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Prenatal care for incarcerated women

Shannon Bell, MD
Ronald E Iverson, Jr, MD
Section Editor
Vincenzo Berghella, MD
Deputy Editor
Vanessa A Barss, MD, FACOG


While the same standards of obstetric care apply whether patients are living in correctional facilities or the community, the risk factors associated with incarceration and the operating systems of correctional facilities create specific challenges to the provision of routine obstetrical care for inmates. These include difficulties with communication and transportation, implementation of care plans, follow-up of abnormal tests, and guardianship for newborns after delivery.

This topic will discuss issues encountered in caring for incarcerated pregnant women. While much of the discussion is based on data and experience from the United States, the general care principles may be applicable to other locations. Topics on general medical care in correctional facilities, general prenatal care, and the impact of incarceration on children are presented separately.

(See "Clinical care of incarcerated adults".)

(See "Prenatal care: Initial assessment".)

(See "Prenatal care: Second and third trimesters".)

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Literature review current through: Nov 2017. | This topic last updated: Dec 01, 2017.
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  1. United Nations Office on Drugs and Crime. Handbook for prison managers and policymakers on women and imprisonment, 2nd ed, United Nations, 2008. https://www.unodc.org/documents/justice-and-prison-reform/women_and_imprisonment_-_2nd_edition.pdf (Accessed on May 10, 2016).
  2. Alejandro Corda. Drug policy reform in Latin America: Discourse and reality. The Research Consortium on Drugs and the Law (CEDD), 2015. http://www.drogasyderecho.org/publicaciones/pub-priv/alejandro_i.pdf (Accessed on June 14, 2016).
  3. http://www.sentencingproject.org/wp-content/uploads/2016/02/Incarcerated-Women-and-Girls.pdf (Accessed on May 10, 2016).
  4. http://www.bjs.gov/content/pub/pdf/cpus14.pdf (Accessed on May 10, 2016).
  5. Clarke JG, Hebert MR, Rosengard C, et al. Reproductive health care and family planning needs among incarcerated women. Am J Public Health 2006; 96:834.
  6. Committee on Health Care for Underserved Women of American College Obstetricians and Gynecologists. ACOG Committee Opinion No. 511: Health care for pregnant and postpartum incarcerated women and adolescent females. Obstet Gynecol 2011; 118:1198.
  7. ACLU briefing paper: The shackling of pregnant women & girls in US prisons, jails, and youth detention centers. https://www.aclu.org/files/assets/anti-shackling_briefing_paper_stand_alone.pdf (Accessed on June 14, 2016).
  8. http://www.ncchc.org/filebin/Resources/Pregnancy-and-Postpartum-Care-2014.pdf (Accessed on May 10, 2016).
  9. Committee on Health Care for Underserved Women. Committee opinion No. 535: reproductive health care for incarcerated women and adolescent females. Obstet Gynecol 2012; 120:425.
  10. OCR privacy brief: Summary of HIPAA privacy rule. United States Department of Health and Human Services. http://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html (Accessed on June 14, 2016).
  11. Sufrin CB, Creinin MD, Chang JC. Incarcerated women and abortion provision: a survey of correctional health providers. Perspect Sex Reprod Health 2009; 41:6.
  12. Kasdan D. Abortion access for incarcerated women: are correctional health practices in conflict with constitutional standards. Perspect Sex Reprod Health 2009; 41:59.
  13. Roth R. Abortion access for imprisoned women: marginalized medical care for a marginalized group. Womens Health Issues 2011; 21:S14.
  14. https://www.ashp.org/doclibrary/bestpractices/settingsgdlcorrectional.aspx (Accessed on May 10, 2016).
  15. United States Constitution Eighth Amendment: Common interpretation. http://constitutioncenter.org/interactive-constitution/amendments/amendment-viii (Accessed on June 23, 2016).
  16. http://www.aclu.org/state-standards-pregnancy-related-health-care-and-abortion-women-prison-map (Accessed on December 13, 2011).
  17. http://www.direct.gov.uk/en/CrimeJusticeAndTheLaw/Sentencingprisonandprobation/Goingtoprison/DG_196230 (Accessed on December 13, 2011).
  18. World Health Organization. Women's health in prison. 2009.
  19. Bartels L, Gaffney A. Good practice in women's prisons: A literature review. Australia Institute of Criminology 2011.
  20. US Department of Justice. Program statement 6070.05: Birth control, pregnancy, child placement and abortion. Federal Bureau of Prisons, 1996. http://www.bop.gov/policy/progstat/6070_005.pdf (Accessed on October 10, 2011).
  21. Women's health care in correctional settings: Position statement. National Commission on Correctional Health Care, 2005. http://www.ncchc.org/filebin/Positions/Womens_Health_Care_in_Correctional_Settings.pdf (Accessed on May 10, 2016).
  22. Ferszt GG, Erickson-Owens DA. Development of an educational/support group for pregnant women in prison. J Forensic Nurs 2008; 4:55.
  23. Schroeder C, Bell J. Doula birth support for incarcerated pregnant women. Public Health Nurs 2005; 22:53.
  24. Kyei-Aboagye K, Vragovic O, Chong D. Birth outcome in incarcerated, high-risk pregnant women. J Reprod Med 2000; 45:190.
  25. Fogel CI. Pregnant inmates: risk factors and pregnancy outcomes. J Obstet Gynecol Neonatal Nurs 1993; 22:33.
  26. Egley CC, Miller DE, Granados JL, Ingram-Fogel C. Outcome of pregnancy during imprisonment. J Reprod Med 1992; 37:131.
  27. Cordero L, Hines S, Shibley KA, Landon MB. Perinatal outcome for women in prison. J Perinatol 1992; 12:205.
  28. Cordero L, Hines S, Shibley KA, Landon MB. Duration of incarceration and perinatal outcome. Obstet Gynecol 1991; 78:641.
  29. Maruschak L, Berzofsky M, Unangst J. Medical problems of state and federal prisoners and jail inmates, 2011-12. NCJ248491, Office of Justice Programs; US Department of Justice, 2015.
  30. Willers DM, Peipert JF, Allsworth JE, et al. Prevalence and predictors of sexually transmitted infection among newly incarcerated females. Sex Transm Dis 2008; 35:68.
  31. Committee opinion no: 635: Prenatal and perinatal human immunodeficiency virus testing: expanded recommendations. Obstet Gynecol 2015; 125:1544.
  32. http://www.cdc.gov/hiv/group/correctional.html (Accessed on May 10, 2016).
  33. http://www.bjs.gov/content/pub/pdf/mhppji.pdf (Accessed on May 10, 2016).
  34. Maruschak LM. Medical problems of jail inmates. US Department of Justice; Office of Justice Programs, 2006.
  35. Jordan BK, Schlenger WE, Fairbank JA, Caddell JM. Prevalence of psychiatric disorders among incarcerated women. II. Convicted felons entering prison. Arch Gen Psychiatry 1996; 53:513.
  36. Fogel CI, Martin SL. The mental health of incarcerated women. West J Nurs Res 1992; 14:30.
  37. Committee on Obstetric Practice. The American College of Obstetricians and Gynecologists Committee Opinion no. 630. Screening for perinatal depression. Obstet Gynecol 2015; 125:1268.
  38. http://www.who.int/mental_health/prevention/suicide/resource_jails_prisons.pdf (Accessed on May 10, 2016).
  39. https://suicideinfo.ca/LinkClick.aspx?fileticket=FYDhcywiI74%3D&tabid=538 (Accessed on May 10, 2016).
  40. http://www.prearesourcecenter.org/ (Accessed on May 10, 2016).
  41. Durrah TL. Correlates of daily smoking among female arrestees in New York City and Los Angeles, 1997. Am J Public Health 2005; 95:1788.
  42. http://www.bjs.gov/content/pub/pdf/dudsfp04.pdf (Accessed on May 10, 2016).
  43. Simpler A, Langhinrichsen-Rohling J. Substance use in prison: How much occurs and is it associated with psychopathology? Addict Res Theory 2005; 13:503.
  44. Mothers behind bars: A state-by-state report card and analysis of federal policies on conditions of confinement for pregnant and parenting women and the effect on their children. The Rebecca Project for Human Rights, National Women's Law Center, 2010. http://www.nwlc.org/sites/default/files/pdfs/mothersbehindbars2010.pdf (Accessed on June 16, 2016).
  45. Practice Bulletin No. 153: Nausea and Vomiting of Pregnancy. Obstet Gynecol 2015; 126:e12.
  46. Best practices in the use of restraints with pregnant women and girls under correctional custody, 2014. US Department of Justice, Bureau of Justices Associates, Center for Effective Public Policy, 2014. http://www.nasmhpd.org/sites/default/files/Best_Practices_Use_of_Restraints_Pregnant(2).pdf (Accessed on May 10, 2016).
  47. Bill text 105th Congress (1997-1998), the Library of Congress. June 24, 2010. https://www.congress.gov/bill/105th-congress/house-bill/2281 (Accessed on October 04, 2016).
  48. Amnesty International. Pregnant and imprisoned in the United States. Birth 2000; 27:266.
  49. http://www.aclu.org/reproductive-freedom/pregnancy-related-health-care-prison (Accessed on October 18, 2011).
  50. Second chance act of 2007: Community safety through recidivism prevention. http://research.policyarchive.org/13999.pdf (Accessed on October 04, 2016).
  51. Hall RC, Friedman SH, Jain A. Pregnant Women and the Use of Corrections Restraints and Substance Use Commitment. J Am Acad Psychiatry Law 2015; 43:359.
  52. Knight M, Plugge E. The outcomes of pregnancy among imprisoned women: a systematic review. BJOG 2005; 112:1467.
  53. Martin SL, Rieger RH, Kupper LL, et al. The effect of incarceration during pregnancy on birth outcomes. Public Health Rep 1997; 112:340.
  54. Howard DL, Strobino D, Sherman SG, Crum RM. Timing of incarceration during pregnancy and birth outcomes: exploring racial differences. Matern Child Health J 2009; 13:457.
  55. Howard DL, Strobino D, Sherman SG, Crum RM. Maternal incarceration during pregnancy and infant birthweight. Matern Child Health J 2011; 15:478.
  56. Howard DL, Strobino D, Sherman S, Crum R. Within prisons, is there an association between the quantity of prenatal care and infant birthweight? Paediatr Perinat Epidemiol 2008; 22:369.
  57. Martin SL, Kim H, Kupper LL, et al. Is incarceration during pregnancy associated with infant birthweight? Am J Public Health 1997; 87:1526.
  58. Laughlin H. Eugenical sterilization in the United States. Municipal Court of Chicagoc 1922. https://repository.library.georgetown.edu/bitstream/handle/10822/556984/EugenicalSterilizationInTheUS.pdf (Accessed on October 04, 2016).
  59. Kline W. From segregation to sterilization: Changing approaches to the problem of female sexuality. In: Building a Better Race: Gender, Sexuality, and Eugenics from the Turn of the Century of the Baby Boom, University of California Press, Berkeley 2001.
  60. Clarke JG, Rosengard C, Rose JS, et al. Improving birth control service utilization by offering services prerelease vs postincarceration. Am J Public Health 2006; 96:840.
  61. Clarke JG, Phipps M, Tong I, et al. Timing of conception for pregnant women returning to jail. J Correct Health Care 2010; 16:133.
  62. Sufrin CB, Tulsky JP, Goldenson J, et al. Emergency contraception for newly arrested women: evidence for an unrecognized public health opportunity. J Urban Health 2010; 87:244.
  63. Glaze LE, Maruschak LM. Special report: Parents in prison and their minor children, 2008. http://bjs.ojp.usdoj.gov/content/pub/pdf/pptmc.pdf (Accessed on October 10, 2011).
  64. Margolies JK, Kraft-Stolar T. When “Free” Means Losing Your Mother: The Collision of Child Welfare and the Incarceration of Women in New York, Correction Association of New York Women in Prison Project, 2006.