16 Maternal Health in Prison and Jails

This chapter is based on the Social Ecological Model.

In recent years, the number of incarcerated women in the United States prison system has increased. According to Budd (2024), “the number of incarcerated women has increased by more than 585%, from 26,326 in 1980 to 180,684 in 2022.” Additionally, many incarcerated women have adverse perinatal outcomes, such as miscarriage and infants with low birth weights. One reason is lack of prenatal care policies in correctional facilities (Roh, 2022).

According to a study conducted by Miller-Bedell (2021), giving birth in prison or jail puts both the expecting mother and her unborn child at risk for health issues, such as higher infant mortality rates, birth defects, and higher maternal mortality ratios. This study also found that incarcerated women are seven times more likely to experience mental health issues when compared to non-incarcerated women. Mental health issues, such as depression and anxiety, can contribute to preterm birth and delays in a child’s development. Because of potential complications associated with these conditions, an incarcerated mother’s mental state may have a long-term impact on her unborn child’s well-being (Miller-Bedell, 2021). Additionally, the physical and psychosocial needs of pregnant incarcerated women vary by facility and are often inadequate. These needs may include support programs, proper nutrition, and work and rest accommodations (Wilson et al., 2022). While incarcerated women face many challenges, there are still several ways to provide them with quality maternal care.

Individual

Contributing factors to health issues for incarcerated pregnant women can include inadequate prenatal care, lack of mental health resources, stigma about being pregnant while incarcerated, and trauma from being restrained during labor (Hendricks et al., 2024). According to Johnson (2023), studies show that when a mother has high levels of stress hormones, her baby’s amygdala may be more active, which leads to increased anxiety. Additionally, when a mother has depression, her baby’s brain has less activity between the areas of the brain that control emotions (Johnson, 2023).

In order to improve health outcomes for both an incarcerated mother and her unborn child, mothers can participate in mental well-being programs, such as the Seeking Safety and Skills Training in Affective and Interpersonal Regulation program or STAIR (Tripodi et al., 2022). STAIR is a cognitive behavioral intervention that uses teaching modules to provide incarcerated women with the skills necessary to manage mental health conditions. Program benefits include increased coping skills and decreased anxiety, depression, and post-traumatic stress disorder (PTSD) (Tripodi et al., 2022). Mental health screenings should be conducted during the pregnancy and postpartum periods, allowing for early interventions for any mental health issues (American College of Obstetricians and Gynecologists, 2025). These screenings can decrease negative pregnancy outcomes, such as premature delivery (Nair et al., 2021).

Relationship

Pregnant incarcerated women need support to improve both physical and psychological health outcomes. Renbarger et al. (2021) found that social support is a protective factor for pregnant women. Additionally, social support reduces anxiety by providing encouragement, decreasing stress, and improving self-esteem (Renbarger et al., 2021). Programs like the Minnesota Prison Doula Project (MnPDP) provide this support (MnPDP). This program offers pregnant incarcerated women with a trained professional known as a doula. These doulas offer psychological, physical, and informational support during pregnancy (MnPDP, n.d.). According to a study by Wilson et al. (2023), the MnPDP also offers Pregnancy and Beyond and Mothering Inside, both support groups that aim to provide parental education for incarcerated mothers. The authors found that program participants wanted to join the Pregnancy and Beyond group because they “‘heard that the group was supportive and helpful to other people…so they wanted to come in and experience that’” (Wilson et al., 2023). The MnPDP also offers one-on-one counseling, which teaches inmates how to cope with their situation and attempts to improve successful reentry once released from their correctional facility. These resources help incarcerated mothers become more confident in their parenting skills and build healthier relationships with others (MnPDP, n.d.).

Community

The prisons can and should implement interventions that target environmental risk factors for maternal health, such as nutrition. Organizations such as the United States Department of Agriculture (USDA) and the United States Department of Health & Human Services (HHS) provide guidelines to educate women on their nutritional needs during pregnancy. These guidelines state that during pregnancy, women should increase their intake of nutrients such as folic acid, iron, iodine, and choline (USDA & HHS, 2020). However, a study by Dallaire et al. (2017) found that correctional facilities often have limited food options that do not meet the recommended intake levels of many vitamins and nutrients, including iron. Because poor diets can lead to anemia, hemorrhage, stillbirth, and other adverse health outcomes, it is necessary to address maternal nutrition in prisons and jails (United Nations Children’s Fund [UNICEF], n.d.; Delaire et al., 2017).

One program that accomplishes this is the William and Mary Healthy Beginnings Program, or W&M HBP. This program utilizes qualified community volunteers to provide nutritional counseling to pregnant women in correctional facilities. The women were tested on background nutrition knowledge and then enrolled in various educational sessions that lasted approximately an hour (Delire et al., 2017).  Volunteers held one-hour-long sessions where they reviewed participants’ nutrition goals, provided educational information about the benefits of vitamins and minerals during pregnancy, and encouraged healthy eating habits using MyPlate (Delaire et al., 2017),. Study participants experienced improved pregnancy lengths, higher birth weights, and a generally increased knowledge about nutrition and pregnancy. While participants still had limited food choices, the W&M HBP program allowed them to consider the quality of their diet both during and after pregnancy (Delaire et al., 2017).

Societal

In addition to poor nutrition, pregnant incarcerated women often experience shackling during childbirth. According to Dufresne (2023), the use of shackles during childbirth can result in limited mobility, decreased ability to bond with one’s baby, adverse psychological effects, and a higher risk of blood clots. This study also found that, oftentimes, correctional officers view pregnant incarcerated women as “aggressive,” and they may use shackles even if the individual does not have a history of violence. This perspective towards this population may be rooted in racist beliefs, as women of color represent over two-thirds of incarcerated women (Dufresne, 2023). The use of shackles during labor can result in trauma for these women. One pregnant prisoner described her experience with shackles, stating that she “felt like a farm animal.” Anti-shackling laws exist in 22 states but are not consistently enforced (Dufresne, 2023).

While these laws prohibit the use of shackles for pregnant inmates, officers can use them if they deem the individual a “threat to themselves or others” (Kramer et al., 2022). In order to decrease the chance of the inmate falling, shackles should not restrict leg movement (Brawley & Kurnat-Thoma, 2024). Healthcare providers, especially nurses, have a key role in preventing adverse health outcomes for pregnant women in prison or jail. They can notify the hospital if they witness the use of shackles for pregnant inmates. Additionally, they can inform the correctional officers about the many health risks of shackling pregnant women  (Brawley & Kurnat-Thoma, 2024).

In 2023, Congress introduced the Pregnant Women in Custody Act, but it did not reach a vote.  This law would require correctional facility employees and health personnel to receive education regarding the dangers of restraints and alternative methods they can use. In addition, the law would provide pregnant women in correctional facilities with prenatal education, which includes information about breastfeeding, family preservation support services, nutritional needs for mom and baby, and pregnancy and childbirth complications (United States House of Representatives, 2023).  Advocates need to continue to promote the intentions of the law until the US Congress can pass it.

Resources

American College of Obstetricians and Gynecologists. (2025) Implementing perinatal mental health screening. https://www.acog.org/programs/perinatal-mental-health/implementing-perinatal-mental-health-screening

Brawley, V., & Kurnat-Thoma, E. (2023). Use of shackles on incarcerated pregnant women. JOGN Nursing, 53(1), 79–91. https://doi.org/10.1016/j.jogn.2023.09.005

Budd, K. (2024). Incarcerated women and girls. The Sentencing Project. https://www.sentencingproject.org/fact-sheet/incarcerated-women-and-girls/

Dallaire, D. H., Forestell, C., Kelsey, C., Ptachick, B., & MacDonnell, K. (2017). A nutrition-based program for pregnant incarcerated women. Journal of Offender Rehabilitation, 56(4), 277–294. https://doi.org/10.1080/10509674.2017.1306008

Dufresne, L. (2023). Pregnant prisoners in shackles. Voices in Bioethics, 9. https://doi.org/10.52214/vib.v9i.11638

Hendricks, C. A., Rajagopal, K. M., Sufrin, C. B., Kramer, C., & Jiménez, M. C. (2024). Mental health, chronic and infectious conditions among pregnant persons in US state prisons and local jails, 2016–2Women’s S Health, 20. https://doi.org/10.1177/17455057241228748

Kramer, C., Thomas, K., Patil, A., Hayes, C. M., & Sufrin, C. B. (2022). Shackling and pregnancy care policies in US prisons and jails. Maternal and Child Health Journal, 27(1), 186–196. https://pmc.ncbi.nlm.nih.gov/articles/PMC9660187/

Miller-Bedell, E. R., Sie, L., Carmichael, S. L., Matoba, N., Weiner, Y., Kim, J. J., Anoshiravani, A., Seidman, D., Lyell, D. J., & Lee, H. C. (2024). Birth outcomes of individuals who have experienced incarceration during pregnancy. Nature News. https://doi.org/10.1038/s41372-024-02170-4

Minnesota Prison Doula Project. (n.d.). What we do. https://www.mnprisondoulaproject.org/about

Nair, S., McGreevy, J. E., Hutchinson-Colas, J., Turock, H., Chervenak, F., & Bachmann, G. (2021). Pregnancy in incarcerated women: need for national legislation to standardize care. Journal of Perinatal Medicine, 49(7), 830–836. https://doi.org/10.1515/jpm-2021-0145

Renbarger, K. M., Place, J. M., & Schreiner, M. (2021). The influence of four constructs of social support on pregnancy experiences in group prenatal Women’s Health Reports, 2(1), 154–162. https://doi.org/10.1089/whr.2020.0113

Roh, A. (2022). Forced to give birth alone: How prisons and jails neglect pregnant people who are incarcerated. Columbia University Mailman School of Public Health. https://www.publichealth.columbia.edu/news/forced-give-birth-alone-how-prisons-jails-neglect-pregnant-people-who-are-incarcerated

Tripodi, S. J., Killian, M. O., Gilmour, M., Curley, E., & Herod, L. (2022). Trauma-informed care groups with incarcerated women: An alternative treatment design comparing seeking safety and STAIR. Journal of the Society for Social Work and Research, 13(3), 511–531. https://doi.org/10.1086/712732

United Nations Children’s Fund [UNICEF]. (n.d.). Maternal nutrition. https://www.unicef.org/nutrition/maternal#:~:text=During%20pregnancy%2C%20poor%20diets%20lacking,and%20developmental%20delays%20for%20children

United States Congress (2023). Pregnant Women in Custody Act, H.R.982, 118th Cong. https://www.congress.gov/bill/118th-congress/house-bill/982

US Department of Agriculture & US Department of Health and Human Services [USDA & HHS]. (2020). Dietary Guidelines for Americans, 2020-2025. https://DietaryGuidelines.gov

WebMD Editorial Contributor. (2023, April 19). Does a mother’s mental health affect pregnancy? WebMD. https://www.webmd.com/baby/does-a-mothers-mental-health-affect-pregnancy

Wilson, S. H., Marsh, L. N., Zielinski, M., Corbett, A., Siegler, A., & Shlafer, R. (2022). Enhanced perinatal programs for people in prisons: A summary of six states’ programs. Journal of Criminal Justice, 83, 101965. https://doi.org/10.1016/j.jcrimjus.2022.101965