A3

Assignment 3 1630737 University of Washington SPH 380, AA

Among incarcerated women, 5 – 10% are pregnant,1 with 90% giving birth while in prison.2 This subgroup is at increased risk for poor prenatal care, stress, anxiety, major depression and substance abuse, which in turn increase the chances for preterm delivery, miscarriage, low birth weight, and other fatal conditions to the mother and baby.1-3 The first 1000 days of an infant’s development are critical for the child’s brain and immune system, with nutrition levels and other risk factors determining whether they will be predisposed to various chronic, non-communicable diseases throughout their lifetime.4 These 1000 days begin with pregnancy; the treatment and well-being of an incarcerated mother is imperative to the health of her child. We must start by providing proper nutrition to pregnant inmates as prenatal care in prison is often limited or “absent”.1,2 Additionally, to counteract preexisting risk factors, correctional facilities must have mandatory pregnancy tests, HIV and other STD tests, and substance abuse screening upon entry to ensure all pregnant inmates are identified and preexisting risk factors for the fetus are addressed. After these screenings, treatment and withdrawal programs must be present to remove these risk factors to the fetus’s development, if the mother decides to carry to term. As of now only 37.7% of facilities do pregnancy tests upon entry, and 68% provide limited infectious disease screening, however these numbers are cited as optimistic estimates.5 Forty-eight states do not offer HIV screening for pregnant women, highlighting another significant public health issue as the rate of mother-to-child HIV transmission drastically increases without medical intervention.6 Additionally, shackling (chaining of the waist, hands, and feet) during the third trimester of pregnancy should be relaxed, as the mother’s balance is already altered, with restraints further increasing her susceptibility to falling and seriously harming the baby.1 Furthermore, these restraints prevent timely and adequate examination during labor, which can harm both the mother and baby.1

Postpartum, most mothers are only allowed 24 hours with their infant, after which the child is given to family or put into foster care. This early separation predisposes these children to mental and behavioral ailments such as low self-esteem and poor coping mechanisms.7 However, if placed in foster care for a prolonged period, the rate of depression increases by a factor of seven, behavioral problems by a factor of six, and anxiety by a factor of five.8 With most women spending more than 18 months in prison, if their child enters the foster care system their parental rights will be petitioned for termination and the child may remain in the system for a prolonged period, further impacting their mental wellbeing.9 Additionally, the immune system development of a child is enhanced by the ingestion of breastmilk. Breastmilk reduces the risk for contraction of infectious disease and later development of chronic diseases as well as establishes an emotional connection between the mother and baby.10 This emotional connection reduces postpartum depression among mothers as well as creates a viable mother-child relationship which can be used to help prevent the termination of their parental rights and, in turn, the mental distress of their children.9 For new mothers, their infants must be allowed and brought for visitation, as this is the only way to create such a relationship. As of now, 54.2% of facilities allow contact visits and 68.2% allow breastmilk delivery, however these numbers are cited as optimistic estimates.10 Correctional facilities can positively act upon the well-being of babies born by imprisoned mothers. With adequate screening and treatments required, proper nutrition provided, shackling relaxed in the third trimester, and postpartum breastfeeding and visits encouraged, the mental and physical health of the child are drastically improved, and lifelong effects determined in the first 1000 days of life become positive. We must advocate change: call your representatives to create the prioritization of unborn children within our prisons.

Word count: 632

Bibliography 1.

Dignam B, Adashi EY. Health Rights in the Balance: The Case Against Perinatal Shackling of Women Behind Bars. Source Heal Hum Rights. 2014;16(2):13-23.

2.

Baldwina, Adele; Sobolewskab, Agnieszka; Capper T. Pregnant in prison: An integrative literature review. Elsevier. 2018. Accessed March 7, 2019.

3.

Mukherjee S, Pierre-Victor D. Mental Health Issues Among Pregnant Women in Correctional Facilities: A Systematic Review. Women Health. 2014;54(8):816-842.

4.

Why 1,000 Days - 1,000 Days. https://thousanddays.org/the-issue/why-1000-days/. Accessed March 8, 2019.

5.

Kelsey CM, Nickole M, Mullins C, Dallaire D, Forestell C. An Examination of Care Practices of Pregnant Women Incarcerated in Jail Facilities in the United States. Matern Child Health J. 2017;21(6):1260-1266.

6.

WHO | Mother-to-child transmission of HIV. WHO. 2018. https://www.who.int/hiv/topics/mtct/en/. Accessed March 8, 2019.

7.

Clarke JG, Simon RE. Shackling and Separation: Motherhood in Prison. Vol 15.; 2013. Accessed March 6, 2019.

8.

Turney K, Wildeman C. Mental and Physical Health of Children in Foster Care. Pediatrics. 2016;138(5). Accessed March 6, 2019.

9.

Genty PM. Permanency Planning in the Context of Parental Incarceration: Legal Issues and Recommendations. Child Welfare. 1998;77(5):543-559. Accessed March 10, 2019.

10.

Shlafer RJ, Davis L, Hindt LA, Goshin LS, Gerrity E. Intention and Initiation of Breastfeeding Among

Women Who Are Incarcerated. Nurs Womens Health. 2018;22(1). Accessed March 10, 2019.