Maternal and Infant Mortality in Prisons

The United States (US) is experiencing dual public health crises in maternal mortality and incarceration. Both phenomena are characterized by racial inequities and other negative structural determinants of health. Substance use and mental health conditions are exceedingly common among incarcerated women and are also substantial and increasing causes of pregnancy-associated deaths.

However, the contribution of incarceration during pregnancy or postpartum to maternal mortality has not been studied. Yet, each year, tens of thousands of pregnant women are incarcerated. Studies on deaths in custody and post-release mortality have not reported whether the decedent was pregnant or postpartum. Similar social and structural risk factors exist for fetal and infant mortality among infants whose mothers were incarcerated. Nonetheless, we know little about the association and trends of maternal incarceration up to one year postpartum with incidence of fetal and infant mortality. The overall goal of this proposed R01 is to provide the first population-based estimates of incidence, causes, and disparities in pregnancy-associated death, stillbirth, and infant mortality among women who were incarcerated during pregnancy and/or up to one year postpartum; a further goal is to examine gaps and opportunities in how public health and correctional health agencies address risk factors for preventable mortality in this group of mothers and infants affected by numerous adverse systemic, social, and environmental conditions.

Our first aim is to create databases in three states (Maryland, Minnesota, and Washington) of women who were incarcerated during pregnancy, delivery, and/or up to one year postpartum (“perinatal period”) between 2010-2024; we will accomplish this by linking prison admissions and release data from state Departments of Corrections with birth certificate and fetal death certificate data from state vital records. Our second aim is to calculate the incidence of pregnancy-associated, fetal, and infant death among mothers incarcerated during the perinatal period by integrating death certificate data with the linked dataset of perinatal incarceration that is created in Aim 1. Our third aim is to identify health care and incarceration system barriers and opportunities to reduce risk for maternal and infant mortality; we will accomplish this aim through qualitative interviews with national samples of practitioners in correctional health and child welfare and of review committee members for maternal and fetal/infant mortality. Together, results from these aims will identify key modifiable risk factors, especially related to incarceration. The proposed research will extend the current knowledge base on maternal and infant mortality to include incarceration, which carries numerous adverse health risks. Achieving our aims will enable clinical and policy interventions to optimize care that can prevent mortality and advance equity.

Funded by: National Institute of Child Health and Human Development (1R01HD117944-01)