Maternal incarceration, child protection, and infant mortality: a descriptive study of infant children of women prisoners in Western Australia

Numeracy and literacy attainment of children exposed to maternal incarceration and other adversities: A linked data study

Parental incarceration has been associated with educational disadvantages for children, such as lower educational attainment, increased grade retention, and truancy and suspensions. However, children exposed to parental incarceration often experience other adversities that are also associated with educational disadvantage; the contribution of these co-occurring adversities has not been considered in previous research. This study aimed to investigate the educational outcomes of children exposed to (a) maternal incarceration alone and (b) maternal incarceration plus other adversities (i.e., maternal mental illness and/or child protective services [CPS] contact). We used linked administrative data for a sample of children whose mothers were incarcerated during the children's childhood (i.e., from the time of mother's pregnancy through the child's 18th birthday; n = 3828) and a comparison group of children whose mothers had not been incarcerated (n = 9570). Multivariate multinomial logistic regressions examined the association between exposure to the three adversities (i.e., maternal incarceration, maternal mental illness, and child CPS contact) and above or below average reading and numeracy attainment in Grades 3, 5, 7 and 9. At all grade levels, children exposed to maternal incarceration alone and those exposed to maternal incarceration plus other adversities had increased odds of below average numeracy and reading attainment and decreased odds of above average numeracy and reading attainment compared to children without any of the recorded exposures. Children exposed to maternal incarceration and CPS contact and those exposed to all three adversities had increased odds of below average reading and numeracy attainment compared to children exposed to maternal incarceration alone. The findings highlight the complex needs of children of incarcerated mothers that must be considered when designing and delivering educational support programs. These children would benefit from the implementation of multi-tiered, trauma-informed educational and clinical services.

Maternal incarceration increases the risk of self-harm but not suicide: a matched cohort study

AIMS

Children of incarcerated mothers are at increased risk of experiencing multiple adversity such as poverty, mental illness and contact with child protection services (CPS), including being taken into out of home care (OOHC). However, little is known about whether these children are at increased risk of suicide or self-harm compared to children not exposed to maternal incarceration or about the factors that may contribute to this. We aimed to investigate differences in the risk of suicide and self-harm between children exposed to maternal incarceration and those not exposed and examine how socio-demographic factors, maternal mental illness and CPS contact (with or without OOHC) may affect these outcomes.

METHODS

We used a retrospective matched cohort study design, comparing 7674 children exposed to maternal incarceration with 7674 non-exposed children. We used multivariable Cox proportional hazards regression to compare the risk of suicide and self-harm between exposed and non-exposed groups, controlling for geographical remoteness, CPS contact and maternal mental illness.

RESULTS

There was no significant difference in the rate of suicide (rate ratio [RR] = 1.49; 95% confidence interval [CI]: 0.78, 2.87) or risk of suicide (adjusted hazard ratio [aHR] = 0.92; 95% CI: 0.43, 1.96) between the two groups. However, the exposed group had a significantly higher rate of self-harm (RR = 2.83; 95% CI: 2.50, 3.21) and a significantly higher risk of self-harm (aHR = 1.74; 95% CI: 1.45, 2.09) compared to those non-exposed. CPS contact with or without OOHC was independently associated with an increased risk of self-harm for both groups.

CONCLUSION

Children exposed to maternal incarceration are at an increased risk of self-harm and should be prioritized to receive targeted, multimodal support that continues after the mother's release from prison. The association between CPS contact and self-harm warrants further research.

Child protection system involvement in children of incarcerated mothers: A linked data study

BACKGROUND

Women prisoners are a growing portion of the prison population. Health and social outcomes of their children have been studied and found to be poor, but little is known about child protection outcomes.

OBJECTIVES

Ascertain child protection system contact of children exposed to maternal incarceration.

PARTICIPANTS AND SETTING

All children born between 1985 and 2011 exposed to the incarceration of their mothers in a Western Australian correctional facility and a matched comparison group.

METHODS

A matched cohort study using linked administrative data on 2637 mothers entering prison between 1985 and 2015 and their 6680 children. We estimated hazard ratios (HRs) and incidence rate ratios (IRRs) of child protection service (CPS) contact post maternal incarceration (four concern levels), comparing rates for children exposed to maternal incarceration with a matched non-exposed group, adjusting for maternal and child factors.

FINDINGS

Exposure to maternal incarceration increased risk of CPS contact. Unadjusted HRs exposed vs unexposed children were 7.06 (95%CI = 6.49-7.69) for substantiated child maltreatment and 12.89 (95%CI = 11.42-14.55) for out-of-home care (OOHC). Unadjusted IRRs were 6.04 (95%CI = 5.57-6.55) for number of substantiations and 12.47 (95%CI = 10.65-14.59) for number of removals to OOHC. HRs and IRRs were only slightly attenuated in adjusted models.

CONCLUSIONS

Maternal incarceration is a warning flag for a child at high risk of serious child protection concerns. Family-friendly rehabilitative women's prisons, incorporating support for more nurturing mother-child relationships could provide a placed-based public health opportunity for disrupting distressing life trajectories and intergenerational pathways of disadvantage of these vulnerable children and their mothers. This population should be a priority for trauma-informed family support services.

Sex differences in suicide, suicidal ideation, and self-harm after release from incarceration: a systematic review and meta-analysis

PURPOSE

People released from incarceration are at increased risk of suicide compared to the general population. We aimed to synthesise evidence on the incidence of and sex differences in suicide, suicidal ideation, and self-harm after release from incarceration.

METHODS

We searched MEDLINE, EMBASE, PsycINFO, Web of Science and PubMed between 1 January 1970 and 14 October 2021 for suicide, suicidal ideation, and self-harm after release from incarceration (PROSPERO registration: CRD42020208885). We calculated pooled crude mortality rates (CMRs) and standardised mortality ratios (SMRs) for suicide, overall and by sex, using random-effects models. We calculated a pooled incidence rate ratio (IRR) comparing rates of suicide by sex.

RESULTS

Twenty-nine studies were included. The pooled suicide CMR per 100,000 person years was 114.5 (95%CI 97.0, 132.0, I² = 99.2%) for non-sex stratified samples, 139.5 (95% CI 91.3, 187.8, I² = 88.6%) for women, and 121.8 (95% CI 82.4, 161.2, I² = 99.1%) for men. The suicide SMR was 7.4 (95% CI 5.4, 9.4, I² = 98.3%) for non-sex stratified samples, 14.9 for women (95% CI 6.7, 23.1, I² = 88.3%), and 4.6 for men (95% CI 1.3, 7.8, I² = 98.8%). The pooled suicide IRR comparing women to men was 1.1 (95% CI 0.9, 1.4, I² = 82.2%). No studies reporting self-harm or suicidal ideation after incarceration reported sex differences.

CONCLUSION

People released from incarceration are greater than seven times more likely to die by suicide than the general population. The rate of suicide is higher after release than during incarceration, with the elevation in suicide risk (compared with the general population) three times higher for women than for men. Greater effort to prevent suicide after incarceration, particularly among women, is urgently needed.

Navigating pregnancy and early motherhood in prison: a thematic analysis of mothers' experiences

BACKGROUND

Maternal imprisonment negatively impacts mothers and their children and is likely to have lifelong and intergenerational sequelae. In many jurisdictions nationally and internationally, young children (usually those less than 5 years) can reside with their mothers in prison. However, there is considerable debate regarding the impact of prison environments on incarcerated mothers and their children who are born, and/or raised in prison. Research to date on the pregnancy and mothering experiences of imprisoned mothers and their preferences for care arrangements for their babies and young children is limited.

METHODS

This study was part of the Transforming Corrections to Transform Lives project, in which workshops were conducted with imprisoned mothers to understand their needs while in custody and post-release, and the kind of supports and system changes that are required to meet those needs. Incarcerated mothers (n = 75) participated in seven workshops conducted across four Queensland prisons. Themes were generated through reflexive thematic analysis.

RESULTS

Three themes characterised mothers' experiences of being pregnant and undertaking a mothering role of a young child while in prison. First, for most mothers, imprisonment adds vulnerability and isolation during pregnancy and childbirth. Second, although mothers felt that residing together with their children in prison motivated them to change for a better future, they were concerned about the potential negative impact of the prison environment on the child's development. Lastly, most mothers voiced losing autonomy and agency to practice motherhood independently within custodial settings. Mothers expressed a need for the correctional system to be adapted, so it is better equipped to address the unique and additional needs of mothers with young children.

CONCLUSION

Mothers' experiences indicated that the correctional system and policies, which were predominantly designed for men, do not adequately address the varied and complex needs of pregnant women, mothers, and their young children. Imprisonment of pregnant women and mothers with young children should be the last resort, and they should be provided with holistic, individually tailored support, most preferably in community settings, to address their multiple intersecting needs.

Supporting Aboriginal and Torres Strait Islander Families to Stay Together from the Start (SAFeST Start): Urgent call to action to address crisis in infant removals

Reducing the rate of over-representation of Aboriginal and Torres Strait Islander children in out-of-home care (OOHC) is a key Closing the Gap target committed to by all Australian governments. Current strategies are failing. The "gap" is widening, with the rate of Aboriginal and Torres Strait Islander children in OOHC at 30 June 2020 being 11 times that of non-Indigenous children. Approximately, one in five Aboriginal and Torres Strait Islander children entering OOHC each year are younger than one year. These figures represent compounding intergenerational trauma and institutional harm to Aboriginal and Torres Strait Islander families and communities. This article outlines systemic failures to address the needs of Aboriginal and Torres Strait Islander parents during pregnancy and following birth, causing cumulative harm and trauma to families, communities and cultures. Major reform to child and family notification and service systems, and significant investment to address this crisis, is urgently needed. The Family Matters Building Blocks and five elements of the Aboriginal and Torres Strait Islander Child Placement Principle (Prevention, Participation, Partnership, Placement and Connection) provide a transformative foundation to address historical, institutional, well-being and socioeconomic drivers of current catastrophic trajectories. The time for action is now.

The needs and experiences of mothers while in prison and post-release: a rapid review and thematic synthesis

BACKGROUND

Women in prison are a vulnerable group, often with a history of abuse, out-of-home care, mental health problems and unemployment. Many are mothers when they become involved in the criminal justice system and their gender and parenting related needs are often not considered. The aim of this rapid review was to thematically synthesize the existing research on the needs and experiences of mothers while in, and following release from, prison in Australia.

METHODS

We conducted a rapid systematic search of electronic databases, search engines, the websites of key agencies, and contacted key agencies and researchers.

RESULTS

Twenty-two publications from 12 studies met the inclusion criteria and were thematically synthesized in relation to the mothers, their children, family and community, and systems and services which mothers had contact with. We found that mothers in prison have a history of disadvantage which is perpetuated by the trauma of imprisonment. Release from prison is a particularly challenging time for mothers. In relation to their children, the included studies showed that the imprisonment of mothers impacts their maternal identity and role and disrupts the mother-child relationship. Specific strategies are needed to maintain the mother-child relationship, and to ensure the needs and rights of the child are met. In relation to family and community, we found that although family and social support is an important need of women in prison, such support may not be available. Moreover, the stigma associated with having been in prison is a significant barrier to transitions into the community, including finding employment and housing. In relation to systems and services, although limited services exist to support women in prison and on release, these often do not consider the parenting role. Evaluations of parenting programs in prison found them to be acceptable and beneficial to participants but barriers to access limit the number of women who can participate.

CONCLUSION

Mothers have gender- and parenting-specific needs which should be considered in planning for corrective services in Australia. Any service redesign must place the woman and her children at the centre of the service.

Family member incarceration and physical health problems: A longitudinal study among Australian households

This study examines the relationship between poor physical health and exposure to family member incarceration. Longitudinal data (2001–2015) from an Australian nationally representative household-based panel study was used (177,312 observations within 26,572 respondents). Hybrid random-effects models showed a strong correlation between poor physical health and family member imprisonment. However, this strong association can be explained for a large part by differences between individuals, since the association of physical health with within-individual changes in family member imprisonment was considerably lower. Nevertheless, the within-individual analyses showed that male sample members were significantly more likely to experience physical health problems in years in which they experienced family member imprisonment, compared to years in which they did not. This association was not found among females. Moreover, no effect of parental imprisonment on the physical health of young sample members was found.

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Imprisonment of a family member is strongly related to poor physical health.

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This association can be explained for a large part by time-constant confounders.

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Males have poorer health in years in which family members are imprisoned.

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Females do not have poorer health in years in which family members are imprisoned.

Holistic Conceptualizations of Health by Incarcerated Aboriginal Women in New South Wales, Australia

While there has been extensive research on the health and social and emotional well-being (SEWB) of Aboriginal women in prison, there are few qualitative studies where incarcerated Aboriginal women have been directly asked about their health, SEWB, and health care experiences. Using an Indigenous research methodology and SEWB framework, this article presents the findings of 43 interviews with incarcerated Aboriginal women in New South Wales, Australia. Drawing on the interviews, we found that Aboriginal women have holistic conceptualizations of their health and SEWB that intersect with the SEWB of family and community. Women experience clusters of health problems that intersect with intergenerational trauma, perpetuated and compounded by ongoing colonial trauma including removal of children. Women are pro-active about their health but encounter numerous challenges in accessing appropriate health care. These rarely explored perspectives can inform a reframing of health and social support needs of incarcerated Aboriginal women establishing pathways for healing.

Recidivism, health and social functioning following release to the community of NSW prisoners with problematic drug use: study protocol of the population-based retrospective cohort study on the evaluation of the Connections Program

INTRODUCTION

The rising rate of incarceration in Australia, driven by high reoffending, is a major public health problem. Problematic drug use is associated with increasing rates of reoffending and return to custody of individuals. Throughcare provides support to individuals during imprisonment through to post-release, improving both the transition to community and health outcomes post-incarceration. The aim of this study is to evaluate the Connections Programme (CP) that utilises a throughcare approach for release planning of people in prison with a history of problematic drug use. The study protocol is described.

METHODS AND ANALYSIS

Population-based retrospective cohort study. The study will use record linkage of the Connections dataset with 10 other New South Wales (NSW) population datasets on offending, health service utilisation, opioid substitution therapy, pregnancy, birth and mortality. The study includes all patients who were eligible to participate in the CP between January 2008 and December 2015 stratified by patients who were offered CP and eligible patients who were not offered the programme (non-CP (NCP)). Propensity-score matching will be used to appropriately adjust for the observable differences between CP and NCP. The differences between two groups will be examined using appropriate univariate and multivariate analyses. A generalised estimating equation approach, which can deal with repeat outcomes for individuals will be used to examine recidivism, mortality and other health outcomes, including perinatal and infant outcomes. Survival analysis techniques will be used to examine the effect of the CP by sex and Indigenous status on the 'time-to' health-related outcomes after adjusting for potential confounders.

ETHICS AND DISSEMINATION

Ethical approval was received from the NSW Population and Health Services Research Ethics Committee, the Justice Health and Forensic Mental Health Network Human Research Ethics Committee, the Aboriginal Health and Medical Research Council Ethics Committee, the Corrective Services NSW Ethics Committee and the University of Technology Sydney Human Research Ethics Committee.

Aboriginal mothers in prison in Australia: a study of social, emotional and physical wellbeing

OBJECTIVE

To describe the social, emotional and physical wellbeing of Aboriginal mothers in prison.

METHODS

Cross-sectional survey, including a Short Form Health Survey (SF-12) and Kessler Psychological Distress Scale (5-item version) administered to Aboriginal women who self-identified as mothers.

RESULTS

Seventy-seven Aboriginal mothers in New South Wales (NSW) and 84 in Western Australia (WA) participated in the study. Eighty-three per cent (n=59) of mothers in NSW were in prison for drug-related offences, 64.8% (n=46) of mothers in WA were in prison for offences committed under the influence of alcohol. Sixty-eight per cent (n=52) of mothers in NSW and 35% (n=28) of mothers in WA reported mental health problems. Physical (PCS) and Mental (MCS) component scores of SF-12 varied for mothers in NSW and WA. Mothers in NSW experienced poorer health and functioning than mothers in WA (NSW: PCS 49.5, MCS 40.6; WA: PCS 54.4, MCS 48.3) and high levels of psychological distress (NSW: 13.1; WA 10.1).

CONCLUSIONS

Aboriginal mothers in prison have significant health needs associated with physical and mental health, and psychological distress. Implications for public health: Adoption of social and emotional wellbeing as an explanatory framework for culturally secure healthcare in prison is essential to improving health outcomes of Aboriginal mothers in prison in Australia.

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.

Determinants of infant mortality for children of women prisoners: a longitudinal linked data study

BACKGROUND

There is limited information on the determinants of infant mortality outcomes for the children of women prisoners. This study aimed to explore determinants of infant mortality for Indigenous and non-Indigenous children, with a specific focus on maternal imprisonment during pregnancy as a risk factor.

METHODS

Using linked administrative data we obtained a longitudinal sample of 42,674 infants born in Western Australia between October 1985 and June 2013. Data were analysed by maternal contact with corrective services, including; (i) imprisonment during pregnancy, (ii) imprisonment before (but not during) pregnancy, (iii) imprisonment after birth, (iv) community-based correctional orders (but no imprisonment), and (v) no corrections record. Infant mortality rates were calculated. Univariate and multivariate log-binomial regression was undertaken to identify key demographic and pregnancy-related risk factors for infant mortality. Risk factor prevalence was calculated for infants by maternal corrections history.

RESULTS

430 Indigenous and 116 non-Indigenous infants died aged 0-12 months. For singletons, infant mortality rates were highest in Indigenous infants with mothers imprisoned during pregnancy (32.1 per 1000) and non-Indigenous infants whose mothers were first imprisoned after birth (14.2 per 1000). For all Indigenous children, the strongest determinants of infant mortality were: abruptio placentae and other placental disorders (RR = 2.85; 95%CI 1.46-5.59; p = 0.002), maternal imprisonment during pregnancy (RR = 2.55; 95%CI 1.69-3.86; p < 0.001), and multiple gestation (RR = 2.29; 95% CI1.51-3.46; p < 0.001). Indigenous and non-Indigenous infants with mothers imprisoned at any time, and particularly before or during pregnancy, experienced higher prevalence of key pregnancy risk factors.

CONCLUSIONS

This is the first comprehensive study of the determinants of infant mortality for children of women prisoners. Infants with any maternal corrections history, including community-based orders or imprisonment outside of pregnancy, had increased infant mortality. Indigenous infants whose mothers were imprisoned during pregnancy were at particular risk. There was a low incidence of infant death in the non-Indigenous sample which limited the investigation of the impact of the specific aspects of maternal corrections history on infant mortality. Non-Indigenous Infants whose mothers were imprisoned before or during pregnancy experienced higher prevalence of pregnancy risk factors than infants of mothers first imprisoned after birth.