Programs for Pregnant Women During and After Incarceration

Background and Purpose: Approximately 70% of women who are incarcerated have children under age 18 and are more likely than men to act as their child’s primary caregiver prior to incarceration. Additionally, 6-10% of women are pregnant upon incarceration with elevated biopsychosocial risks for pre-term births, miscarriages, and delivery of infants with low birth weights. Programs to support pregnant women during and after incarceration carry potential to improve outcomes for mothers and infants; however, there is limited systematic understanding of the types and effectiveness of such programs in the United States. To address this gap, particularly in light of continued high rates of incarceration of women and race-related disproportionality in these rates, this scoping review examines programs and services available in the U.S. for pregnant women who are currently incarcerated or within one year of returning to the community.

Methods: Journal articles focused on programs and services for pregnant adult women ages 18-44 who were incarcerated in U.S. jails and prisons or within one year of community return. Articles that evaluated program effectiveness also met inclusion criteria. The scope of this review included all geographic locations within the U.S. and considered programs in jails, prisons, and communities. Searches were conducted in PubMed and EMBASE databases and identified 1,706 relevant citations published between 1990 and 2018. Two independent reviewers screened 1,082 articles that met inclusion criteria based on title and abstract. The two sets of results were then independently screened by two content experts. Any discrepancies were resolved as a research team utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This process resulted in a final citation list of 21 articles. The literature was reviewed using a thematic synthesis framework.

Results: Six programmatic themes emerged from the 21 articles: (1) case management programs, (2) prison nursery programs, (3) parenting classes, (4) prenatal and perinatal healthcare services, (5) community residential care programs, and (6) doula support programs. Overall, the findings indicate that there are limited services for pregnant women who are incarcerated or returning to the community. Evaluation research suggests promising implications of prison nursery programs and doula support programs in promoting positive outcomes for mothers and infants.

Conclusions and Implications: Programs that assess and meet the specific needs of pregnant women who are incarcerated or returning to the community are urgently required. Additional intervention research focused on this population of women and infants who face numerous biopsychosocial risks is crucial to improve immediate and long-term health and quality of life across generations of families.