The Ubuntu Center On Racism, Global Movements and Population Health Equity, Drexel University Dornsife School of Public Health, 3600 Market St, Philadelphia, PA, 19104, USA.
Department of Sociology, Boston University, 100 Cummington Mall, Boston, MA, 02215, USA.
BMC Public Health. 2022 May 12;22(1):954. doi: 10.1186/s12889-022-13359-7.
High rates of imprisonment in the U.S. have significant health, social, and economic consequences, particularly for marginalized communities. This study examines imprisonment as a contextual driver of receiving prenatal care by evaluating whether early and adequate prenatal care improved after Pennsylvania's criminal sentencing reform reduced prison admissions.
We linked individual-level birth certificate microdata on births (n = 999,503) in Pennsylvania (2009-2015), to monthly county-level rates of prison admissions. We apply an interrupted time series approach that contrasts post-policy changes in early and adequate prenatal care across counties where prison admissions were effectively reduced or continued to rise. We then tested whether prenatal care improvements were stronger among Black birthing people and those with lower levels of educational attainment.
In counties where prison admissions declined the most after the policy, early prenatal care increased from 69.0% to 73.2%, and inadequate prenatal care decreased from 18.1% to 15.9%. By comparison, improvements in early prenatal care were smaller in counties where prison admissions increased the most post-policy (73.5 to 76.4%) and there was no change to prenatal care inadequacy (14.4% pre and post). We find this pattern of improvements to be particularly strong among Black birthing people and those with lower levels of educational attainment.
Pennsylvania's sentencing reforms were associated with small advancements in racial and socioeconomic equity in prenatal care.
美国高监禁率对健康、社会和经济都有重大影响，尤其是对边缘化社区。本研究通过评估宾夕法尼亚州刑事判决改革减少入狱人数后，早期和充分的产前护理是否有所改善，考察监禁作为获得产前护理的背景驱动因素。
我们将宾夕法尼亚州（2009-2015 年）的个人层面出生证明微观数据（n=999503）与每月县级监狱入院率相关联。我们采用中断时间序列方法，对比在监狱入院人数有效减少或继续上升的县，政策变化前后早期和充分的产前护理情况。然后，我们测试了产前护理的改善是否在黑人产妇和教育程度较低的人群中更为明显。
在政策实施后监狱入院人数下降最多的县，早期产前护理从 69.0%增加到 73.2%，产前护理不足从 18.1%下降到 15.9%。相比之下，在政策实施后监狱入院人数增加最多的县，早期产前护理的改善较小（从 73.5%增加到 76.4%），产前护理不足没有变化（分别为 14.4%和 14.4%）。我们发现，这种改善模式在黑人产妇和教育程度较低的人群中尤为明显。
宾夕法尼亚州的判决改革与产前护理在种族和社会经济公平方面的微小进展有关。
