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Pregnant in Jail: Dealing With Special Challenges

By Kate Bryan  |  March 28, 2022

Women represent the fastest growing population in the justice system, with a more than 700% increase from 1980 to 2019. It’s no wonder policymakers and other stakeholders have been closely examining the conditions, rights and unique challenges presented by justice-involved women.

One study, for example, estimated that about 55,000 pregnant women enter U.S. jails annually. Of these, research suggests 14% have an opioid use disorder, also known as OUD.

Opioid overdose deaths have jumped 642% for women since 1999, compared with 439% for men.

Women are particularly vulnerable to OUD and its effects. A 2021 study found that opioid overdose deaths have jumped 642% for women since 1999, compared with 439% for men. While there are many factors contributing to substance use disorder generally, research suggests that women have a higher rate of co-occurring psychiatric disorders such as anxiety, depression, history of suicidal behavior and post-traumatic stress disorder. Women are also more likely to report a history of physical or sexual abuse, or both.

Treating opioid use disorder with medications such as methadone or buprenorphine is considered the standard of care for pregnant women. A recent study , however, showed that treatment in jail is inconsistent. Data from 836 respondents found:

  • 60% of jails provided medications for opioid use disorder, or MOUD, if it was initiated prior to the individual entering the carceral setting.
  • 32% of jails initiated medication assisted treatment for pregnant women during confinement.
  • 23.8% of jails continued medication assisted treatment postpartum.

According to the researchers, the study “suggests that there is an opportunity for intervention to improve care for pregnant people who are incarcerated.”

Opioid withdrawal affects both the mother and fetus. A drop in opioid levels in the bloodstream increases the risk of neonatal opioid withdrawal syndrome, poor fetal growth, preterm labor, fetal convulsions and fetal death.

Treatment Often a Patchwork

North Carolina has felt the impact of the national opioid epidemic—particularly as it relates to justice-involved women. As reported by North Carolina Health News, opioid use disorder treatment for justice-involved individuals, specifically pregnant women, is a patchwork between jurisdictions. Of the state’s 100 counties, only 13 have initiated such programs.

Carolyn Sufrin, associate professor of gynecology and obstetrics at Johns Hopkins University, notes that when considering MOUD in the justice system, “Some jail administrators are concerned that incarcerated individuals will divert the medications to other people and sell the drugs in the jail, and so there are those concerns that may lead some people to be hesitant to provide these treatments.”

Fiscal concerns can also stymie implementation of MOUD programs. Using data gathered from a jail located in New Mexico, researchers calculated that providing methadone to justice-involved individuals cost an average of $115 per person per week. But just as this treatment can require up-front costs, a study in California found costs of crime decreased by an average of $17,550 per person by providing MOUD over a six-month period.

In 2021, the American College of Obstetricians and Gynecologists reaffirmed its position that, “for pregnant women with an opioid use disorder, opioid agonist pharmacotherapy is the recommended therapy and is preferable to medically supervised withdrawal because withdrawal is associated with high relapse rates, which lead to worse outcomes.” Opioid agonist treatment uses drugs such as methadone and buprenorphine to help prevent withdrawal and blunt opioid cravings.

Kate Bryan is a policy analyst in NCSL’s Criminal Justice Program.

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