Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Womens Health Issues. 2024 Sep-Oct;34(5):488-497. doi: 10.1016/j.whi.2024.06.001. Epub 2024 Jul 8.
In Canada, colonial policies have resulted in health inequities between First Nations and other Canadians. These policies contribute to overrepresentation of First Nations in the criminal legal system, where incarcerated people and their infants face elevated health risks. We investigated the association between prenatal incarceration and adverse birth outcomes among First Nations and other birthing parents in Manitoba, Canada.
Using linked whole-population administrative data, we identified all live births (2004-2017) in which the birthing parent (First Nations n = 1,449; other Manitoban n = 278) was prenatally incarcerated and compared them to birthing parents who were postnatally incarcerated (First Nations n = 5,290; other Manitoban n = 790) or not incarcerated (First Nations n = 19,950; other Manitoban n = 3,203). We used generalized linear models adjusted for measured confounders with propensity score weighting to calculate risk differences and 95% confidence intervals for adverse birth outcomes among those prenatally versus postnatally incarcerated in each group.
Low birthweight births were more likely among First Nations birthing parents who were prenatally (vs. postnatally) incarcerated (risk difference 1.59, 95% CI [.79, 2.38]) but less likely among other Manitoban birthing parents (risk difference -2.33, 95% CI [-4.50, -.16]) who were prenatally (vs. postnatally) incarcerated. Among First Nations, prenatal incarceration was also associated with large-for-gestational-age births, low Apgar scores, and no breastfeeding (vs. postnatal incarceration), as well as preterm births (vs. no incarceration). Among other Manitobans, prenatal incarceration was also associated with small-for-gestational-age births, low Apgar scores, and no breastfeeding (vs. postnatal incarceration), as well as preterm births (vs. no incarceration).
The findings suggest that incarceration may contribute to intergenerational systems of oppression by compromising birth outcomes among First Nations and other birthing parents in Canada and underscore the need to both improve care for pregnant people who are incarcerated and invest in alternatives to incarceration.
在加拿大，殖民政策导致了第一民族和其他加拿大公民之间的健康不平等。这些政策导致第一民族在刑事司法系统中的代表性过高，在该系统中，被监禁的人和他们的婴儿面临更高的健康风险。我们调查了在加拿大马尼托巴省，产前监禁与第一民族和其他分娩父母不良出生结局之间的关联。
使用链接的全人群行政数据，我们确定了所有活产儿（2004-2017 年），其中分娩父母（第一民族 n=1449；其他马尼托巴省 n=278）在产前被监禁，并将其与产后被监禁的分娩父母（第一民族 n=5290；其他马尼托巴省 n=790）或未被监禁的分娩父母（第一民族 n=19950；其他马尼托巴省 n=3203）进行比较。我们使用广义线性模型，在倾向评分加权调整后，针对测量的混杂因素进行了调整，以计算每个组中产前与产后监禁的不良出生结局的风险差异和 95%置信区间。
与产后监禁相比，产前监禁的第一民族分娩父母更有可能出现低出生体重儿（风险差异 1.59，95%CI [0.79，2.38]），而其他马尼托巴省分娩父母则不太可能出现低出生体重儿（风险差异-2.33，95%CI [-4.50，-.16]）。在第一民族中，产前监禁还与巨大儿、低阿普加评分和无母乳喂养（与产后监禁相比）以及早产（与无监禁相比）有关。在其他马尼托巴人中，产前监禁也与小于胎龄儿、低阿普加评分和无母乳喂养（与产后监禁相比）以及早产（与无监禁相比）有关。
研究结果表明，监禁可能通过损害加拿大第一民族和其他分娩父母的出生结局，导致代际压迫制度，因此需要改善对被监禁孕妇的护理，并投资于监禁的替代方案。
