Pregnant Behind Bars: Meeting the Nutrition Needs of Incarcerated Pregnant Women

  • Catherine A. ForestellEmail author
  • Danielle H. Dallaire
Part of the Nutrition and Health book series (NH)


The number of women involved in the criminal justice system has increased dramatically over the past 20 years. Due to their marginalized background, incarcerated women have a complex set of health-related needs. This is especially true of those who are pregnant, a particularly vulnerable, high-risk group. Although guidelines have been developed that recommend pregnancy screening, provision of dietary supplements, regular nutritious meals, and nutritional counseling for incarcerated pregnant women, jail policies and health care protocols often fail to heed these recommendations. In this chapter, we discuss the nutritional needs of pregnant incarcerated women as well as breastfeeding in the context of the criminal justice system and consider some of the challenges in developing programming and policies to address these health-related needs. We also present findings from the William & Mary Healthy Beginnings Project, a nutrition intervention program developed for pregnant incarcerated women in Southeastern Virginia. Assessment of this program suggests that through the development of protocols and polices that consider the health-related needs of pregnant women, correctional facilities could play a pivotal role in helping incarcerated women develop healthier habits to better care for themselves and their newborns.


Incarceration Nutrition knowledge Breastfeeding High-risk pregnancy Jail Prison 


  1. 1.
    Minton TD. Jail inmates at midyear 2011: statistical tables (NCJ-237961). In: Bureau of Justice Statistics Special Report. US Department of Justice. 2011. Accessed 30 Jun 2016.
  2. 2.
    Carson EA. Prisoners in 2014 (NCJ-248955). In: Bureau of Justice Statistics Special Report. US Department of Justice. 2015. Accessed 30 Jun 2016.
  3. 3.
    Spjeldnes S, Goodkind S. Gender differences and offender reentry: a review of the literature. J Offender Rehabil. 2009;48:314–35. Scholar
  4. 4.
    Ferszt GG, Clarke JG. Health care of pregnant women in US state prisons. J Health Care Poor Underserved. 2012;23:557–69. Scholar
  5. 5.
    Dallaire DH, Forestell CA, Shlafer R. Policy, programs, and interventions regarding pregnant incarcerated women. In: Arditti J, Le Roux T, editors. And justice for all: families and the criminal justice system. Ann Arbor: Michigan; 2015. p. 39–58.Google Scholar
  6. 6.
    Goshin LS, Arditti JA, Dallaire DH, Shlafer RJ, Hollihan A. An international human rights perspective on maternal criminal justice involvement in the United States. Psychol Public Policy Law. 2017;23:53.CrossRefGoogle Scholar
  7. 7.
    Carson EA, Sabol WJ. Prisoners in 2011 (NCJ 239808). In: Bureau of Justice Statistics Special Report. US Department of Justice. 2012. Accessed 30 Jun 2016.
  8. 8.
    Committee on Health Care for Underserved Women. Reproductive health care for incarcerated women and adolescent females. Committee opinion no. 535. Obstet Gynecol. 2012;120:425–9. Scholar
  9. 9.
    James DJ, Glaze LE. Mental health problems of prison and jail inmates (NCJ 213600). In: Bureau of Justice Statistics Special Report. US Department of Justice. 2006. Accessed 30 Jun 2016.
  10. 10.
    Bloom B, Owen B, Covington S. Women offenders and the gendered effects of public policy. Rev Policy Res. 2004;21:31–48. Scholar
  11. 11.
    Greenfeld LA, Snell TL. Women offenders (NCJ-175688). In: Bureau of Justice Statistics Special Report. US Department of Justice. 1999. Accessed 30 Jun 2016.
  12. 12.
    Fazel S, Bains P, Doll H. Substance abuse and dependence in prisoners: a systematic review. Addiction. 2006;101:181–91. Scholar
  13. 13.
    Grella CE, Lovinger K, Warda US. Relationships among trauma exposure, familial characteristics, and PTSD: a case-control study of women in prison and in the general population. Women Crim Just. 2013;23:63–79. Scholar
  14. 14.
    Brennan T, Breitenbach M, Dieterich W, Salisbury EJ, Van Voorhis P. Women’s pathways to serious and habitual crime: a person-centered analysis incorporating gender responsive factors. Crim Justice Behav. 2012;39:1481–508. Scholar
  15. 15.
    Salisbury EJ, Van Voorhis P. Gendered pathways: a quantitative investigation of women probationers’ paths to incarceration. Crim Justice Behav. 2009;36:541–66. Scholar
  16. 16.
    Tyndall MW, Patrick D, Spittal P, Li K, O'Shaughnessy MV, Schechter MT. Risky sexual behaviours among injection drugs users with high HIV prevalence: implications for STD control. Sex Transm Infect. 2002;78(Suppl 1):i170–5. Scholar
  17. 17.
    Clarke JG, Hebert MR, Rosengard C, Rose JS, DaSilva KM, Stein MD. Reproductive health care and family planning needs among incarcerated women. Am J Public Health. 2006;96:834–9. Scholar
  18. 18.
    Bell JF, Zimmerman FJ, Cawthon ML, Huebner CE, Ward DH, Schroeder CA. Jail incarceration and birth outcomes. J Urban Health. 2004;81:630–44. Scholar
  19. 19.
    Maruschak LM. Medical problems of jail inmates (NCJ-210696). In: Bureau of Justice Statistics Special Report. US Department of Justice. 2006. Accessed 30 Jun 2016.
  20. 20.
    Cordero L, Hines S, Shibley KA, Landon MB. Duration of incarceration and perinatal outcome. Obstet Gynecol. 1991;78(4):641–5.PubMedGoogle Scholar
  21. 21.
    Martin SL, Rieger RH, Kupper LL, Meyer RE, Qaqish BF. The effect of incarceration during pregnancy on birth outcomes. Public Health Rep. 1997;112:340–6.PubMedPubMedCentralGoogle Scholar
  22. 22.
    National Commission on Correctional Health Care. Women’s health care in correctional settings. 2014. Accessed 4 Jun 2016.
  23. 23.
    Timmermans S, Jaddoe VW, Hofman A, Steegers-Theunissen RP, Steegers EA. Periconception folic acid supplementation, fetal growth and the risks of low birth weight and preterm birth: the Generation R Study. Br J Nutr. 2009;102(5):777–85. Scholar
  24. 24.
    Peña-Rosas JP, De-Regi LM, Dowswell T, Viteri FE. Daily oral iron supplementation during pregnancy. Cochrane Database Syst Rev. 2012;12:CD004736. Scholar
  25. 25.
    Collins SA, Thompson SH. What are we feeding our inmates? J Correct Health Care. 2012;18(3):210–8. Scholar
  26. 26.
    Shlafer R. Jail administrators’ perspectives of the services and needs of pregnant women incarcerated in county jails. In: 142nd American Public Health Association Annual Meeting and Exposition. Washington, DC: American Public Health Association (APHA); 2014. Accessed 30 Jun 2016.
  27. 27.
    Liu J, Raine A. The effect of childhood malnutrition on externalizing behavior. Curr Opin Pediatr. 2006;18:565–70. Scholar
  28. 28.
    Olsen SF, Hansen HS, Secher NJ, Jensen B, Sandström B. Gestation length and birth weight in relation to intake of marine n-3 fatty acids. Br J Nutr. 1995;73:397–404.CrossRefGoogle Scholar
  29. 29.
    Freeman M, Hibbeln JR, Wisner KL, Brumbach BH, Watchman M, Gelenberg AJ. Randomized dose-ranging pilot trial of omega-3 fatty acids for postpartum depression. Acta Psychiatr Scand. 2006;113:31–5. Scholar
  30. 30.
    Lapillonne A. Vitamin D deficiency during pregnancy may impair maternal and fetal outcomes. Med Hypotheses. 2010;74:71–5. Scholar
  31. 31.
    Institute of Medicine, Food and Nutrition Board. Dietary reference intakes for calcium and vitamin D. Washington: National Academy Press; 2010.Google Scholar
  32. 32.
    Hollis BW, Johnson D, Hulsey TC, Ebeling M, Wagner CL. Vitamin D supplementation during pregnancy: double-blind, randomized clinical trial of safety and effectiveness. J Bone Miner Res. 2011;26:2341–57. Scholar
  33. 33.
    Forestell CA, Mennella JA. Food, folklore and flavor preference development. In: Lammi-Keefe CJ, Couch SC, Philipson E, editors. Handbook of nutrition and pregnancy. Totowa: Humana Press; 2008. p. 55–64.CrossRefGoogle Scholar
  34. 34.
    Godderis R. Dining in: the symbolic power of food in prison. Howard J Crim Just. 2006;45:255–67. Scholar
  35. 35.
    Cate S. “Breaking bread with spread” in a San Francisco County jail. Gastronomica. 2008;8:17–24. Accessed 30 Jun 2016.CrossRefGoogle Scholar
  36. 36.
    Godfrey KM, Lillycrop KA, Burdge GC, Gluckman PD, Hanson MA. Epigenetic mechanisms and the mismatch concept of the developmental origins of health and disease. Pediatr Res. 2007;61:5R–10R. Scholar
  37. 37.
    Burdge GC, Slater-Jefferies J, Torrens C, Phillips ES, Hanson MA, Lillycrop KA. Dietary protein restriction of pregnant rats in the F0 generation induces altered methylation of hepatic gene promoters in the adult male offspring in the F1 and F2 generations. Br J Nutr. 2007;97:435–9. Scholar
  38. 38.
    Kelsey CM, Medel N, Mullins C, Dallaire D, Forestell C. An examination of care practices of pregnant women incarcerated in jail facilities in the United States. Matern Child Health J. 2017:1–7. Scholar
  39. 39.
    Silver HM. Listeriosis during pregnancy. Obstet Gynecol Surv. 1998;53:737–40.CrossRefGoogle Scholar
  40. 40.
    Procter SB, Campbell CG. Position of the academy of nutrition and dietetics: nutrition and lifestyle for a healthy pregnancy outcome. J Acad Nutr Diet. 2014;114:1099–103. Scholar
  41. 41.
    Shlafer RJ, Stang J, Dallaire D, Forestell CA, Hellerstedt W. Best practices for nutrition care of pregnant women in prison. J Correct Health Care. 2017;23(3):297–304. Scholar
  42. 42.
    Dallaire DH, Holmquist Z, Kelsey C. Healthy beginnings in difficult environments: the William & Mary Healthy Beginnings Project. Healthy Generations Newsletter. Winter 2015.Google Scholar
  43. 43.
    Boyd NR, Windsor RA. A formative evaluation in maternal and child health practice: the partners for life nutrition education program for pregnant women. Matern Child Health J. 2003;7:137–43.CrossRefGoogle Scholar
  44. 44.
    Sachdeva R, Mann SK. Impact of nutrition education and medical supervision on pregnancy outcome. Indian Pediatr. 1993;30:1309–14.PubMedGoogle Scholar
  45. 45.
    American Academy of Pediatrics. Breastfeeding and the use of human milk. Pediatrics. 2012;129:e827–41. Scholar
  46. 46.
    World Health Organization. WHO recommendations on postnatal care of the mother and newborn. Geneva: World Health Organization; 2014. Accessed 30 Jun 2016.
  47. 47.
    Mennella JA, Jagnow CP, Beauchamp GK. Prenatal and postnatal flavor learning by human infants. Pediatrics. 2001;107(6):E88. Scholar
  48. 48.
    Galloway AT, Lee Y, Birch LL. Predictors and consequences of food neophobia and pickiness in young girls. J Am Diet Assoc. 2003;103:692–8. Scholar
  49. 49.
    Shim JE, Kim J, Mathai RA, STRONG Kids Research Team. Associations of infant feeding practices and picky eating behaviors of preschool children. J Am Diet Assoc. 2011;111:1363–8. Scholar
  50. 50.
    Else-Quest NM, Hyde JS, Clark R. Breastfeeding, bonding, and the mother-infant relationship. Merrill-Palmer Q. 2003;49:495–517. Scholar
  51. 51.
    Britton C, McCormick FM, Renfrew MJ, Wade A, King SE. Support for breastfeeding mothers (review). Cochrane Database Syst Rev. 2007;1:CD001141. Scholar
  52. 52.
    Poehlmann J. Incarcerated mothers’ contact with children, perceived family relationships, and depressive symptoms. J Fam Psychol. 2005;19(3):350–7. Scholar
  53. 53.
    Wismont JM. The lived pregnancy experience of women in prison. J Midwifery Womens Health. 2000;45:292–300. Scholar
  54. 54.
    Ystrom E. Breastfeeding cessation and symptoms of anxiety and depression: a longitudinal cohort study. BMC Pregnancy Childbirth. 2012;12:36. Scholar
  55. 55.
    Ystrom E, Niegel S, Klepp KI, Vollrath ME. The impact of maternal negative affectivity and general self-efficacy on breastfeeding: the Norwegian Mother and Child Cohort Study. J Pediatr. 2008;152:68–72. Scholar
  56. 56.
    Libster NR. Breastfeeding initiation among women who have experience with incarceration. College of William & Mary undergraduate honors theses. Paper 933. 2016. Accessed 1 Aug 2016.
  57. 57.
    Dennis CL. Breastfeeding initiation and duration: a 1990–2000 literature review. J Obstet Gynecol Neonatal Nurs. 2002;31:12–32.CrossRefGoogle Scholar
  58. 58.
    Corbett KS. Explaining infant feeding style of low-income black women. J Pediatr Nurs. 2000;15:73–81. Scholar
  59. 59.
    Guise JM, Palda V, Westhoff C, Chan BK, Helfand M, Lieu TA. The effectiveness of primary care-based interventions to promote breastfeeding: systematic evidence review and meta-analysis for the US Preventive Services Task Force. Ann Fam Med. 2003;1:70–8. Scholar
  60. 60.
    Hannon PR, Willis SK, Bishop-Townsend V, Martinez IM, Scrimshaw SC. African-American and Latina adolescent mothers’ infant feeding decisions and breastfeeding practices: a qualitative study. J Adolesc Health. 2000;26:399–407. Scholar
  61. 61.
    Huang K, Atlas R, Parvez F. The significance of breastfeeding to incarcerated pregnant women: an exploratory study. Birth. 2012;39:145–55. Scholar
  62. 62.
    Schafer E, Vogel MK, Viegas S, Hausafus C. Volunteer peer counselors increase breastfeeding duration among rural low-income women. Birth. 1998;25:101–6. Scholar
  63. 63.
    Warner J. Infants in orange: an international model-based approach to prison nurseries. Hastings Women’s Law J. 2015;26:65–91.Google Scholar
  64. 64.
    American College of Obstetricians and Gynecologists. Weight gain during pregnancy. Committee opinion no. 548. Obstet Gynecol. 2013;121:210–2.CrossRefGoogle Scholar
  65. 65.
    Dallaire DH, Forestell CA, Kelsey C, Ptachick B, McDonnell K. A nutrition-based program for pregnant incarcerated women. J Offender Rehabil. 2017;56:277–94. Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Catherine A. Forestell
    • 1
    Email author
  • Danielle H. Dallaire
    • 1
  1. 1.Department of Psychological SciencesThe College of William & MaryWilliamsburgUSA

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