Perinatal health care services for imprisoned pregnant women and associated outcomes: a systematic review

Abstract

Background: Women are an increasing minority of prisoners worldwide, and most are of childbearing age. Prisons offer unique opportunities for improving the pregnancy outcomes of these high-risk women, and no systematic review to date has looked at their care. This systematic review identified studies describing models of perinatal health care for imprisoned women which report maternal and child health and care outcomes.

Methods: We systematically searched for literature published between 1980 and April 2014. Studies were eligible if they included a group of imprisoned pregnant women, a description of perinatal health care and any maternal or infant health or care outcomes. Two authors independently extracted data. We described relevant outcomes in prisons (including jails) under models of care we termed PRISON, PRISON+ and PRISON++, depending on the care provided. Where outcomes were available on a comparison group of women, we calculated odds ratios with 95 % confidence intervals.

Results: Eighteen studies were reported, comprising 2001 imprisoned pregnant women. Fifteen were in the US, two in the UK and one in Germany. Nine contained a comparison group of women comprising 849 pregnant women. Study quality was variable and outcome reporting was inconsistent. There was some evidence that women in prisons receiving enhanced prison care, PRISON+, were less likely to have inadequate prenatal care (15.4 % vs 30.7 %, p < 0 · 001), preterm delivery (6.4 % vs 19.0 %, p = 0 · 001) or caesarean delivery (12.9 % vs 26.5 %, p = 0 · 005) compared to women in prisons receiving usual care (PRISON). Women participating in two PRISON++ interventions, that is, interventions which included not only enhanced care in prisons but also coordination of community care on release, demonstrated reductions in long term recidivism rates (summary OR 0 · 37, 95 % CI 0 · 19-0 · 70) compared to pregnant women in the same prisons who did not participate in the intervention.

Conclusions: Enhanced perinatal care can improve both short and long-term outcomes but there is a lack of data. Properly designed programmes with rigorous evaluation are needed to address the needs of this vulnerable population. The cost to mothers, children and to society of failing to address these important public health issues are likely to be substantial.

Trial registration: PROSPERO registration: CRD42012002384 .

Keywords: Antenatal care; Perinatal care; Postnatal care; Pregnancy outcomes; Pregnant women; Prison; Prisoner.

Fig. 1

Study Selection

Fig. 2

Caesarean deliveries to imprisoned women, stratified by level of care

Fig. 3

Imprisoned women receiving inadequate prenatal care, stratified by level of care

Fig. 4

Preterm deliveries to imprisoned women, stratified by level of care

Fig. 5

Stillbirths of babies born to imprisoned women, stratified by level of care

Fig. 6

Neonatal unit admissions of babies born to imprisoned women, stratified by level of care

Fig. 7

Low birthweight of babies born to women in PRISON intervention groups compared to controls, stratified by type of comparison group

Fig. 8

Recidivism of women in PRISON++ intervention groups compared to disadvantaged controls