Evidence-based recommendations to improve reproductive healthcare for incarcerated women

Care Transitions for Incarcerated Pregnant People: A Needs Assessment

Incarcerated pregnant people face significant barriers when seeking health care services in prisons and jails, but little is known about their transitions from state prison health care systems to outside hospitals. This project analyzed current policies and procedures for care transitions for incarcerated people and presents policy recommendations to address issues of concern. We conducted in-depth interviews with stakeholders at a state prison, academic hospital, and private hospital to identify the barriers and facilitators to care transitions. Themes emerging from these interviews were operational, including medical records, communication, and education; and structural, including implicit biases and care of marginalized groups. These findings are likely applicable to similar facilities throughout the United States. A multipronged, interdisciplinary approach is needed to address challenges of care transitions.

Implementing High-Intensity, Trauma-Informed Sexual Risk Reduction in Women Involved in the Criminal Legal System

Although research supports using brief or extended behavioral interventions to increase prevention of sexually transmitted infections (STIs), there is a shortage of current information about the specific effects on women in a short-stay carceral environment. This evidence-based practice implementation project aimed to employ the Safer Sex Efficacy (SSE) Workshop in a jail setting. A repeated measures design was used to compare STI knowledge acquisition and reports of condom use self-efficacy in a group of incarcerated women before, immediately after, and 3 weeks after participation in a high-intensity behavioral counseling intervention. Twenty-one females between the ages of 20 and 45 years participated in the program. STI knowledge acquisition and reports of condom use self-efficacy were measured using the Sexually Transmitted Disease Knowledge Questionnaire and the Condom Use Self-Efficacy Scale. Findings support the feasibility of implementing evidence-based sexual health education programming incorporating information about sexual risk behaviors, STI knowledge, and behavioral skills practice in a short-stay correctional setting and further investigation with a larger sample.

Building an implementation framework to address unmet contraceptive care needs in a carceral setting: a systematic review

BACKGROUND

The provision of contraceptive care for incarcerated individuals has been largely inconsistent and has contributed to, at best, inadequate care, and at worst reproductive abuses, violence, and coercion. While previous research has identified strategies to remedy known issues, to date, very few recommendations have been implemented across the carceral system. To address this, we conducted a systematic review of policy and practice recommendations to improve contraceptive care to reproductive-aged, incarcerated individuals in the United States.

METHODS

We conducted this systematic review utilizing the Joanna Briggs Institute methodology and framed it within the National Implementation Research Network's (NIRN) Exploration stage. We searched PubMed, PSYCInfo, SCOPUS, ProQuest, Web of Science, MedLine, Social Science Citation Index and reference sections of included materials. Basic study information, explicitly stated policy and practice recommendations, and discussions and conclusions that subtly provide recommendations were extracted in full text. We utilized a thematic analysis approach to analyze the extracted text.

RESULTS

A total of 45 materials met the inclusion criteria. Seven overarching themes were identified: 1) policy changes needed to implement care; 2) need for contraceptive care in carceral systems; 3) justice agency barriers regarding contraceptive care provision; 4) policy barriers to contraceptive access; 5) funding strategies to improve care; 6) patient preferences for contraceptive care delivery; and 7) healthcare provider knowledge regarding contraceptive care. The seven themes identified shed light on the need for, gaps, barriers, and facilitators of current contraceptive care provision to incarcerated individuals.

CONCLUSION

This systematic review accomplished two goals of NIRN's Exploration stage. First, the compiled evidence identified a clear need for change regarding policies and practices pertaining to contraceptive care provision to incarcerated individuals in the United States. Second, our findings identified several evidence-based solutions supported both by research and professional healthcare organizations to address the identified need for change. This study provides an initial blueprint for correctional agencies to implement the necessary changes for improving contraceptive care provision to incarcerated populations. The correctional system is in a unique position to deliver much-needed care, which would result in many potential benefits to the individuals, correctional system, and community at large.

Health of female prisoners in Brazil

Abstract The majority of the women in prisons comes from the poorest strata of society with limited access to education, income and health services. This contributes to the fact that female prisoners have a higher burden of adverse health events than both male prisoners and women in general population We objectived to estimate the prevalence of different morbidities and risk factors among female prisoners in Brazil. A total of 1,327 women were recruited in this cross-sectional study. Data were collected using a using audio computer-assisted self-interviewing questionnaire, rapid antibody tests and physical examination. The higher prevalences was of syphilis, infection sexually disease, arterial hypertense, asthma, common mental disorders and severe physical violence. Regarding risk factors, 36.3% have good knowledge about HIV, 55.8% were smokers, 72.3% had ever used any illicit drug, 92.1% are sedentary and 92.1% maintained an unhealthy diet. Female prisoners are disproportionately affected by various adverse health conditions. There is a need for an effective surveillance system inside prisons for early diagnosis and treatment.

Lactation Support for People Who Are Incarcerated: A Systematic Review

Background: Lactation support, defined here as the access to educational resources, supplies, mental health and psychosocial support, skilled lactation counseling, and peer support, has been identified as critical to optimal health outcomes for birthing parents and infants. People who give birth while incarcerated are likely to receive suboptimal lactation support. The purpose of this review is to explore the literature on lactation support for incarcerated people to identify existing programs and policies, gaps in lactation support and ways to address the gaps, and incarcerated people's perspectives on breastfeeding and lactation support. Methods: We conducted a systematic review of the peer-reviewed literature to identify studies that addressed two main concepts: (1) breastfeeding and (2) incarcerated populations in the United States. Results: After meeting the eligibility criteria, 29 studies were included in the qualitative synthesis of the findings. Studies highlight the importance of supporting birthing people who want to provide milk to their infants in a way that is desired, psychologically safe, and structurally supported. Programs are needed to delay or prevent parent-infant separation after birth, provide education around breastfeeding misconceptions, and link to resources and ongoing support for both breastfeeding and milk expression. Implementation of breastfeeding programs may be most effectively undertaken with clear policies and dedicated leadership either internally or through community or health care partnerships. Discussion: This review highlights the policies and practices that hinder adequate lactation support for birthing parent-infant dyads who are incarcerated and describes feasible policies, education, and clinical support that can be used to improve care.

General Approaches to Medical Management of Menstrual Suppression: ACOG Clinical Consensus No. 3

SUMMARY

The purpose of this document is to review currently available management options, general principles, and counseling approaches for reproductive-aged patients requesting menstrual suppression. It includes considerations for unique populations, including adolescents, patients with physical or cognitive disabilities or both, and those with limited access to health care. Gynecologists should be familiar with the use of hormonal therapy for menstrual suppression (including combined oral contraceptive pills, combined hormonal patches, vaginal rings, progestin-only pills, depot medroxyprogesterone acetate, the levonorgestrel-releasing intrauterine device, and the etonogestrel implant). Approaches to counseling should be individualized based on patient preferences and goals, average treatment effectiveness, and contraindications or risk factors for adverse events. Counseling regarding the choice of hormonal medication for menstrual suppression should be approached with the utmost respect for patient autonomy and be free of coercion. Complete amenorrhea may be difficult to achieve; thus, obstetrician-gynecologists and other clinicians should counsel patients and caregivers, if applicable, about realistic expectations.

Social Resources, Abortion, and Contraceptive Use Among Women With Criminal Justice Histories

Women in the criminal legal system face structural barriers to social resources such as education, employment, and benefits. Little is known how these resources intersect with their reproductive lives, specifically with obtaining abortions. We explored the relationship between social resources and abortion history among women incarcerated in a county jail through a secondary analysis of survey data from a 2014 to 2016 jail-based sexual health intervention. Regression analyses determined correlates of having an abortion history. Thirty percent of participants had an abortion and were more likely to have at least a high school education (adjusted odds ratio [aOR] = 3.3; 95% confidence interval [CI] = 1.25-8.77) and a history of sexually transmitted infections (aOR = 3.2; 95% CI = 1.25-8.06). Appropriate systems-level efforts should be expanded to support women with criminal legal histories in their reproductive lives.

Romantic attachment, childhood stability, depression, and PTSD in couples with an incarcerated partner

Incarceration has a multitude of effects on prisoners' finances, health, education, employment, and family relationships. Incarceration complicates the maintenance of attachment bonds between romantic partners. Data from the Multi-site Family Study on Incarceration, Parenting, and Partnering were analyzed to examine the effects of childhood stability on adult romantic attachment while controlling for the effects of PTSD and depression within the carceral population. Findings indicate that posttraumatic stress disorder (PTSD) and depression have statistically significant effects on adult romantic attachment. PTSD on romantic attachment for men is statistically significant (p < 0.05) at -0.193 with an overall standardized effect of -0.086. For women, the effect is statistically significant (p < 0.01) at -0.235 with an overall standardized effect of -0.1. Effects of depression on romantic attachment for men is statistically significant (p < 0.001) -0.129 with an overall standardized effect of -0.229. For women, depression is also statistically significant (p < 0.001) at -0.153 with a standardized effect of -0.265. We examined the effects of childhood stability on adult romantic attachment while controlling for the effects of PTSD and depression within the carceral population. Findings supported our hypothesis that individuals with better childhood stability will experience better romantic attachments. Findings related to our hypothesis that having a partner with better childhood stability is positively associated with better romantic attachment produced mixed results. Clinical implications are discussed, and future directions call for research, practice, and training to improve outcomes for justice-involved romantic partners, their attachment, and consideration of covariates of depression and PTSD.

The contraceptive needs and pregnancy desires of women after incarceration: A qualitative study

OBJECTIVE

Prior qualitative research with women incarcerated at Rikers Island Jail asked women to anticipate their future contraceptive needs and pregnancy desires upon re-entering the community. We conduct this follow-up study to understand better the actual contraceptive needs and pregnancy desires experienced by women after incarceration.

STUDY DESIGN

We conducted semi-structured in-depth interviews in New York City in 2014 with 10 women incarcerated within the past three years. We coded transcripts using an iterative process, identified emerging themes, and stopped recruitment after reaching thematic saturation.

RESULTS

Most participants desired to wait to become pregnant until they had stable housing, income, and employment. A few faced systemic barriers to obtaining contraception, including the process of re-applying for insurance and obtaining medical appointments. For many, incarceration disrupted their use of contraception, insurance status, and relationship with trusted medical providers. Most women lacked trust in the new health professionals they encountered after incarceration.

CONCLUSIONS

Incarceration disrupted medical care in general, and contraceptive care in particular. Assistance should be provided to re-apply for insurance, make appointments, and support women to see trusted health professionals.

IMPLICATIONS

Incarceration further disenfranchises an already marginalized community through disrupting access to medical care and constrains women's reproductive autonomy long after return to the community.