A landmark 2016-2017 study, Pregnancy in Prison Statistics, found that each year more than 1,000 women give birth while incarcerated in U.S. prisons and jails. Prior to this study, there were no requirements to collect data about pregnancy and pregnancy outcomes for incarcerated individuals. With the First Step Act of 2018, the Bureau of Justice Statistics is now required to collect pregnancy outcomes data from federal prisons and according to the Bureau of Justice Statistics, nearly 75 percent of women in prison are of childbearing age, many of whom are already mothers of children under the age of 18.

Thanks to the research of Rebecca Shlafer, associate professor of pediatrics and adolescent health in the Medical School, demonstrating the negative impacts of incarceration on the health and wellbeing of children and families, there have been widespread changes to supporting incarcerated parents and their children. Shlafer's research with the Minnesota Prison Doula Project (MnPDP), whose mission is to work in "compassionate solidarity with incarcerated parents to create community, opportunity, and change," has led to an increase in perinatal support programs for pregnant and postpartum people in prisons across the country, with Minnesota as a model. Shlafer’s work has also directly informed practice and policy changes, both locally and nationally, including the Minnesota Model Jail Practices Learning Community, Minnesota Healthy Start Act, Oregon HB 2535, and more.

“Most pregnant women in prison will give birth in prison and be separated from their babies, which is not only bad for the mother, but also really bad for babies,” said Shlafer.

A Partnership with Purpose

Through decades of research and evaluation, Shlafer has become a nationally recognized leader on the impact of the criminal legal system on child and family health and wellbeing. Her body of work demonstrating the negative impacts of incarceration on the health and wellbeing of children and families has led to changes both locally and nationally to support incarcerated parents and their children.

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Shlafer’s partnership with the Minnesota Prison Doula Project, which provides pregnancy and parenting support to incarcerated parents, seeks to offer trained doulas, group education, one-on-one counseling, and supportive visitation with the goal to nurture healthy relationships and increase parenting confidence and skills. They work with those serving sentences at Minnesota’s only women’s state prison and those held in county correctional facilities throughout Minnesota.

What started as a community-university pilot grant has grown into an ongoing NIH-funded, multi-site implementation study of enhanced pregnancy programs in eight state prisons including Alabama, Arkansas, Connecticut, Georgia, Michigan, Minnesota, Oregon, and Virginia. The partnership between Shlafer and MnPDP and their collective success was also recently featured as an in-depth case study in a leading journal on translational science. This work has directly benefitted Departments of Corrections (DOC), prison birth programs, and importantly, hundreds of pregnant and postpartum people and their families not only in the state of Minnesota but across the country.

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Shlafer's seminal work directly informed the passage of two Minnesota state laws—one banning the use of restraints on pregnant and postpartum incarcerated women and another, more recently, providing the commissioner of corrections with the authority to release pregnant and postpartum women into community-based alternatives to incarceration. She is considered the nation’s foremost expert on this topic, regularly being asked to consult with other states trying to develop similar support for pregnant and postpartum people. In the last year alone, she testified in the Oregon Legislature (HB 2535) and provided written testimony to the District of Columbia.

Shlafer has also advanced statewide initiatives on supporting the wellbeing of youth impacted by parental incarceration. She led seminal work documenting the prevalence of parental incarceration in Minnesota and has published dozens of papers describing the health disparities among this population. In 2021, the Minnesota Legislature allocated funding for a statewide initiative that Shlafer co-leads with partners at the Minnesota Department of Health. The Model Jail Practices Learning Community (ongoing) now includes jails and community partners in 14 counties across the state that are all implementing innovative policies and practices that support incarcerated parents and their children. Shlafer’s research directly informed the creation of this Learning Community and through her leadership, this work has led to direct practice changes to support families across the state.

What’s Next?

Importantly, Shlafer's work does not stop after a policy is passed; she is a partner in implementation, research and community-based evaluation, and continuous improvement, as evidenced by a recent report (2025) on the implementation of Minnesota’s Healthy Start Act.

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While her research impact to date is impressive, Shlafer has shared that her goal is to reduce the number of pregnant and postpartum women in the legal system in general. “If the reason people are incarcerated is related to complex mental health and substance use disorders, what we really need is treatment and community-based supports, not prison,” said Shlafer.

To support this important initiative, learn more about the criminal legal system in the state and the country, some of which can be found on the Department of Pediatrics website or learn more about the recent Enhanced Perinatal Programs for People in Prison (E4P) Study.

Supporting the Health of Children and Families Impacted by Incarceration in Minnesota

A Partnership with Purpose

What’s Next?