex differences in human and animal societies'.

Female children with incarcerated adult family members at risk for lifelong neurological decline

A secondary analysis of data from adult female prison inmates in the mid-Atlantic United States defined relationships between having incarcerated adult family members during childhood and neurological outcomes. Of 135 inmates, 99 (60%) had one or more incarcerated adult family members during childhood. Regression analyses revealed that having incarcerated adult family members was related to greater frequency and severity of childhood abuse and higher incidence of neurological deficits in adulthood, especially related to traumatic brain injuries, compared to those without incarcerated adult family members. Along with being role models, adult family members impact the neurological health of children throughout their life-span.