HEALTH OUTCOMES OF INCARCERATED PREGNANT WOMEN AND THEIR INFANTS IN A COMMUNITY-BASED PROGRAM Violet H. Barkauskas, PhD, RN, Lisa Kane Low, CNM, PhD and Sheryl Pimlott, MSW, PhD(c) An experimental, community-based, residential program, fo- cused on health promotion, was established in 1990 for incarcerated pregnant women with short-term sentences and histories of drug abuse in a large, midwestern metropolitan area in the United States. Infants resided with mothers after birth. Prenatal care, delivery, postpartum, and family-planning ser- vices were initiated and provided by a nurse-midwifery service. Community-based health care, job training, and drug rehabili- tation were provided for women during pregnancy through the fourth postpartum month. Program participants’ prenatal, de- livery, postpartum, and neonatal health outcomes are presented and compared with those of incarcerated women in the same state prison system who experienced usual correctional facility care and support. Program participants represented a group of obstetrically high-risk women. Health outcomes for both groups of incarcerated women and their infants were similar and more optimal than would have been expected given their preexisting health conditions and risk factors. J Midwifery Womens Health 2002;47:371–9 © 2002 by the American College of Nurse-Midwives. INTRODUCTION Incarcerated women are a medically high-risk group because of their preincarceration lifestyles, health prob- lems, and related environmental influences (1–5). In 1998, Henderson (6) conducted a comprehensive review of the available literature on incarcerated women’s health and concluded that incarcerated women demonstrate an excess of drug abuse, mental health problems, and physical and sexual abuse. As stated by Safyer and Richmond (7) in a 1995 review of the course of preg- nancy in women who are incarcerated: “With so many of the prison population from backgrounds of poverty, violence, and drug use, and with limited access to health care in their communities, it is to be expected that women behind bars suffer from a broad range of health prob- lems.” In 1996, approximately 138,000 women were impris- oned in the United States (8), of which an estimated 25% were pregnant upon incarceration or had delivered in the past year (7). Approximately 64% of incarcerated women are mothers of dependent children (6). The health care needs of female prisoners in general, and pregnant prisoners in particular, challenge the traditional models of health care provided within prisons. In response to those challenges, a special residential program for preg- nant, drug-dependent women was established in 1990 as an option within a midwestern state’s corrections system. The purpose of this article is to describe the development of the residential program and to present data about selected program health outcomes during the most recent program years, 1996 –1999. The health outcome study was part of a larger program evaluation that also exam- ined the mental health of the mothers before, during, and upon completion of residential program treatment; as- sessed mothers’ long-term stability in the community after discharge via follow-up interviews at 6 months and 1 year after release; and evaluated the interaction of residential program mothers with their infants. LITERATURE REVIEW Various studies have explored the effects of incarceration on maternal and infant health. Reports have described deliveries without adequate assistance or in shackles, as well as difficult separations of mothers and infants (9,10). As prison health care has become more humane, reports of maternity care outcomes in prison populations have been more favorable, especially considering the high-risk health status of most incarcerated pregnant women (11–14). Many arrests of women are drug related, and studies have documented that most female arrestees test positive for illicit drugs (15). Cordero and colleagues (16) studied 233 incarcerated pregnant women receiving care in a comprehensive prenatal care program in Ohio. Seventy- one percent of the women had drug abuse problems, 70% smoked, and 21% had other medical problems. In this sample, the cesarean section rate was 16%. Adverse infant outcomes included a 3% prematurity rate, and 8% were assessed as being small for gestational age. Egley and colleagues (17) compared 69 incarcerated women with nonincarcerated controls, matched for age, parity, race, and date of prenatal care entry. In the incarcerated sample, 36% of the women had abused drugs and 68% smoked. The outcomes in both groups were similar: 12% of the infants had low birth weight, and 8.5% required intensive care. Mertens (18) studied a sample of 71 pregnant inmates in a large county jail setting. In this Address correspondence to Violet H. Barkauskas, 400 North Ingalls, Ann Arbor, MI 48109-0482. Journal of Midwifery & Women’s Health • Vol. 47, No. 5, September/October 2002 371 © 2002 by the American College of Nurse-Midwives 1526-9523/02/$22.00 • PII S1526-9523(02)00279-9 Issued by Elsevier Science Inc.