Maternity in prison: influence on physical and emotional health

integrative review based on research in electronic databases: Medline (PubMed), LILACS, SciELO and Nursing Database (BDENF), using the following search strategy: (“Prisons” [Majr] AND “Pregnancy” [ Mesh]), as of 2016.

Results:

the research ended with 33 bibliographic references, being the highest level of evidence from cohort studies, which demonstrate the precariousness of health care offered to these pregnant women. Three main groups of results were identified: low quality prenatal care, negative maternal and neonatal health indicators in relation to the general population and the emotional issues involved in prison reality during the period of pregnancy and puerperium.

Conclusions:

prenatal care has flaws that influence, in some way, the maternal and neonatal health indicators. In addition, the precarious structure of prison system directly interferes with the emotional health of these women.

Keywords
Women’s health; Prisons; Public health; Pregnancy; Stress psychological

Author/year	Study design	Sample	Objective	Results	Quality of study
Shlafer et al.¹⁴14 Shlafer R, Saunders JB, Boraas CM, Kozhimannil KB, Mazumder N, Freese R. Maternal and neonatal outcomes among incarcerated women who gave birth in custody. Birth. 2021 Mar; 48 (1): 122-31. (2020) EUA	Retrospective cohort	117♀	To describe 5 maternal and neonatal health indicators (type of delivery, LBW, preterm, NICU admission and Apgar) between incarcerated ♀ that received support to pregnancy or not.	Adverse maternal and neonatal outcomes in this sample were rare. Absence of difference in results between incarcerated mothers that received support adapted to pregnancy the history control group.	Adequate selection, measurement and outcome.
Ramirez et al.¹⁵15 Ramirez AC, Liauw J, Costescu D, Holder L, Lu H, Kouyoumdjian FG. Infant and Maternal Outcomes for Women Who Experience Imprisonment in Ontario, Canada: A Retrospective Cohort Study. J Obstet Gynaecol Can. 2020 Apr; 42 (4): 462-72. (2020) Ontario (Canada)	Retrospective cohort	2700 pregnant women. Pregnancy in prison(n=544) + Prison control (n=2,156)	To describe the risk of infant and maternal negative outcome for ♀ that experience prison and compare to general population outcomes.	In detainees and control, the chance of preterm birth was 15.5% and 12.5%, respectively. Adjusted for maternal age and parity compared to births from general population (N= 1,284,949), the chance of prematurity doubled in pregnant detainees and controls (OR=2.7; CI95%= 2.2-3.4) and (OR=2.1; CI95%= 1.9-2.4) For LBW it triplicated in detainees and doubled in controls (OR-=2.7) The chance for SGA increased 60% and 80% (OR= 1.6 and 1.8).	Adequate selection, measurement and outcome.
Nunes et al.¹⁶16 Nunes LRC, Deslandes SF, Jannotti CB. Narrativas sobre as práticas de maternagem na prisão: a encruzilhada da ordem discursiva prisional e da ordem discursiva do cuidado. Cad Saúde Pública. 2020; 36 (12): e00215719. (2020) Brazil	Qualitative study	5♀ and 1♂	To analyze the execution of maternal care practices in prison.	The prison and care rules are tensioned and converge in search for benefiting the child without ceasing the punishment to the mother. The motherhood experience in prison acts as a manner of reaffirming gender morality, defined in the role of a good mother.	Risk of selection, measurement and outcome bias.
Silva et al.¹⁷17 Silva JB, Moraes MN, Brandão BMLS, Freitas WMF, Souto RQ, Dias MD. Mulheres em privação de liberdade: narrativas de des(assistência) obstétrica. REME - Rev Min Enferm. 2020; 24: e-1346. (2020) Brazil	Qualitative study	6♀	To expose narratives of ♀deprived of liberty regarding obstetric assistance offered during experience of pregnancy puerperal cycle.	It was observed in the interviews the fragility of healthcare in all phases of pregnancy-puerperal cycle, involving dis(assistance) of PN, non-perceived experience of obstetric violence, feelings of abandonment in delivery and inadequate environment within prison.	Risk of selection, measurement and outcome bias.
Abbott et al.¹⁸18 Abbott L, Scott T, Thomas H, Weston K. Pregnancy and childbirth in English prisons: institutional ignominy and the pains of imprisonment. Sociol Health Illn. 2020 Mar; 42 (3): 660-75. (2020) United Kingdom	Qualitative study	22 prisoners, 6♀former detaineesand 10 professionals.	To propose a new concept of institutional ignominy to understand the deepness and complexity of pregnant detainees.	Many women experienced a growing feeling of fear along the advance of pregnancy. Some women expressed anger for not having special status of pregnant prisoner; others perceived that the pregnancy could provide protection against life in prison.	Risk of selection, measurement and outcome bias.
Chaves et al.¹⁹19 Chaves LH, Araújo ICA. Gestação e maternidade em cárcere: cuidados de saúde a partir do olhar das mulheres presas em uma unidade materno-infantil. Physis (Rio J.). 2020; 30 (1): e300112. (2020) Brazil	Qualitative study	Semi structured interview (n=7) e and structured questionnaire(n=25) N=32♀	To relate impressions of women arrested at Centro de Referência à Gestante Privada de Liberdade (CRGPL) in relation to healthcare offered by the institution.	Presents somewhat positive assessment to healthcare in the perspective of pregnant women and puerperal women in the Center, and this is well marked, according to reports, by the previous prison experiences of interviewees. On the other hand, some problems faced in CRGPL were related by the inmates and described as the source of several sufferings.	Risk of selection, measurement and outcome bias.
Sufrin et al.²⁰20 Sufrin C, Jones RK, Mosher WD, Beal L. Pregnancy Prevalence and Outcomes in U.S. Jails. Obstet Gynecol. 2020 May; 135 (5): 1177-83. (2020) EUA	Cross-sectional study	6 prisons	To describe the number of pregnant women admissions in the United States and the outcomes of pregnancies that ended under custody.	1,622 hospitalizations of pregnant women occurred in 12 months at the selected prisons. Of the 224 pregnancies that ended in prison, 144 (64%) were live births, 41 (18%) were spontaneous abortions, 33 (15%) were inducted abortions and 4 were ectopic. (1.8%). A third of deliveries were cesarean sections and 8% preterm. There were 2 stillbirths, 1 death of NB and no maternal death	Adequate selection and measurement (without assessment of confounding factors)
Sufrin et al.²¹21 Sufrin C, Beal L, Clarke J, Jones R, Mosher WD. Pregnancy Outcomes in US Prisons, 2016-2017. Am J Public Health. 2019 May; 109 (5): 799-805. (2019) EUA	Cross-sectional study	22 state and federal prison systems	To collect data on frequency of pregnancy and results among women in state and federal prisons from the USA.	1,396 pregnant women were admitted in prisons; 3.8% of recently admitted women and 0.6% of all detainees were pregnant in Dec/2016. There were 753 LB (92%), 46 spontaneous abortions (16%), 11 abortions (1%), 4 stillbirths (0.5%), 3 NB deaths and no maternal death. Prematurity was 6% and 30% were born from cesarean section. Distributions of results varied from state.	Adequate selection and measurement (without assessment of confounding factors)
Matos et al.²²22 Matos KKC, Silva SPC, Lima JKS. Representações de mulheres encarceradas sobre gestar na prisão. Rev. enferm. UFPE. 2018; 12(11): 3069-77. (2018) Brazil	Qualitative study	19♀	To comprehend social representations of incarcerated pregnant and puerperal women about pregnancy while living in prison colonies.	The representations of pregnancy during incarceration were marked by the absence of services and structure, with lame prenatal and difficulties between wanting to be with the child, and having to raise him/her in such an environment. It is characterized being pregnant in prison by the non-acceptance, generating attitudes of denial, however the affect for the baby is present with detainees and soothes this reality.	Risk of selection, measurement and outcome bias.
Fochiet al.²³23 Fochi MCS, Higa R, Camisão AR, Turato ER, Lopes MHBM. Vivências de gestantes sem situação de prisão. Rev Eletr Enf. 2017; 19: a57. (2017) Brazil	Qualitative study	14♀	To understand the experiences of pregnant women in prison situation.	Were identified, after research, the following categories: Search for self-protection, feeling of guilt and building of a new identity. The experience in prison meant loneliness, fear, powerlessness and resignation. There is a restriction in familiar relationships, social living, food supply, privacy and the right to sleep/rest, besides impairment of exercise of motherhood. Demonstrated feelings of guilt and pain for the deprivation of experiencing motherhood and breastfeeding, besides fear of losing the custody of the child.	Risk of selection, measurement and outcome bias.
Diuanaet al.²⁴24 Diuana V, Corrêa MCDV, Ventura M. Mulheres nas prisões brasileiras: tensões entre a ordem disciplinar punitiva e as prescrições da maternidade. Physis (Rio J.). 2017; 27 (3): 727-47. (2017) Brazil	Qualitative study	22♀ (pregnant or puerperal women) + 19 professionals from prison	To analyze the intersections of gender rules and disciplinary relations in the context of motherhood in prison, identifying controversies in the values field and in relations of power that sustain them.	Institutional closure, penal regulation, constant surveillance, restriction of decision power of mothers and compulsory separation of children generate tensions and promote peculiar manners of experiencing motherhood, with vulnerability of these women, exposing them and their children to moral and psychic suffering.	Risk of selection, measurement and outcome bias.
Santana et al.²⁵25 Santana AT, Oliveira GRSA, Bispo, TCF. Mães do cárcere: vivências de gestantes frente à assistência no pré-natal. Rev Baiana Saúde Pública. 2017; 40 (1): 38-54. (2017) Brazil	Qualitative study	10♀	To comprehend the experiences of women towards pregnancy, motherhood and prenatal care in prison.	It was observed the perception of pregnant women deprived of liberty towards the actions provided by physicians during conduction of prenatal. It was identified the following subcategories: dissatisfaction, fear and insecurity towards prenatal care; prenatal consultations too technical and poorly humanized; lack of nursery assistance during prenatal.	Risk of selection, measurement and outcome bias.
Ferreira et al.²⁶26 Ferreira LS, Moreira WC, Nascimento MVF, Sousa GN, Sertão MAL, Lago EC, et al. Percepção de presidiárias sobre a assistência à saúde materna em uma penitenciária feminina. Rev Cuba Enferm. 2017; 33 (4): 776-92. (2017) Brazil	Qualitative study	14♀	To describe and analyze the perception of detainees about maternal healthcare in a female prison.	Two thematic categories emerged: present nurse in prenatal and puerperal care of detainees; lack of humanized care, towards detainees of pregnant puerperal cycle.	Risk of selection, measurement and outcome bias.
Leal et al.²⁷27 Leal MC, Ayres BVS, Esteves-Pereira AP, Sánchez AR, Larouzé B. Nascer na prisão: gestação e parto atrás das grades no Brasil. Ciênc Saúde Colet. 2016; 21 (7): 2061-70. (2016) Brazil	Case series	241♀	To identify the profile of the population	45% were <25 years, 57% brown, 53% < 8 years of schooling and 83% multiparous. In the prison, 89% were already pregnant and 2/3 did not want pregnancy. Access to inadequate prenatal to 36% During hospitalization, 15% reported having suffered some kind of violence (verbal, psychological or physical) Only 15% evaluated the care received as excellent. Presented low social/familiar support and more 1/3 reported use of handcuffs during hospitalization.	Adequate selection and measurement. Risk of outcome bias (without assessment of confounding factors)

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[1] Associated Editor: Leila Katz