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Claire Keen1, Emilia Janca1, Melissa Willoughby1,2, Annie Carter1,2
1Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
2Centre for Adolescent health, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
 
 
 
The number of people in prison is growing around the world, often at a rate faster than population growth. Incarceration has been connected to poor health and social outcomes for both people who experience incarceration, and their families. As the prison population grows, the number of families with a family member who has experienced incarceration also grows rapidly. In the United States, almost one in two adults has a family member who has been incarcerated for at least one night.1,2 Thirty-four percent of young adults (aged 18-29) have had a parent incarcerated.1 More than half of the parents who are incarcerated are the primary breadwinners for their family.1 In Australia, 38% of people entering prisons have a child dependent on them for care.3 This figure rises to 50% when only women are considered.3  
 
The health and well-being of children of incarcerated parents has been recognised as an issue of concern internationally. The Bangkok Rules, issued by the United Nations Office on Drugs and Crime, make recommendations to address the needs of children with incarcerated parents.4 The rules call for women who are incarcerated to have the opportunity to make arrangements for the needs of their children, including the possibility of a reasonable suspension of detention, taking into account the best interests of the children. The Rules also call for the need to recognise the central role of both parents in the lives of children, and to promote practices that address the physical, emotional, social and psychological development of babies and children affected by the imprisonment of either parent.
 
Despite being published in 2010, very little is known about the extent to which the Bangkok Rules and their guidelines have been implemented by countries, if at all. However, there is evidence that incarceration negatively impacts the health and wellbeing of the families of those incarcerated, particularly children.
 
Children living in the community with incarcerated parents are more likely than those without incarcerated parents to exhibit behavioural problems 5 and low self-esteem 6 and experience traumatic separation, unstable childcare arrangements 7, and reduced income or employment opportunities. Children living in the community with incarcerated parents are also more likely to be detained as a youth and incarcerated as an adult, continuing the intergenerational cycle of social exclusion and entrenched disadvantage.8
 
The alternative to children remaining in the community, separated from their parent, is for the child to remain with their parent during the parent’s incarceration. Not much is known about the health of children who are incarcerated with their parents in prison. Limited available evidence suggests that children detained with their mothers experience poorer physical health9 10 and mental health,11 compared with their non-detained peers, as well as below average cognitive and language development.12 Research has also reported high rates of HIV and hepatitis infection,13 lice and scabies infestation,14 and stunting and malnutrition.14 Importantly, the association between living in prison with a parent and poor health outcomes does not necessarily indicate that incarceration has caused these poor outcomes. Children whose parents experience incarceration are typically characterised by pre-existing disadvantage and health risks.
 
There is also some, albeit limited, evidence to suggest that children incarcerated with their parents have more favourable developmental outcomes than those separated from their mothers during incarceration.13,14 For example, allowing babies and small children to remain with their incarcerated mother permits breastfeeding and promotes secure attachment between mother and child.4,15,16 Prison is clearly not an optimal environment for a child. However, in circumstances where there is no other appropriate caregiver available in the community, accommodating the child with their mother in prison may be preferable to the child being moved into institutionalised care. Given the lack of evidence and the potential negative health outcomes of both separating an incarcerated mother and her child but also raising a child in prison, further research in this space is strongly indicated.
 
The profound effects of incarcerating parents on their children’s health outcomes and life trajectories is yet another reason to lower incarceration rates in favour of non-custodial sanctions, especially for women, who are usually the primary caregiver of dependent children. The extended impact of incarceration can entrench already marginalised and disenfranchised groups into poverty, unemployment and poor health. Interrupting this cycle is a key response in addressing the health and social inequalities experienced by the children and adolescents with parents who have been incarcerated.

 
 
References
1.           Every second: the impact of the incarceration crisis on America's families: FWD.us, 2018.
2.           Enns PK, Yi Y, Comfort M, et al. What Percentage of Americans Have Ever Had a Family Member Incarcerated?: Evidence from the Family History of Incarceration Survey (FamHIS). Socius 2019; 5: 2378023119829332.
3.           Australian Institute of Health and Welfare. The health of Australia's prisoners 2018. Canberra: AIHW, 2019.
4.           United Nations. United Nations Rules for the Treatment of Women Prisoners and Non-custodial Measures for Women Offenders (‘the Bangkok Rules’). New York: United Nations, 2010.
5.           Wildeman C. Paternal Incarceration and Children's Physically Aggressive Behaviors: Evidence from the Fragile Families and Child Wellbeing Study. Social Forces 2010; 89(1): 285-309.
6.           Geller A, Garfinkel I, Cooper Carey E, Mincy Ronald B. Parental Incarceration and Child Well‐Being: Implications for Urban Families*. Social Science Quarterly 2009; 90(5): 1186-202.
7.           Travis J, McBride EC, Solomon AL. Families left behind: The hidden costs of incarceration and reentry. Washington, DC: Urban Institute Justice Policy Centre; 2003.
8.           Miller KM. The impact of parental incarceration on children: An emerging need for effective interventions. Child and Adolescent Social Work Journal 2006; 23(4): 472-86.
9.           Al Salami AAH, M.; Hussein, I.; Kowash, M. Oral health status of pre-school children of incarcerated mothers in United Arab Emirates prison nurseries and oral health knowledge and attitudes of their caregivers. Eur Arch Paediatr Dent 2018; 13: 13.
10.         Domingues RL, M. D. C.; Pereira, A. P. E.; Ayres, B.; Sanchez, A. R.; Larouze, B. Prevalence of syphilis and HIV infection during pregnancy in incarcerated women and the incidence of congenital syphilis in births in prison in Brazil. Cad Saude Publica 2017; 33(11): e00183616.
11.         Kutuk MO, Altintas E, Tufan AE, et al. Developmental delays and psychiatric diagnoses are elevated in offspring staying in prisons with their mothers. Scientific Reports 2018; 8(1): 1856-.
12.         Lejarraga HB, C.; Ortale, S.; Contreras, M. M.; Sanjurjo, A.; Lejarraga, C.; Martinez Caceres, M. J.; Rodriguez, L. Growth, development, social integration and parenting practices on children living with their mothers in prison. [Spanish]. Archivos Argentinos de Pediatria 2011; 109(6): 485-91.
13.         Jiménez JM, Palacios J. When home is in jail: Child development in Spanish penitentiary units. Infant and Child Development: An International Journal of Research and Practice 2003; 12(5): 461-74.
14.         Senanayake MPA, J. K.; Wickremasinghe, V. P. Children of imprisoned mothers. Ceylon Med J 2001; 46(2): 51-3.
15.         Byrne MW, Goshin LS, Joestl SS. Intergenerational transmission of attachment for infants raised in a prison nursery. Attachment & Human Development 2010; 12(4): 375-93.
16.         Sleed M, Baradon T, Fonagy P. New Beginnings for mothers and babies in prison: A cluster randomized controlled trial. Attachment & Human Development 2013; 15(4): 349-67.