The COVID-19 pandemic brought unprecedented challenges, causing widespread financial strain, heightened mental health struggles, and deepening existing inequalities across communities. While this wave of challenges was felt nationwide, for some, these challenges were magnified. Two such groups particularly impacted by the COVID-19 pandemic include those exposed to incarceration—either directly or through a partner—and those who experienced a pregnancy during the COVID-19 pandemic. Indeed, incarceration is a stressful experience, not just for those behind bars but for their loved ones as well. Going through the uncertainty of the COVID-19 pandemic was a hardship for millions of Americans, but handling this stress while dealing with the impacts of having a husband or partner incarcerated and during pregnancy can amplify stress levels and stressful experiences.

Incarceration is not just an isolated event. It reverberates through families, especially during periods of instability like a pandemic. Even before COVID-19, incarceration exposure has been tied to economic and emotional hardships. During the pandemic, these existing issues were compounded, leading to even more struggles for those trying to navigate pregnancy and prepare for a newborn. When a partner or loved one is incarcerated, families are often in need of critical sources of support. The pandemic made accessing community resources and social networks that could have provided some relief even harder. Under these conditions, these valuable resources are even more critical when coupled with preparing for a birth or caring for a newborn. Even so, whether women exposed to incarceration during pregnancy endured heightened stressors had not been subject to research.

Our Study

Our study explored how exposure to incarceration affected women’s experiences during the initial months of the COVID-19 pandemic. Using data from the 2020 Pregnancy Risk Assessment Monitoring System (PRAMS), we analyzed responses from recent mothers in 17 states that participated in a special COVID-19 supplement. The survey included questions about various stressors brought on by the pandemic, such as job loss, difficulty paying rent, food insecurity, and mental health struggles.

To understand the impact of incarceration, we assessed differences in COVID-19-related stressors between women who had experienced incarceration themselves or through a partner in the year before giving birth and women who had not reported such experiences. The findings showed that women exposed to incarceration reported significantly more COVID-19-related stressors than their peers. On average, they experienced about five different stressors, compared to fewer than three among those without incarceration exposure. They were over twice as likely to face difficulties such as homelessness, increased anxiety, and depression, physical, sexual, or emotional aggression from a husband/partner, as well as problems paying bills and meeting basic necessities like food. For example, nearly 39% of incarceration-exposed women worried that food would run out, while only 14% of non-exposed women shared this concern. These results highlight the unique vulnerabilities that incarceration-exposed families faced during a time of widespread uncertainty and upheaval.

Implications

Our study emphasizes the need for more targeted support for families impacted by incarceration, especially during times of widespread crisis like a pandemic. Programs that focus on helping with housing stability, mental health support, and economic relief can make a big difference. For example, connecting families with community organizations offering public assistance or expanded access to home visiting programs could help ease the burden during tough times.

It is also important for healthcare providers to recognize the unique challenges faced by these families. Screening for incarceration exposure and other social determinants of health during prenatal visits could open the door to resources that can mitigate some of the hardships these families face. By focusing on holistic care that includes social and public assistance support, we can better aid mothers and their families through such challenging times.

While the height of the COVID-19 pandemic has passed, challenges—especially for families who faced compounded difficulties due to incarceration—show few signs of slowing down. As the babies born during 2020 grow into toddlers, their families continue to grapple with the long-term effects caused by the stressors endured by the pandemic and the ongoing collateral consequences tied to incarceration for families and children. Our research highlights a crucial need for policies and programs that support these vulnerable families, especially during their most critical moments.

Alexander Testa is an Assistant Professor in the Department of Management, Policy, and Community Health at the University of Texas Health Science Center at Houston. His research examines the consequences of criminal justice contact and violence exposure on health over the life course. Follow him on Twitter @testaalex

Chantal Fahmy is an Associate Professor in the Department of Criminology and Criminal Justice at The University of Texas at San Antonio. Her research focuses on reentry and reintegration from prison, health criminology, social support and social health, and the intersection of public health and incarceration. Her recent work has been published in Social Science & Medicine, American Journal of Preventive Medicine, Journal of Traumatic Stress, and Journal of Mental Health. Follow her on Twitter @ChantalFahmy

Benjamin Jacobs is a resident physician in Obstetrics and Gynecology at Duke University. His research interests center around adverse childhood experiences (ACEs) and its impact on the prenatal, perinatal, and postpartum periods. Follow him on Twitter @ben_m_jacobs1

Dylan B. Jackson is an Associate Professor in the Department of Population, Family and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health. He is a developmental and health criminologist who uses a life-course lens to study the intersection of crime, criminal legal system contact, and health among children, adolescents, and families. His research aims to inform policies and interventions that 1) promote health as a developmental crime-prevention tool, and 2) reduce health inequities for children, adolescents, and families impacted by crime and the criminal legal system. Follow him on Twitter @Dr_DylanJackson