Introduction
The United States has the second-highest female incarceration rate, trailing only Thailand. In the United States, 64 women are imprisoned for every 100,000 people, with Oklahoma having the highest rate of 142.1 per 100,000. (Friedman et al., 2020). Most women incarcerated are of reproductive age, and many are pregnant when they arrive. Because of the stress caused by incarceration, pregnant women in correctional facilities are at a higher risk of developing mental health problems, which can hurt fetal and maternal outcomes. The fastest-growing population in the United States correctional facilities consists of women. Jailed women often are victims of abuse and have significant reported substance abuse and mental illness rates. Moreover, as the number of incarcerated women has increased, pregnancy during incarceration has become an essential concern. Correctional centers are not mandated to report or track pregnancy-related information, and most of the centers do o have any routine process for collecting such information. According to a report by the Bureau of Justice, four percent of women reported that they were pregnant at the admission period. Therefore this paper reviews the literature on sexual and physical trauma, separation, substance abuse and treatment, perinatal mental health, and research gaps in incarcerated pregnant women.
Literature Review
Sexual/Physical Trauma
According to Alirezaei and Roudsari, 2020, trauma, whether physical, sexual, or both, is frequently common among female inmates. Physical or sexual trauma can lead to an increased risk of pregnancy or pregnancy-related issues. Providing evidence-based interventions for the affected persons can enhance the women’s health and the child. However, according to Shlafer et al. 2019, trauma evidence-based methods by the correctional facilities’ health care team can mitigate the adverse impact on their cognitive health. Pelvic and sexual abuse, for instance, maybe traumatic in the case of a pregnant woman with past breast exams, but it may be necessary to address the issue further. Furthermore, physical exposure to the female genital organ during childbirth might result in trauma in previously traumatized women, and in some cases, surgery may be a better choice. Furthermore, those who have PTSD may require specialized birth rooms because the symptoms of PTSD might be prompted by increased stress during childbirth.
Separation
According to Shlafer et al. (2015), incarcerated women are more likely to have cognitive issues, with roughly two-thirds reporting such matters. Though women in prison may have had more right to entry to behavioral health therapy than before imprisonment, they got little or no mental illness treatment in their communities before incarceration. Women are especially susceptible to mental health issues during pregnancy, and their mental health may suffer even more if they are stressed.
Furthermore, Nair et al. 2021 state that cognitive screening in prison prior to, during, and after pregnancy permits for the timely discovery of cognitive problems, the complication of cognitive issues, and their time supervision. Timely interventions improve maternal and fetal outcomes, such as premature birth and low birthweight. Furthermore, Paynter et al. 2020 found significant connections between adverse birth results and mothers’ anxiety. The child is forced to be separated from the mother during delivery; additionally, maternal stress creates an increased-stress environment that benefits cognitive health. Furthermore, incarceration causes forced separations between children and mothers, disrupting attachments, re-evoking traumatic memories, and causing clinical psychological distress.
Substance Abuse and Treatment
Drug addiction is reported by up to 90% of women in correctional facilities, including pregnant women (Sufrin, 2020). Medication-assisted treatment is a therapy approach for pregnant women with opioid use disorder, according to Knittel et al., 2019. A multifaceted approach to opioid addiction includes various therapeutic options and support, such as MAT, support groups, close progress monitoring, and cognitive behavioral therapy. Furthermore, to avoid withdrawal symptoms, newly imprisoned women must be instantly screened for substance abuse to reduce treatment delays, according to Peeler et al. 2019. Methadone, for example, is a MAT medication that has been shown to help pregnant women with OUD. The therapy has been linked to lower heights of drug use following discharge. According to Baldwin et al. 2020, withdrawal symptoms associated with discontinuing opioid use without MAT are associated with significant relapse risks and, later, an overdose post-release.
Perinatal Mental Health
The several risk factors for a perinatal mental health issue are likely to be more prevalent in correctional facilities than in women in society. According to Baker 2019, pregnant women in prison have increased mental disorders, for instance, depression which increases the risk of developing perinatal depression. Women in jail spend more time during their pregnancy time in prison. The actual and perceived social support levels might be lower than those in the community, leading to risks of developing postnatal depression. Moreover, Goshin et al. 2019 outline that several women in health care facilities are lone parents and those who are not being separated from their partners by imprisonment. Most of them are unemployed and in a low social class, increasing perinatal mental disorder risks. Furthermore, pregnant females who have newly given birth are at a higher risk of developing the disorder or exacerbating it. Imprisonment during pregnancy raises the risk of perinatal illness, limiting the woman’s ability to make appropriate preparations or plans for the infant’s care.
Methodology
The information was gathered from various sources pertaining to the Mental Health of Incarcerated Pregnant Women. A search of several online databases, including Google Scholar, CINAHL, EMBASE, ASSIA, and PubMed, yielded relevant citations from 2015 to 2022 with the keywords: correctional, mental health, pregnant, and incarceration.
Research Gaps
Correctional facilities are denied to report health information on pregnant women, making it hard to draw additional conclusions about the adverse effects on the inmates’ mental health. Furthermore, data collection from medical records is another approach to evaluating the pregnancy statuses of incarcerated women; however, prison health records are not standardized; for example, some prisons and jails use paper charts while others use electronic systems, and every system tracks medical outcomes separately. Finally, future research should focus on separated women’s mental health and the design and evaluation of support approaches.
Conclusion
In conclusion, Correctional physicians are in a critical position to address mental health issues and traumas experienced by women in correctional facilities and assist them in healing. Addressing mental health issues and traumas women have gone through could enhance their health status, preparing them for release from correctional facilities. The mental health issues prevalent in this group, particularly depression and anxiety, need to be addressed to reduce the risks and enhance the outcomes for the unborn children and the women themselves. Mental health screening for pregnant women should be put in place to ensure all the women are diagnosed and access treatment during elevated risks. Lastly, the levels of postnatal support for the women separated from their kids born during the imprisonment period need to be measured. More provisions for such approval should be put in place. Future research should specifically focus on women separated, impacts on mental health, and designing and evaluating support approaches.
References
Alirezaei, S., & Roudsari, R. L. (2020). Promoting health care for pregnant women in prison: a review of international guidelines. Iranian journal of nursing and midwifery research, 25(2), 91. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7055189/
Baker, B. (2019). Perinatal outcomes of incarcerated pregnant women: an integrative review. Journal of Correctional Health Care, 25(2), 92-104. Retrieved from https://www.liebertpub.com/doi/full/10.1177/1078345819832366
Baldwin, A., Sobolewska, A., & Capper, T. (2020). Pregnant in prison: An integrative literature review. Women and Birth, 33(1), 41-50. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S1871519218301781
Friedman, S. H., Kaempf, A., & Kauffman, S. (2020). The realities of pregnancy and mothering while incarcerated. J Am Acad Psychiatry Law, 48(3), 365-375. Retrieved from https://web.archive.org/web/20200709191841id_/http://jaapl.org/content/jaapl/early/2020/05/13/JAAPL.003924-20.full.pdf
Goshin, L. S., Sissoko, D. G., Neumann, G., Sufrin, C., & Byrnes, L. (2019). Perinatal nurses’ experiences with and knowledge of the care of incarcerated women during pregnancy and the postpartum period. Journal of Obstetric, Gynecologic & Neonatal Nursing, 48(1), 27-36. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S0884217518303666
Knittel, A. K., Zarnick, S., Thorp Jr, J. M., Amos, E., & Jones, H. E. (2020). Medications for opioid use disorder in pregnancy in a state women’s prison facility. Drug and alcohol dependence, 214, 108159. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S0376871620303240
Nair, S., McGreevy, J. E., Hutchinson-Colas, J., Turock, H., Chervenak, F., & Bachmann, G. (2021). Pregnancy in incarcerated women: the need for national legislation to standardize care. Journal of perinatal medicine, 49(7), 830-836. Retrieved from https://www.degruyter.com/document/doi/10.1515/jpm-2021-0145/html?lang=de
Paynter, M., Jefferies, K., McKibbon, S., Martin-Misener, R., Iftene, A., & Murphy, G. T. (2020). Mother-child programs for incarcerated mothers and children and associated health outcomes: a scoping review. Nurs Leadersh, 33(1), 81-99. Retrieved from https://d1wqtxts1xzle7.cloudfront.net/63898371/MotherChildScopingReview_stamped20200712-20707-1cy130l-with-cover-page-v2.pdf
Peeler, M., Fiscella, K., Terplan, M., & Sufrin, C. (2019). Best practices for pregnant incarcerated women with opioid use disorder. Journal of Correctional Health Care, 25(1), 4-14. Retrieved from https://www.liebertpub.com/doi/10.1177/1078345818819855
Shlafer, R. J., Gerrity, E., & Duwe, G. (2015). Pregnancy and parenting support for incarcerated women: Lessons learned. Progress in community health partnerships: research, education, and action, 9(3), 371. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5536343/
Shlafer, R. J., Hardeman, R. R., & Carlson, E. A. (2019). Reproductive justice for incarcerated mothers and advocacy for their infants and young children. Infant Mental Health Journal, 40(5), 725-741. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1002/imhj.21810
Sufrin, C., Sutherland, L., Beal, L., Terplan, M., Latkin, C., & Clarke, J. G. (2020). Opioid use disorder incidence and treatment among incarcerated pregnant women in the United States: results from a national surveillance study. Addiction, 115(11), 2057-2065. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1111/add.15030
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