Perinatal Supports
Challenges and Case Building
When pregnant people in prison get the physical and mental health care they need, they have a better chance of thriving and so do their babies. Our work aims to disrupt and prevent trauma to children and families affected by incarceration.
Pregnancy in prison is characterized by a lack of supportive policies and practices: pregnancy-related care is consistently described as poor. Pregnant patients in prison are at risk for preterm birth, delivery complications, and postpartum depression. Pre-existing health conditions such as substance use and mental health problems, and conditions of confinement including stress and limited social support can contribute to this increased risk for poor outcomes. Approximately 75% of women in prison are of childbearing age.
When we began this research, there was no systematic data collection on pregnant people behind bars in the U.S. or the outcomes of those pregnancies.
In 2009, Dr. Shlafer learned of a new parenting program for pregnant and postpartum people that had been just launched at the Shakopee Women’s Prison, Minnesota’s only prison for women. Studies show that having doulas significantly helps birth outcomes. This prison-based program provided individual and group-based pregnancy and parenting support to incarcerated parents and birth support from trained doulas. Shlafer formally joined forces with founder Erica Gerrity in 2010. They applied for and received funding from the Clinical and Translational Science Institute to evaluate the Minnesota Prison Doula Project (MnPDP), a community-university-corrections partnership. MnPDP has since expanded to serve pregnant people in jails across the state.
The 2014 legislation bans shackling and codifies incarcerated pregnant people’s access to doula care and to community standards of care.
The 2021 Healthy Start Act is the first legislation of its kind in the United States. It actively reduces harm to children through alternatives to incarceration.
Conducting this evaluation afforded us access, and allowed us to observe other systems issues affecting maternal and infant health. For example, Minnesota prisons and jails routinely shackled women immediately after giving birth, adding to trauma and disrupting developmentally crucial mother-child bonding. Laboring women were denied contact with family members, delivering with no emotional support.)
We knew Minnesota could do better.
In 2013, Dr. Shlafer and partners at the Minnesota Prison Doula project analyzed national anti-shackling laws to find a model policy for Minnesota. This research, the recommendations of a legislative advisory committee chaired by Dr. Shlafer, and a coalition that included Better Birth Project and MN Children’s Defense Fund, convinced the Minnesota legislature to pass anti-shackling legislation.
A 2016 landmark study by Dr. Carolyn Sufrin and colleagues found that over 1,000 women each year give birth while incarcerated and affirmed that there is a maternal and child public health need for this work. Funds from UMN’s Program in Health Disparities Research allowed us to document the lessons learned from our Minnesota community-university-corrections partnership. The National Institute of Child Health and Human Development funded a two-year study (R03) to assess the efficacy and cost-benefits of doula care for pregnant women in prisons. These studies, summarized in a 2023 Journal of Clinical and Translational Science article, helped Shlafer and her team make the case for a 5-year multi-site study of similar perinatal programs in six state prisons.
Community-engaged Solutions
Research shows that for both parent and child, postpartum early bonding is the key to healthy brain development, secure attachment and strong relationships. But, until 2021, incarcerated pregnant individuals in Minnesota were regularly separated from their newborns just days after birth. When moms return to prison, they are separated from their newborn, who was placed with a relative or foster family.
Using our research on pregnant people in Minnesota jails and the research on infant development and in coalition with community-based supporters and the Governor’s Children’s Cabinet, the MN Department of Corrections sponsored the Minnesota’s 2021 Healthy Start Act which allows incarcerated mothers to be released from prison for up to one year.
The next challenge is to understand which perinatal programs for people in prison are most successful, and why. Our current, five-year (R01) research project, funded through the National Institutes of Health, is called E4P: Enhanced Perinatal Programs for People in Prison. It’s a multi-site study of existing enhanced pregnancy and postpartum programs in seven state prisons (Alabama, Arkansas, Connecticut, Georgia, Michigan, Minnesota, and Virginia).
We are identifying facilitators and barriers to implementation of pregnancy, childbirth, and postpartum support programs for pregnant people in prison, and evaluating the pregnancy, birth, and postpartum outcomes of program participants. We also have supplemental funding from the National Institutes of Health to study the impact of COVID-19 on health services and social supports for pregnant and postpartum people in prison.