Forgotten Fundamentals: A Review of State Legislation on Nutrition for Incarcerated Pregnant and Postpartum People.

Adequate nutritional intake during pregnancy is critical to infant health and development. People with the capacity for pregnancy who are incarcerated have limited control over their diets and rely on prisons and jails to meet their nutritional needs. This study examined state and federal statutes pertaining to nutrition care for pregnant people while incarcerated. Following a systematic search and review, we identified four qualitative codes relating to access to vitamins, supplemental food, additional hydration, and prenatal nutrition education. Summaries of state and federal statutes pertaining to nutrition were developed and compared with current prenatal nutrition recommendations. Less than a third of states had nutrition-related mandates and no states had statutes that included all key nutrition recommendations. No federal statutes addressed nutrition during pregnancy. Additionally, our review found no provisions for enforcement of the limited nutritional statutes that do exist. To mitigate adverse health consequences for pregnant people and their fetuses, policymakers should enact or amend legislation to align nutrition standards in all prisons and jails with national policy recommendations and provide mechanisms to oversee compliance.

Maternal and neonatal outcomes among incarcerated women who gave birth in custody.

BACKGROUND: In the United States, the population of incarcerated women has increased by more than 600% since the 1980s. With this rise, correctional facilities have faced new challenges meeting the health care needs of women, especially those who are pregnant. This retrospective cohort study sought to describe five indicators of maternal and neonatal health among women who gave birth in custody, and to compare outcomes among incarcerated women who did and did not receive enhanced pregnancy support. METHODS: We used deidentified electronic health records (EHRs) to examine maternal and neonatal birth outcomes (ie, mode of birth, low birthweight, preterm birth, APGAR score, NICU admission) among women who gave birth in custody. Regression models examined differences in outcomes between women who received enhanced pregnancy support-group prenatal education and one-on-one doula visits-and a historical control group of women who received standard prenatal care. RESULTS: Adverse maternal and neonatal birth outcomes in this sample were rare. No differences in outcomes were found between incarcerated women who received enhanced pregnancy support and the historical control group. CONCLUSIONS: Despite evidence for the benefits of enhanced pregnancy support in the general population, this study did not find differences in outcomes between incarcerated women who did and did not receive support. Integrated data from prison and hospital records are innovative, but effect measurement is limited by sample size. Future research should include primary data collection on maternal, neonatal, and dyadic outcomes longitudinally and across prisons.

Corrections officers' knowledge and perspectives of maternal and child health policies and programs for pregnant women in prison.

BACKGROUND: In response to the dramatic increase in the number of women incarcerated in the United States-and a growing awareness that a small proportion of women enter prison pregnant and have unique health needs-some prisons have implemented policies and programs to support pregnant women (defined here as maternal and child health [MCH] policies and programs). Corrections officers (COs) are key stakeholders in the successful implementation of prison policies and programs. Yet, little empirical research has examined prison COs' knowledge and perspectives of MCH policies and programs, particularly the impact such policies and programs have on COs' primary job responsibility of maintaining safety and security. The objective of this mixed-methods study was to understand COs' knowledge and perspectives of MCH policies and programs in one state prison, with a specific emphasis on the prison's pregnancy and birth support (doula) program. RESULTS: Thirty-eight COs at a single large, Midwestern women's prison completed an online survey, and eight of these COs participated in an individual, in-person qualitative interview. Results indicated that COs' perspectives on MCH policies and programs were generally positive. Most COs strongly approved of the prison's doula program and the practice of not restraining pregnant women. COs reported that MCH policies and programs did not interfere, and in some cases helped, with their primary job task of maintaining safety and security. CONCLUSIONS: Findings support expansion of MCH programs and policies in prisons, while underscoring the need to offer more CO training and to gather more CO input during program development and implementation. MCH services that provide support to pregnant women that are outside the scope of COs' roles may help reduce CO job demands, improve facility safety, and promote maternal and child health.

Federal and State Policy Efforts to Address Maternal Opioid Misuse: Gaps and Challenges.

BACKGROUND: Opioid misuse during pregnancy is increasingly common and is associated with preterm birth and neonatal abstinence syndrome. As such, there is increased policy attention on reducing opioid misuse and increasing detection and treatment of opioid use disorder around the time of childbirth. METHODS: We conducted a review of peer-reviewed and grey literature to identify policy strategies to address opioid misuse among pregnant women; to describe current federal and state laws that impact women before pregnancy, during pregnancy, at birth, and postpartum; and to identify gaps and challenges related to these efforts. RESULTS: We identify two gaps in current efforts: 1) limited attention to prevention of opioid misuse among reproductive-age women, and 2) lack of policies addressing opioid misuse among postpartum women. We also discuss barriers to accessing care for women who misuse opioids, including provider shortages (e.g., too few addiction medicine specialists accept pregnant women or Medicaid beneficiaries as patients), logistical barriers (e.g., lack of transportation, child care), stigma, and fear of legal consequences. CONCLUSIONS: As policymakers pursue strategies to address the opioid epidemic, the unique needs of pregnant and postpartum women and barriers to treatment should be addressed.

Most nursing home social service directors lack training in working with lesbian, gay, and bisexual residents.

The purpose of this descriptive study is to report findings from a nationally representative mail-in survey of nursing home social service directors (n = 1,071) who were asked if they had received at least one hour of training in six different areas of cultural competency in the past five years. Of the six areas, the lowest percentage of directors reported having training in homophobia. Three-fourths of the sample had not received even one hour of homophobia training over the past five years. Directors who were more recently educated were more likely to report having received homophobia training, as were directors with a college degree, and those who worked in nursing homes located in the West and South regions of the United States. Directors with the most experience were less likely to report having received training. Findings call for immediate development and dissemination of heterosexism and homophobia training of social service staff, policy changes within the nursing home, and policy advocacy priorities for social workers.

Characteristics of nursing home social services directors: how common is a degree in social work?

PURPOSE: To report the percentage of nursing homes whose social services director has a degree in social work, to report the characteristics of social service directors, and to describe the characteristics of nursing homes most likely to employ a degreed social worker. These questions are important because social workers are core members of the interdisciplinary team in nursing homes and have responsibilities for the psychosocial well-being of residents. DESIGN AND METHODS: Cross-sectional nationally representative survey of 1071 social service directors employed in US nursing homes certified to receive Medicare and/or Medicaid. RESULTS: Most nursing homes do employ at least one (and typically only one) social service staff person. Most are employed full-time and half have a degree in social work. About 20% do not have a college degree. The vast majority of social service directors are white and are women. Close to 40% are licensed social workers. Full-time salaries varies enormously from less than $15,000 to over $60,000 per year. Most do not belong to an organization that helps them keep apprised of developments in nursing home social services. Using logistic regression and controlling for the effects of other independent variables, for-profit nursing homes with fewer than 121 beds, in sparsely populated counties in the West are the least likely to hire a degreed social worker as social service director. IMPLICATIONS: The wide range in educational preparedness and salary indicates 2 roles: a social work role and a social services role. The different roles have implications for initial role preparation and continuing education. Clear communication about the role expectations associated with social services and social work would benefit residents, family, staff, and physicians, who would then be better prepared to draw on their skills in helping to meet the psychosocial needs of residents.