Corrections officers' knowledge and perspectives of maternal and child health policies and programs for pregnant women in prison

Use of Shackles on Incarcerated Pregnant Women

The United States has the largest population of prisoners worldwide, and profound racial and structural inequities exist within this population. Qualitative and quantitative data suggest that shackling incarcerated pregnant women occurs in the United States despite anti-shackling legislation and recommendations from professional organizations against shackling. Incarcerated women are vulnerable to adverse health outcomes when shackled during labor, birth, and the postpartum period. Because anti-shackling legislation is often nonexistent or not comprehensive, nurses play a critical patient advocacy role. The purpose of this article is to increase awareness of state anti-shackling legislation and deficiencies. We also aim to promote effective state advocacy and meaningful change in clinical practice to improve patient safety and health care quality for incarcerated pregnant women.

Experiences of midwifery care in English prisons

BACKGROUND

In the United Kingdom (UK), all prisoners must receive healthcare equivalent to that available in the community. However, evidence suggests that equality in healthcare provision for perinatal women in UK prisons is not always achieved. The aim of this research was to examine pregnant women prisoners' and custody staffs' experiences and perceptions of midwifery care in English prisons.

METHODS

A qualitative approach based on institutional ethnography was used to research women's experiences in three English prisons over a period of 10 months. In total, 28 women participated in audio-recorded, semi-structured interviews. Ten staff members were interviewed, including six prison service staff and four health care personnel. Ten months of prison fieldwork enabled observations of everyday prison life. NVivo was used for data organization with an inductive thematic analysis method.

RESULTS

Women's experiences included: disempowerment due to limited choice; fear of birthing alone; and a lack of information about rights, with a sense of not receiving entitlements. Some women reported favorably on the continuity of midwifery care provided. There was confusion around the statutory role of UK midwifery.

DISCUSSION

Experiences of perinatal prisoners contrast starkly with best midwifery practice-women are unable to choose their care provider, their birth companions, or their place of birth. In addition, a reliance upon "good behavior" in return for appropriate treatment may be detrimental to the health, safety, and well-being of the pregnant woman and her unborn baby.

CONCLUSION

Prison is an adverse environment for a pregnant woman. This study provides key insights into imprisoned women's experiences of midwifery care in England and shows that midwives play an essential role in ensuring that perinatal prisoners receive safe, high-quality, respectful care.

An integrative literature review of substance use treatment service need and provision to pregnant and postpartum populations in carceral settings

Pregnancy is a critical time to provide access to substance use treatment; this is especially true among incarcerated populations, who are known to be at particularly high risk of poor health outcomes. In this integrated literature review, we (1) report what is known about the prevalence of substance use among incarcerated pregnant and postpartum populations; (2) describe substance use treatment programs and current care practices of pregnant and postpartum populations in carceral settings; and (3) explore recommendations and strategies for increasing access to substance use treatment for incarcerated pregnant and postpartum populations. A comprehensive search of seven electronic databases yielded in the retrieval of 139 articles that were assessed for inclusion. Of the retrieved articles, 33 articles met criteria for inclusion in this review. A review of the literature revealed that the understanding of substance use prevalence among pregnant incarcerated women is limited. We also found that treatment of substance use disorders among pregnant and postpartum populations is not routinely available, enhanced perinatal services are sorely needed, and substance use treatment programs are feasible with the help of community partnerships. More research is required to understand current substance use treatment initiatives and outcomes for pregnant women in prison. In addition, strategies for integrating evidence-based, substance use treatment in carceral settings is also needed. Future directions are discussed.

Enhanced Perinatal Programs for People in Prisons: A Summary of Six States' Programs

Purpose

The purpose of this study was to examine enhanced perinatal support programs for pregnant and postpartum people in six state prisons, describe the service components offered by each program, and discuss similarities and differences of services offered between programs.

Methods

In-depth, semi-structured interviews were conducted with each program's site lead(s) in order to collect information regarding each program's historical context, conception, and key aspects of the implementation of service components offered at each site.

Results

Program components fell into five broad categories: group-based education and support, one-on-one support, labor and birth support, lactation facilitation and support, and other support services. Results highlight similarities and differences within and across programs and common themes that govern program success.

Conclusions

This study provides an initial understanding of the variation in enhanced perinatal programming in six state prisons and offers insights for other states interested in establishing these types of programs. These programs implemented individual components piecemeal to fit site-specific context and needs, instead of adopting the entirety of another program model. Programs' success was largely dependent upon collaboration between program facilitators and partnering prison sites.

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.

Assessing the effectiveness of problem-solving courts on the reduction of overdose deaths in the United States: A difference-in-difference study

BACKGROUND

Criminal justice-involved populations are disproportionately more likely to have an active substance use disorder (SUD) and experience a fatal overdose. One way the criminal justice system connects individuals with SUDs to treatment is through problem-solving drug courts designed to divert offenders into treatment. The aim of this study is to assess the effect of drug court implementation on drug overdoses in U.S counties.

METHODS

A difference-in-difference analysis of publicly available data on problem-solving courts and monthly, county-level overdose death data, was completed to understand the difference in number of overdose deaths per county per year for counties with a drug court and those without. The time frame was 2000-2012, which included 630 courts serving 221 counties.

RESULTS

There was a significant effect of drug courts in reducing county overdose mortality by 2.924 (95% CI: -3.478 - -2.370), after controlling for annual trends. Additionally, having a higher number of outpatient SUD providers in the county (coefficient 0.092, 95% CI: 0.032 - 0.152), a higher proportion of uninsured population (coefficient 0.062, 95% CI: 0.052-0.072), and being in the Northeast region (coefficient 0.51, 95% CI: 0.313 - 0.707), was associated with higher county overdose mortality.

CONCLUSIONS

When considering responses to SUDs, our findings point towards drug courts as a useful component of a compendium of strategies to address opioid fatalities. Policymakers and local leaders who wish to engage the criminal justice system in efforts to address the opioid epidemic should be aware of this relationship.

Pregnancy and childbirth during incarceration: A qualitative systematic review of lived experiences

BACKGROUND

Incarcerated individuals who experience pregnancy or childbirth in correctional facilities face unique considerations for obstetric care and consequently are at greater risk of adverse maternal and fetal outcomes.

OBJECTIVES

To characterise patient experiences regarding pregnancy and childbirth during incarceration via qualitative synthesis.

SEARCH STRATEGY

Medline-OVID, EMBASE, CINAHL, Sociological Abstracts, Social Work Abstracts, Web of Science, Scopus and PsycInfo were systematically searched from inception to 24 December 2020. Supplementary searches were performed using the Scopus database.

SELECTION CRITERIA

Only original, peer-reviewed literature was examined. Eligible studies were assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research.

RESULTS

After screening 4173 original database citations, 24 studies that met inclusion criteria were included and analysed via thematic analysis. The 24 studies included perspectives from 645 female patients who had experienced incarceration, 69 healthcare providers and 70 prison staff. Key patient-reported concerns for the well-being of pregnant individuals during incarceration included mental health challenges, dehumanisation of prenatal care and delivery, lack of privacy, stigma, psychological trauma, lack of emotional support and shackle usage during pregnancy and/or labour. The studies reported a lack of support for patients to access female correctional officers or guards, privacy during intimate examinations, timely medical care and support for breastfeeding. Above all, the psychological trauma of separation from one's newborn after birth was of utmost devastation.

CONCLUSIONS

Our systematic review highlights the dire need for accountability and interventions to improve pregnancy and childbirth care for incarcerated individuals.

TWEETABLE ABSTRACT

This systematic review describes lived experiences of pregnancy & childbirth during incarceration, including dehumanisation, psychological trauma, and use of shackles.

A study of SARS-COV-2 outbreaks in US federal prisons: the linkage between staff, incarcerated populations, and community transmission

Background

Since the novel coronavirus SARS-COV-2 was first identified to be circulating in the US on January 20, 2020, some of the worst outbreaks have occurred within state and federal prisons. The vulnerability of incarcerated populations, and the additional threats posed to the health of prison staff and the people they contact in surrounding communities underline the need to better understand the dynamics of transmission in the inter-linked incarcerated population/staff/community sub-populations to better inform optimal control of SARS-COV-2.

Methods

We examined SARS-CoV-2 case data from 101 non-administrative federal prisons between 5/18/2020 to 01/31/2021 and examined the per capita size of outbreaks in staff and the incarcerated population compared to outbreaks in the communities in the counties surrounding the prisons during the summer and winter waves of the SARS-COV-2 pandemic. We also examined the impact of decarceration on per capita rates in the staff/incarcerated/community populations.

Results

For both the summer and winter waves we found significant inter-correlations between per capita rates in the outbreaks among the incarcerated population, staff, and the community.

Over-all during the pandemic, per capita rates were significantly higher in the incarcerated population than in both the staff and community (paired Student’s t-test p = 0.03 and p < 0.001, respectively). Average per capita rates of incarcerated population outbreaks were significantly associated with prison security level, ranked from lowest per capita rate to highest: High, Minimum, Medium, and Low security.

Federal prisons decreased the incarcerated population by a relative factor of 96% comparing the winter to summer wave (one SD range [90%,102%]). We found no significant impact of decarceration on per capita rates of SARS-COV-2 infection in the staff community populations, but decarceration was significantly associated with a decrease in incarcerated per capita rates during the winter wave (Negative Binomial regression p = 0.015).

Conclusions

We found significant evidence of community/staff/incarcerated population inter-linkage of SARS-COV-2 transmission. Further study is warranted to determine which control measures aimed at the incarcerated population and/or staff are most efficacious at preventing or controlling outbreaks.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12813-w.

Association Between Social Adaptability Index Score and Lifetime Criminal Legal Involvement in U.S. Adults

Background

Exposure to the criminal legal system is associated with negative health outcomes and profound socioeconomic health disparities. The social adaptability index (SAI) is a validated composite scale based on five indicators of socioeconomic status; a higher score predicts better health outcomes. However, little is known about the relationship between cumulative social risk factors as measured by the SAI and lifetime criminal legal involvement (CLI).

Methods

Using a cross-sectional, nationally representative sample of U.S. adults, we calculated SAI score by lifetime CLI status, and used logistic regression with predictive margins to calculate risk of lifetime CLI by SAI quartile adjusting for demographic and clinical covariates.

Results

A total of 213,678 participants were included, among whom 16.8% reported lifetime CLI. Mean SAI score was lower among those with lifetime CLI compared with those without (7.77, 95% confidence interval [CI]: 7.72–7.83 vs. 8.52, 95% CI: 8.50–8.55). There was a linear association between SAI quartile and predicted probability of lifetime CLI: first quartile: 23.9% (95% CI: 23.0–24.7); second quartile: 19.2% (95% CI: 18.6–19.8); third quartile: 17.5% (95% CI: 16.9–18.1); and fourth quartile: 12.5% (95% CI: 12.1–13.0).

Conclusion

The SAI score is associated in a reverse linear manner with lifetime risk of CLI, suggesting that to successfully improve health outcomes among those with CLI, interventions may need to target multiple SAI components simultaneously. Interventions that successfully position individuals to achieve higher social adaptability by targeting multiple factors may reduce the health-harming effects of exposure to the criminal legal system.

O VALOR VITAL DO ALEITAMENTO MATERNO PARA MULHERES CUSTODIADAS

RESUMO Objetivo: compreender as percepções dos valores do aleitamento materno para lactantes custodiadas pelo sistema penal. Método: pesquisa qualitativa e fenomenológica, baseada nos valores schelerianos, com realização de sete entrevistas fenomenológicas com lactantes privadas de liberdade, na unidade prisional feminina do Rio de Janeiro, Brasil. As entrevistas foram realizadas entre novembro 2020 e maio de 2021. Após transcrições das falas, sucedeu-se à análise de conteúdo para o tratamento dos resultados. Resultados: identificaram-se duas categorias para o valor vital: o valor do vínculo como processo de expansão; a lactante como valor de segurança e proteção para o bebê. Por meio da percepção das lactantes privadas de liberdade, o valor vital identificado atua como proteção ao aleitamento materno dentro do espaço prisional, fortalecendo a saúde da mulher e criança. Conclusão: ao desvelar o valor vital, observa-se que este está relacionado à vida cotidiana da mãe e do bebê dentro do cárcere. Entretanto, a instituição prisional não satisfaz as reais necessidades vitais das lactantes custodiadas, sendo, então, necessário redirecionar a prática da amamentação no espaço prisional, transformando-o em ambiente legítimo, que valorize os sentidos do ato de amamentar.

THE VITAL VALUE OF BREASTFEEDING FOR IMPRISONED WOMEN

ABSTRACT Objective: to understand the perceptions about the values of breastfeeding for nursing mothers under custody of the penitentiary system. Method: a qualitative and phenomenological research study based on the Schelerian values, with seven phenomenological interviews conducted with nursing mothers deprived of their freedom in a women's prison unit from Rio de Janeiro, Brazil. The interviews took place between November 2020 and May 2021. Content analysis for treatment of the results was performed after transcribing the testimonies. Results: two categories were identified for the vital value: The value of bonding as a breastfeeding expansion process; and The nursing mother as a safety and protection value for the infant. Through the perception of the nursing mothers deprived of their freedom, the vital value identified acts as protection for breastfeeding within the prison setting, strengthening the woman's and child's health. Conclusion: by unveiling the vital value, it is observed that it is related to the mother's and infant's everyday life in prison. However, the prison institution does not meet the real vital needs of imprisoned nursing mothers, with the consequent need to redirect the breastfeeding practice in the prison setting, transforming it into a legitimate environment that values the meaning of breastfeeding.

Testing an evidence-based drug abuse and violence preventive approach adapted for youth in juvenile justice diversionary settings

BACKGROUND

Universal school-based prevention programs for alcohol, tobacco, and other drug use are typically designed for all students within a particular school setting. However, it is unclear whether such broad-based programs are effective for youth at risk for substance use and violence in juvenile justice settings.

METHOD

The present study tested the feasibility, appropriateness, and efficacy of a preventive intervention to reduce risk factors for substance use and delinquency among youth in juvenile justice diversionary settings by promoting positive youth development and building personal strengths and prosocial relationships. Participants in the study (N = 288) were predominantly male (69%) and in the 9th grade (14 years old) or higher (91%), received the preventive intervention, and completed confidential questionnaires at the pre-test and post-test.

RESULTS

The majority of youth who participated in the intervention rated the program topics (77.9%) and activities (72%) as appropriate for their age, would recommend it to their peers (73.6%), and would use the skills learned in the future (85.4%). Comparison of post-test adjusted means revealed that the prevention program had a significant positive impact on key knowledge, attitudes, and skills including goal-setting, stress-management, and communication skills.

CONCLUSIONS

The findings indicate that an evidence-based prevention approach adapted for youth diversionary settings can be effectively implemented and well-received by participating youth, and can produce positive changes in psychosocial skills and protective factors known to prevent multiple risk behaviors among youth. Future efforts to implement substance use prevention in community juvenile justice settings may benefit from highlighting a positive youth development, skills-based approach.