Perinatal health care services for imprisoned pregnant women and associated outcomes: a systematic review

Background

Women are an increasing minority of prisoners worldwide, and most are of childbearing age. Prisons offer unique opportunities for improving the pregnancy outcomes of these high-risk women, and no systematic review to date has looked at their care. This systematic review identified studies describing models of perinatal health care for imprisoned women which report maternal and child health and care outcomes.

Methods

We systematically searched for literature published between 1980 and April 2014. Studies were eligible if they included a group of imprisoned pregnant women, a description of perinatal health care and any maternal or infant health or care outcomes. Two authors independently extracted data. We described relevant outcomes in prisons (including jails) under models of care we termed PRISON, PRISON+ and PRISON++, depending on the care provided. Where outcomes were available on a comparison group of women, we calculated odds ratios with 95 % confidence intervals.

Results

Eighteen studies were reported, comprising 2001 imprisoned pregnant women. Fifteen were in the US, two in the UK and one in Germany. Nine contained a comparison group of women comprising 849 pregnant women. Study quality was variable and outcome reporting was inconsistent. There was some evidence that women in prisons receiving enhanced prison care, PRISON+, were less likely to have inadequate prenatal care (15.4 % vs 30.7 %, p < 0 · 001), preterm delivery (6.4 % vs 19.0 %, p = 0 · 001) or caesarean delivery (12.9 % vs 26.5 %, p = 0 · 005) compared to women in prisons receiving usual care (PRISON). Women participating in two PRISON++ interventions, that is, interventions which included not only enhanced care in prisons but also coordination of community care on release, demonstrated reductions in long term recidivism rates (summary OR 0 · 37, 95 % CI 0 · 19–0 · 70) compared to pregnant women in the same prisons who did not participate in the intervention.

Conclusions

Enhanced perinatal care can improve both short and long-term outcomes but there is a lack of data. Properly designed programmes with rigorous evaluation are needed to address the needs of this vulnerable population. The cost to mothers, children and to society of failing to address these important public health issues are likely to be substantial.

Trial registration

PROSPERO registration: CRD42012002384.

Drug use and crime: a historical review of research conducted by the UCLA Drug Abuse Research Center

The UCLA Drug Abuse Research Center (DARC) has become one of the nation's most respected research organizations involved in the study of drug abuse by providing reliable, comprehensive findings. This article provides an encapsulation of the crime-related research conducted at DARC during the past quarter century. Research has focused on the correlates of drug use and criminal behavior and the effects of treatment and criminal justice interventions on subsequent drug use and criminal offending. The relationships have been examined, both directly and by statistical modeling, to assess the degree to which criminal behavior covaries with levels of drug use. The article discusses implications from the findings and makes recommendations regarding future directions for policy and research.

Treatment of substance-abusing jail inmates. Examination of gender differences

Females incarcerated for drug-related offenses represent one of the fastest growing populations within jails and prisons. The few studies of female offenders with substance abuse disorders depict a population with multiple psychosocial problems and treatment needs, and one that is characterized by frequent exposure to sexual abuse and other violence. The current study examined intake assessment results from a sample of 1,655 substance-involved jail inmates referred to a jail treatment program in Tampa, Florida, including 26% female and 74% male inmates. The study was designed to identify gender differences in psychosocial characteristics and substance abuse treatment needs among jail inmates. Results indicate that female inmates more frequently experienced employment problems, had lower incomes, more frequently reported cocaine as the primary drug of choice, and were more likely to report depression, anxiety, suicidal behavior, and a history of physical and sexual abuse. Implications for developing specialized treatment approaches for female offenders are discussed, including use of integrated treatment strategies.

Perceived need for treatment among pregnant and nonpregnant women arrestees

Previous research has noted a high rate of drug use by women arrestees. Not only are women arrestees more likely to be found drug positive by urinalysis than are men arrestees, but in recent years, in part because of drug use, women have constituted the fastest growing population segment involved with the criminal justice system. One small but important subgroup of women arrestees are those who are pregnant and, thus, who particularly need intervention. This article utilizes Drug Use Forecasting (DUF) data from Los Angeles jails to examine whether or not pregnant drug-abusing women arrestees differ from nonpregnant drug-abusing women arrestees in terms of perceived need for treatment. Bivariate analyses and multivariate logistic regression show that pregnant drug-using women are not more likely than nonpregnant women to perceive a need for treatment. Although pregnancy status is not related to perceived need, a number of other factors are related, including being single, Euro-American ethnicity, using cocaine or opioids for more than three days in the past 30 days, being self-identified as currently drug dependent, having a substance abuse treatment history, and having lower legal incomes. Interventions with drug-using women arrestees should be made early in their drug use and criminal careers and should target both pregnant and nonpregnant women.