Prison nursery programs (PNPs) provide incarcerated mothers with educational training in child development and parenting skills, while also giving them an opportunity to bond with their newborns. Eight states currently have PNPs; their policies and practices vary from state to state. The Missouri Department of Corrections currently has procedures for incarcerated pregnant women, including prenatal care, counseling, delivery, and follow-up care. Missouri currently does not offer a PNP for incarcerated pregnant women.
Missouri has one of the fastest growing female prison populations in the United States. Missouri ranks seventh in the United States for incarceration rates of women (~100 offenders per 100,000 women).1 In 2020, 79.2% of incarcerated Missouri women were White individuals and 15.7% were Black individuals.1 Between 2000 and 2019, the national rate of Black female imprisonment has decreased by 60%, but the rate is still 1.7 times higher than White females.2
Of the 2,045 Missouri women incarcerated in 2020, 87.3% were in their reproductive years (aged 18–45 years old) and 1% were pregnant (figure 1).1,3 Most recent national estimates approximate that 3-5% of incarcerated women in federal or state prisons and local jails are pregnant and varies significantly between states.4
Figure 1. Number of incarcerated pregnant women in Missouri each month between January 2020 and June 2021.3 Women are repeatedly counted for each month until delivery or departure. The dash line represents the average number of pregnant women each month in a given year. In 2020, the average number of pregnancies across the year was 22. In 2021, the average number of incarcerated pregnancies is currently 28. This figure was produced with unpublished data from the Missouri Department of Corrections.
Children of incarcerated mothers represent a small yet vulnerable group. Since many incarcerated women are likely to experience poverty, homelessness, substance abuse, and mental illnesses, they may expose their child to those same situations once leaving the corrections system. Children of incarcerated mothers are often cared for by a relative or foster caregiver, which is associated with increased time spent in the child welfare system and a decreased likelihood of being reunited with their birth mother. Additionally, if the mother is reincarcerated, the child will need a new caregiver, which can create disruption and have negative effects on intellectual and attachment outcomes.5
Aggressive behavior in young children is associated with hardship in the caregiving and home environment.6,7 Research indicates babies who are born in prison and are able to maintain the mother-child connection after prison have less incidences of depression, anxiety, and associated learning disabilities than babies who were unable to main their mother-child connection.5 The research surrounding paternal incarceration and effects on child development and education outcomes is more thoroughly researched than maternal incarceration.8 While the effects of maternal incarceration are still being investigated, research does suggest maternal incarceration negatively affects educational outcomes for children later in life.9
Forced separation of mother and newborn can potentially have devastating effects on mother- infant attachment and psychological well-being. Prison nursery programs (PNPs) provide incarcerated mothers with educational training in child development and parenting skills. The primary goal of PNPs is to give mothers and infants an opportunity to form emotional attachments or bonds.10 These programs are typically available to low-risk mothers (i.e., mothers without a history of violence or child abuse) that will give birth while in custody;10 this allows the newborn to stay with the mother for a finite amount of time while in prison, either in a separate unit or community corrections center. PNPs vary in maximum number of participants allowed, staffing, housing, and procedures. Women in nursery programs are usually required to participate in parenting courses, take care of their own child, and refrain from behavior that would result in misconduct reports. In some programs, women are required to take classes to complete their general educational degree (GED) or to work part-time within the institution both before and after the baby is born.11
PNPs vary greatly from state to state; there are no standardized requirements or state or federal guidelines. Eight states (Illinois, Indiana, Nebraska, New York, Ohio, South Dakota, Washington, and West Virginia) have operational PNPs that allow incarcerated mothers to keep their babies for 12–36 months after birth; South Dakota’s PNP allows only 1 month. Pennsylvania and California had PNPs which were discontinued due to lack of financial resources and unforeseen negative circumstances (i.e., instances of abuse).12,13 Additional considerations for such programs include the eventual separation of mother and child for those with long sentences and lack of community aftercare programs that can provide additional support to mothers being released to ensure they transition successfully back to ‘normal’. A cost-analysis of Nebraska’s PNP program indicated a cost savings of more than $6 million from 1994–2012.11
Recidivism is the tendency for an individual convicted of a crime to reoffend. Previous research estimates that 30-45% of women will return to prison within 3 years.14 Recent program evaluations of PNPs show significant decreases in recidivism for women who participate in PNP programs compared to those who do not. In Nebraska, participation in the nursery program resulted in a 28% reduction in recidivism and 39% reduction in women returning to prison custody.11 Similar findings were observed in a New York study of recidivism in 139 women three years after release from a PNP; 86.3% of PNP participants remained in the community, with 4% returning to prison for new crimes between 2001 and 2007.14 Similarly, in an Illinois study of 78 PNP participants, approximately 3% of mothers returned to prison for a new crime following their participation in PNPs between 2007 and 2016.12
Nationally, about 12.5% of women experience postpartum depression symptoms. According to the pregnancy risk assessment monitoring system (PRAMS), approximately 14.6% of Missouri women have reported having postpartum depression symptoms.15 Compared to the general population, mothers who have been incarcerated are more likely to be affected by postpartum depression due to the separation from their child.16 Women who give birth while incarcerated describe the experience as traumatic. Self-report data from PNP participants suggests PNPs may contribute to a reduction in postpartum depression symptoms.17 Women who participated in PNPs believe it influenced their personal growth, development, and enhanced their mothering abilities. The women also indicated that they felt more effective in their parenting role.18
Missouri currently does not have a PNP. Missouri Department of Corrections currently has procedures in place for incarcerated pregnant women, including prenatal care, counseling, delivery, and follow-up care.19 Follow-up care is directed at the discretion of the obstetrician. This includes discussion with a case manager about placement of the baby after birth (e.g., foster care or staying with a relative), but no time frame for this placement is listed in the procedures.