"We were on lockdown for pretty much my entire pregnancy": a qualitative study of pregnancy care in prisons and jails during the COVID-19 pandemic.

BACKGROUND

The number of incarcerated women in the United States has increased dramatically over the past 40 years and each year, and some of them are pregnant. It has been demonstrated that the COVID-19 pandemic negatively impacted incarcerated people in myriad ways: through conditions of confinement resulting in increased exposure to COVID-19, restrictive prison and jail policies intended to decrease the spread of COVID-19, and more. However, there has been little attention to the impact of the COVID-19 pandemic on the care and treatment of pregnant and postpartum individuals in carceral settings, given their unique needs.

METHODS

We conducted interviews with 10 formerly incarcerated women who were incarcerated and were pregnant or postpartum between March 2020 and January 2022. Each transcript was coded by two independent coders. Each phase of this work was guided, in part, by a national Community Research Council (CRC) made up of nine formerly incarcerated people who gave birth or were postpartum while incarcerated.

RESULTS

Our analysis revealed factors specific to the COVID-19 pandemic that exacerbated the harm faced by incarcerated pregnant and postpartum people, as well as factors that mitigated these negative impacts. Exacerbating factors include: (1) the use of quarantine and isolation of pregnant people; (2) unclear and inconsistent prevention guidance; (3) disruptions to communication, visitation, and programming; and (4) negative experiences with carceral facility staff. While these factors negatively impacted individuals' birth experiences, postpartum care, mental health, their relationship with their family, and more, interviewees also discussed factors which mitigated these impacts. Mitigating factors included: (1) support they received from external pregnancy or doula organizations; (2) support they received from incarcerated peers; and (3) self advocacy to improve their living conditions or express bodily autonomy.

CONCLUSION

The COVID-19 pandemic exacerbated existing disparities and inequitable access to perinatal care for incarcerated people. We conclude with a series of policy and practice recommendations that carceral facilities may implement to improve the health and wellbeing of incarcerated pregnant people and their babies.