LAUSR

At the end of 2015, an estimated 210 595 women were in state or federal prison or jail in the United States, a 645% increase since 1980, when approximately 28 240 women were incarcerated. Nearly three-quarters of incarcerated women are aged 18-44—prime childbearing years—and two-thirds of incarcerated women are mothers and primary caregivers to minor children. Given these demographic characteristics, it is likely that some women will enter prison or jail while pregnant or during the postpartum period. Women who face the greatest likelihood of incarceration are disproportionately non-Hispanic black and Hispanic. Although the overall imprisonment rate for non-Hispanic black women has declined, in 2014, the imprisonment rate per 100 000 population for non-Hispanic black women (109) was twice the rate of non-Hispanic white women (53). The imprisonment rate for Hispanic women was 64. Similar racial/ethnic disparities are also seen with unintended pregnancies, inadequate access to prenatal care, maternal mortality, and health complications due to pregnancy and its termination. Furthermore, when compared with women in the general US population, women in prison or jail are more likely to have ever had a chronic condition, an infectious disease, any disability, a cognitive disability, or a mental health or substance use disorder. These coexisting health conditions can complicate pregnancies and lead to higher pregnancy-related medical care needs during incarceration. Poor mental health may pose a particular challenge for pregnant women in prison or jail. Research shows that the mental health effects of being incarcerated can compound existing problems or create new problems during pregnancy. Despite what is known about the risks for adverse pregnancy-related outcomes (ie, hemorrhage, preterm birth, maternal mortality) and how they coincide with risks for incarceration, little data on the prevalence of pregnancy or pregnancy-related outcomes among women in prison or jail are available. To provide pregnancy-related services and accommodations (eg, additional calories at mealtime, appropriate prenatal care, special housing, or a bottom bunk) and optimize pregnancy outcomes for these vulnerable women, accurate and comprehensive pregnancy data are needed. This commentary is designed to bring attention to the lack of data on maternal health among women in prison and jails and offer suggestions to remedy these gaps.