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MEDICAL YEAR
IN REVIEW

The Potential Implications of

Maternal Incarceration on Childbirth Outcomes:

The State of Women in the American Prison System

By Philip Whalen MS, OMS III; Chinazaekpele Nweke OMS III; Charley Meadows MS, OMS III; Josephine Sinamano MS, OMS III;
Valentina Bustamante OMS III

Introduction
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As of 2016, there were 111,616 incarcerated women in the United improvements in their child’s fetal birth weight and overall health. As
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States, and an estimated 6-10% were pregnant. The National Com- a whole, this indicates that incarceration may actually prevent harmful
mission on Correctional Health Care (NCCHC) and the American and addictive behaviors that negatively impact mothers and children.
Public Health Association (APHA) defined standards of care for in-
carcerated pregnant women. However, there is no agency that enforces Preterm Birth
these standards resulting in women receiving poor nutrition, lack of Preterm birth is defined as the birth of a fetus before 37 weeks ges-
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exercise, unsanitary living space and little or poor prenatal care. In this tation. According to the Center for Disease Control and Prevention
article, we will be examining the effects of maternal incarceration on (CDC), babies born prematurely are more likely to decease or suffer
childbirth outcomes by looking at three determinants of childbirth suc- from respiratory problems, feeding issues, developmental sluggish-
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cess, as well as the long-term effect on children’s mental health, to pro- ness, vision problems, cerebral palsy or hearing problems. It has been
vide evidence for the need for strict regulation of adequate prenatal speculated that maternal incarceration results in increased risk of
care for incarcerated women. The outcomes examined include birth preterm births.
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weight, the incidence of preterm birth, and the fetal outcomes of infant Shapiro-Mendoza et al., stated that in the United States, preterm
mortality, miscarriage and abortion. birth was the leading cause of death and morbidity of newborns. In
2013, preterm birth was responsible for about 36% of the 8,470 infant
Birth Weight deaths. Some conditions seen in children born prematurely include
Low birthweight is defined as a newborn weighing less than 5 necrotizing enterocolitis, intraventricular hemorrhage, decreased
pounds, 8 ounces or 2,500 grams. The average weight of a newborn school performance, developmental sluggishness and respiratory dis-
child is roughly 8 pounds. While low birth weight may be associated tress syndrome. The risk factors found to increase preterm birth are ad-
with developmental abnormality, this isn’t necessarily a given as some vanced maternal age, low socioeconomic class, recreational drug and
underweight newborns do not have developmental abnormalities. Few tobacco use, high or low Body Mass Index (BMI), multiple gestations,
studies concluded that incarceration during the first trimester led to a previous preterm birth, pregnancy complications (placenta abruption,
decreased birth weight; however, this effect was minimal. In contrast, polyhydramnios, oligohydramnios), and maternal medical disorders
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no correlation has been found in women initially incarcerated during (thyroid disease, asthma, etc.).
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the second and third trimester. This is exemplified by a two-year-long Sufrin et al. conducted a study on pregnant women in prisons and
cross-sectional study of pregnant females incarcerated in Texas state found that out of 753 live births, 6% were preterm. In another study,
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prisons, that reported no children born with low birth weight born by Sufrin et al concluded that out of 224 pregnancies that occurred in
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mothers entering prison past 34-week gestation. Overall, studies jails, 64% resulted in live births, and of them 8% were preterm births.
demonstrated that there is no strong correlation between maternal in- According to Shapiro-Mendoza et al., the risk of preterm birth could
carceration and low birth weight. 4 be minimized by increasing access to preconception care services to
Kyei-Aboagye, K. et al. concluded that the prison environment, women of childbearing age ensuring that they enter pregnancy in peak
which provided limited access to controlled substances and adequate health. They also highlighted the need for early identification of
prenatal care improved fetal and maternal outcomes of expectant moth- women who have an increased risk and providing them with additional
ers. For example, they found that many women who admitted to smok- prenatal care. For example, women with a history of preterm birth
ing and/or using recreational drugs prior to going to prison had should be given 17 alpha-hydroxyprogesterone caproate which helps

26 SAN ANTONIO MEDICINE • December 2021