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Women are a small but increasing minority of the 10 · 2 million people imprisoned worldwide. There are around 100 000 women in prison in Europe on any 1 day, representing 5 % of the total prison population. In the United States (US) there are nearly 215 000 women in prisons and jails, representing 9 % of the incarcerated population and an absolute increase of 30 % since 2000. Despite growing numbers, women’s minority status means that their specific health care needs and those of their children may be overlooked or remain unmet. A review from the United States found that 38 states had inadequate or no prenatal care in their prisons, and a 2008 report from US Department of Justice notes that 46 % of pregnant imprisoned women reported they received no pregnancy care. The World Health Organisation’s (WHO) 2003 Moscow declaration recognises prison health as an important public health issue, and a 2009 WHO declaration acknowledges that current arrangements for dealing with women offenders often fail to meet their basic and health needs and specifically mentions inadequacies in provision for imprisoned pregnant women.
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.
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.
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.
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Bard E, Knight M, Plugge E. BMC Pregnancy Childbirth. 2016 Sep 29;16(1):285.
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