{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T19:35:33Z","timestamp":1788550533812,"version":"build-2803163510"},"reference-count":70,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2020,10,8]],"date-time":"2020-10-08T00:00:00Z","timestamp":1602115200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Previous research demonstrates that exposure to incarceration during pregnancy \u2013 either personally or vicariously through a partner \u2013 worsens parental care. However, little is known about the specific barriers to parental care that are associated with incarceration exposure. Using data from the Pregnancy Risk Assessment Monitoring System (years 2009\u20132016), the current study examines the relationship between exposure to incarceration during pregnancy and barriers to prenatal care in the United States. Negative binomial and logistic regression models were used to assess the association between the recent incarceration of a woman or her partner (i.e., incarceration that occurred in the 12 months prior to the focal birth) and several barriers to prenatal care. Findings indicate that exposure to incarceration, either personally or vicariously through a partner, increases the overall number of barriers to prenatal care and this association operates through several specific barriers including a lack of transportation to doctor\u2019s appointments, having difficulty finding someone to take care of her children, being too busy, keeping pregnancy a secret, and a woman not knowing she was pregnant. Policies designed to help incarceration exposed women overcome these barriers can potentially yield benefits for enhancing access to parental care.<\/jats:p>","DOI":"10.3390\/ijerph17197331","type":"journal-article","created":{"date-parts":[[2020,10,8]],"date-time":"2020-10-08T08:52:41Z","timestamp":1602147161000},"page":"7331","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Incarceration Exposure and Barriers to Prenatal Care in the United States: Findings from the Pregnancy Risk Assessment Monitoring System"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8686-9115","authenticated-orcid":false,"given":"Alexander","family":"Testa","sequence":"first","affiliation":[{"name":"Department of Criminology &amp; Criminal Justice, University of Texas at San Antonio, San Antonio, TX 78207, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dylan B.","family":"Jackson","sequence":"additional","affiliation":[{"name":"Department of Population, Family, and Reproductive Health, Johns Hopkins University, Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,10,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2112","DOI":"10.1177\/0192513X20910168","article-title":"Partner Incarceration and Financial Support from Kin","volume":"41","author":"Bruns","year":"2020","journal-title":"J. Fam. Issues"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1002\/pam.21741","article-title":"Making Ends Meet After Prison","volume":"33","author":"Harding","year":"2014","journal-title":"J. Policy Anal. Manag."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1177\/0033354919826563","article-title":"Linkages Between Incarceration and Health","volume":"134","author":"Massoglia","year":"2019","journal-title":"Public Health Rep."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.childyouth.2019.05.029","article-title":"Health effects of family member incarceration in the United States: A meta-analysis and cost study","volume":"103","author":"Provencher","year":"2019","journal-title":"Child. Youth Serv. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1464","DOI":"10.1016\/S0140-6736(17)30259-3","article-title":"Mass incarceration, public health, and widening inequality in the USA","volume":"389","author":"Wildeman","year":"2017","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1177\/0033354918807974","article-title":"Health Consequences of Family Member Incarceration for Adults in the Household","volume":"134","author":"Wildeman","year":"2019","journal-title":"Public Health Rep."},{"key":"ref_7","first-page":"630","article-title":"Jail incarceration and birth outcomes","volume":"81","author":"Bell","year":"2004","journal-title":"J. Hered."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"112856","DOI":"10.1016\/j.socscimed.2020.112856","article-title":"County-level jail incarceration and preterm birth among non-Hispanic Black and white U.S. women, 1999\u20132015","volume":"250","author":"Jahn","year":"2020","journal-title":"Soc. Sci. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1016\/j.jogc.2019.11.068","article-title":"Infant and Maternal Outcomes for Women Who Experience Imprisonment in Ontario, Canada: A Retrospective Cohort Study","volume":"42","author":"Ramirez","year":"2020","journal-title":"J. Obs. Gynaecol. Can."},{"key":"ref_10","first-page":"725","article-title":"Reproductive justice for incarcerated mothers and advocacy for their infants and young children","volume":"40","author":"Shlafer","year":"2019","journal-title":"Child. Adolesc. Soc. Work. J."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Testa, A., and Jackson, D.B. (2020). Incarceration Exposure During Pregnancy and Infant Health: Moderation by Public Assistance. J. Pediatr., Available online: https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0022347620307587.","DOI":"10.1016\/j.jpeds.2020.06.055"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"112777","DOI":"10.1016\/j.socscimed.2019.112777","article-title":"Incarceration as a unique social stressor during pregnancy: Implications for maternal and newborn health","volume":"246","author":"Testa","year":"2020","journal-title":"Soc. Sci. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1525\/sp.2012.59.2.228","article-title":"Imprisonment and Infant Mortality","volume":"59","author":"Wildeman","year":"2012","journal-title":"Soc. Probl."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2179","DOI":"10.1007\/s10995-014-1466-3","article-title":"Incarceration, maternal hardship, and perinatal health behaviors","volume":"18","author":"Dumont","year":"2014","journal-title":"Matern. Child. Health J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"103","DOI":"10.2307\/1602510","article-title":"The Role of Prenatal Care in Preventing Low Birth Weight","volume":"5","author":"Alexander","year":"1995","journal-title":"Future Child."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1089\/jwh.2017.6817","article-title":"Group Prenatal Care Reduces Risk of Preterm Birth and Low Birth Weight: A Matched Cohort Study","volume":"28","author":"Cunningham","year":"2019","journal-title":"J. Women\u2019s Health"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1055\/s-0032-1316439","article-title":"Inadequate Prenatal Care Utilization and Risks of Infant Mortality and Poor Birth Outcome: A Retrospective Analysis of 28,729,765 U.S. Deliveries over 8 Years","volume":"29","author":"Partridge","year":"2012","journal-title":"Am. J. Perinatol."},{"key":"ref_18","first-page":"515","article-title":"Effect of prenatal care on infant mortality rates according to birth-death certificate files","volume":"91","author":"Poma","year":"1999","journal-title":"J. Natl. Med. Assoc."},{"key":"ref_19","unstructured":"American Academy of Pediatrics (2012). Guidelines for Perinatal Care, American Academy of Pediatrics. [7th ed.]."},{"key":"ref_20","unstructured":"World Health Organization (2015). WHO Recommendations on Health Promotion Interventions for Maternal and Newborn Health 2015, World Health Organization."},{"key":"ref_21","unstructured":"U.S. Department of Health and Human Services (2015). Healthy People 2020."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1053\/j.semperi.2017.04.008","article-title":"Exploring the social determinants of racial\/ethnic disparities in prenatal care utilization and maternal outcome","volume":"41","author":"Gadson","year":"2017","journal-title":"Semin. Perinatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1007\/s10995-019-02822-4","article-title":"Incarceration exposure and maternal food insecurity during pregnancy: Findings from the Pregnancy Risk Assessment Monitoring System (PRAMS), 2004\u20132015","volume":"24","author":"Testa","year":"2020","journal-title":"Mat. Child Health J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1086\/449296","article-title":"Collateral Consequences of Imprisonment for Children, Communities, and Prisoners","volume":"26","author":"Hagan","year":"1999","journal-title":"Crime Justice"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.ssresearch.2018.12.024","article-title":"The third shift: Multiple job holding and the incarceration of women\u2019s partners","volume":"80","author":"Bruns","year":"2019","journal-title":"Soc. Sci. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1093\/sf\/sos055","article-title":"Punishment and Welfare: Paternal Incarceration and Families\u2019 Receipt of Public Assistance","volume":"90","author":"Sugie","year":"2012","journal-title":"Soc. Forces"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1111\/j.1745-9125.2012.00283.x","article-title":"The collateral consequences of incarceration revisited: A qualitative analysis of the effects on caregivers of children of incarcerated parents","volume":"50","author":"Turanovic","year":"2012","journal-title":"Criminology"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1186","DOI":"10.1111\/j.1540-6237.2009.00653.x","article-title":"Parental Incarceration and Child Well-Being: Implications For Urban Families","volume":"90","author":"Geller","year":"2009","journal-title":"Soc. Sci. Q."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1111\/j.1741-3737.2012.00998.x","article-title":"Those They Leave Behind: Paternal Incarceration and Maternal Instrumental Support","volume":"74","author":"Turney","year":"2012","journal-title":"J. Marriag. Fam."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1007\/s11606-009-0977-x","article-title":"Filling the Gap: The Importance of Medicaid Continuity for Former Inmates","volume":"24","author":"Wakeman","year":"2009","journal-title":"J. Gen. Intern. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"807","DOI":"10.2105\/AJPH.2017.303703","article-title":"The Affordable Care Act, Insurance Coverage, and Health Care Utilization of Previously Incarcerated Young Men: 2008\u20132015","volume":"107","author":"Winkelman","year":"2017","journal-title":"Am. J. Public Health"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"145","DOI":"10.2105\/AJPH.2019.305448","article-title":"Mass Incarceration and Subsequent Preventive Health Care: Mechanisms and Racial\/Ethnic Disparities","volume":"110","author":"Widdowson","year":"2020","journal-title":"Am. J. Public Health"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2075","DOI":"10.1007\/s13524-016-0519-1","article-title":"Incarceration and Household Asset Ownership","volume":"53","author":"Turney","year":"2016","journal-title":"Demography"},{"key":"ref_34","unstructured":"Bohmert, M.N. (2014). Access to Transportation and Outcomes for Women on Probation and Parole, Michigan State University."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1111\/socf.12088","article-title":"Romantic Relationships and Criminal Desistance: Pathways and Processes","volume":"29","author":"Wyse","year":"2014","journal-title":"Sociol. Forum"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Heaman, M., Sword, W., Elliott, L., Moffatt, M., Helewa, M., Morris, H., Gregory, P.A., Tjaden, L., and Cook, C. (2015). Barriers and facilitators related to use of prenatal care by inner-city women: Perceptions of health care providers. BMC Pregnancy Childbirth, 15.","DOI":"10.1186\/s12884-015-0431-5"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1111\/j.1745-7599.1994.tb00924.x","article-title":"Factors that Prevent Women of Low Socioeconomic Status from Seeking Prenatal Care","volume":"6","author":"Johnson","year":"1994","journal-title":"J. Am. Acad. Nurse Pr."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/2156869318771439","article-title":"Being \u201con Point\u201d: Exploring the Stress-related Experiences of Incarceration","volume":"9","author":"Porter","year":"2018","journal-title":"Soc. Ment. Health"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1177\/0003122414530398","article-title":"Surveillance and System Avoidance","volume":"79","author":"Brayne","year":"2014","journal-title":"Am. Soc. Rev."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1080\/00224490509552251","article-title":"\u201cYou can\u2019t do nothing in this damn place\u201d: Sex and intimacy among couples with an incarcerated male partner","volume":"42","author":"Comfort","year":"2005","journal-title":"J. Sex. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1111\/1745-9125.12040","article-title":"Explaining the association between incarceration and divorce","volume":"52","author":"Siennick","year":"2014","journal-title":"Criminology"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1093\/socpro\/spv015","article-title":"Liminal Men: Incarceration and Relationship Dissolution","volume":"62","author":"Turney","year":"2015","journal-title":"Soc. Probl."},{"key":"ref_43","unstructured":"Hamilton, B.E., Martin, J.A., Osterman, M.J., and Rossen, L.M. (2019). Births: Provisional Data for 2018."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.2105\/AJPH.2018.304563","article-title":"The Pregnancy Risk Assessment Monitoring System (PRAMS): Overview of Design and Methodology","volume":"108","author":"Shulman","year":"2018","journal-title":"Am. J. Public Health"},{"key":"ref_45","first-page":"874","article-title":"Barriers to timely prenatal care among women with insurance: The importance of prepregnancy factors*1","volume":"95","author":"Braveman","year":"2000","journal-title":"Obs. Gynecol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/S1068-8595(96)80018-3","article-title":"The social pregnancy interaction model: Conceptualizing cognitive, social and cultural barriers to prenatal care","volume":"4","author":"Campbell","year":"1996","journal-title":"Appl. Behav. Sci. Rev."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/j.jmwh.2009.01.002","article-title":"Women\u2019s perceptions of access to prenatal care in the United States: A literature review","volume":"54","author":"Phillippi","year":"2009","journal-title":"J. Midwif. Women Health"},{"key":"ref_48","unstructured":"Carson, E.A. (2020). Prisoners in 2018."},{"key":"ref_49","unstructured":"Zeng, Z. (2020). Jail Inmates in 2018."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1016\/S0029-7844(97)00147-6","article-title":"Effect of a transportation incentive on compliance with the first prenatal appointment: A randomized trial","volume":"89","author":"Melnikow","year":"1997","journal-title":"Obs. Gynecol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1177\/0032885519836996","article-title":"Parents in Prison and Their Minor Children: Comparisons between State and National Estimates","volume":"99","author":"Shlafer","year":"2019","journal-title":"Prison. J."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1177\/0884217504266775","article-title":"Barriers to Prenatal Care for Homeless Pregnant Women","volume":"33","author":"Bloom","year":"2004","journal-title":"J. Obs. Gynecol. Neonatal Nurs."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ajog.2020.05.029","article-title":"Prenatal care redesign: Creating flexible maternity care models through virtual care","volume":"223","author":"Peahl","year":"2020","journal-title":"Am. J. Obs. Gynecol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1377\/hlthaff.2019.01042","article-title":"Improving Birth Outcomes and Lowering Costs for Women on Medicaid: Impacts of \u2018Strong Start for Mothers and Newborns\u2019","volume":"39","author":"Dubay","year":"2020","journal-title":"Health Aff."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1111\/j.1741-3737.2005.00165.x","article-title":"Incarceration and the Formation and Stability of Marital Unions","volume":"67","author":"Lopoo","year":"2005","journal-title":"J. Marriage Fam."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1007\/s10940-018-9402-0","article-title":"Correction to: Incarceration and Personal Networks: Unpacking Measures and Meanings of Tie Strength","volume":"35","author":"Rengifo","year":"2019","journal-title":"J. Quant. Criminol."},{"key":"ref_57","first-page":"547","article-title":"Health Literacy Among a Formerly Incarcerated Population Using Data from the Transitions Clinic Network","volume":"95","author":"Hadden","year":"2018","journal-title":"J. Hered."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.1353\/hpu.2015.0130","article-title":"\u201cThe Vagina is a Very Tricky Little Thing Down There\u201d: Cervical Health Literacy among Incarcerated Women","volume":"26","author":"Ramaswamy","year":"2015","journal-title":"J. Health Care Poor Underserved"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1016\/j.pmedr.2017.04.003","article-title":"Impact of a brief intervention on cervical health literacy: A waitlist control study with jailed women","volume":"6","author":"Ramaswamy","year":"2017","journal-title":"Prev. Med. Rep."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Thomas, S.D., Mobley, S.C., Hudgins, J.L., Sutherland, D.E., Inglett, S., and Ange, B.L. (2018). Conditions and Dynamics That Impact Maternal Health Literacy among High Risk Prenatal-Interconceptional Women. Int. J. Environ. Res. Public Health, 15.","DOI":"10.3390\/ijerph15071383"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1111\/j.1748-0361.2009.00211.x","article-title":"Does Rural Residence Affect Access to Prenatal Care in Oregon?","volume":"25","author":"Epstein","year":"2009","journal-title":"J. Rural. Health"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"53","DOI":"10.2307\/1602543","article-title":"Review of Research on Home Visiting for Pregnant Women and Parents of Young Children","volume":"3","author":"Olds","year":"1993","journal-title":"Future Child."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1007\/BF01321654","article-title":"Effects of a home visiting program on prenatal care and birthweight: A case comparison study","volume":"17","author":"Poland","year":"1992","journal-title":"J. Commun. Health"},{"key":"ref_64","first-page":"340","article-title":"The effect of incarceration during pregnancy on birth outcomes","volume":"112","author":"Martin","year":"1997","journal-title":"Public Health Rep."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1136\/jech-2014-204820","article-title":"Incarceration and perinatal smoking: A missed public health opportunity","volume":"69","author":"Dumont","year":"2015","journal-title":"J. Epidemiol. Commun. Health"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1177\/002214650804900105","article-title":"Incarceration as Exposure: The Prison, Infectious Disease, and Other Stress-Related Illnesses","volume":"49","author":"Massoglia","year":"2008","journal-title":"J. Health Soc. Behav."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1177\/002214650704800202","article-title":"Enduring Stigma: The Long-Term Effects of Incarceration on Health","volume":"48","author":"Schnittker","year":"2007","journal-title":"J. Health Soc. Behav."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1007\/s10995-010-0594-7","article-title":"Complex Calculations: How Drug Use During Pregnancy Becomes a Barrier to Prenatal Care","volume":"15","author":"Roberts","year":"2010","journal-title":"Matern. Child. Health J."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Milligan, R., Wingrove, B.K., Richards, L., Rodan, M., Monroe-Lord, L., Jackson, V., Hatcher, B., Harris, C., Henderson, C., and Johnson, A.A. (2002). Perceptions about prenatal care: Views of urban vulnerable groups. BMC Public Health, 2.","DOI":"10.1186\/1471-2458-2-25"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1111\/j.1525-1446.1993.tb00059.x","article-title":"Maternal Factors That Influence Inadequate Prenatal Care","volume":"10","author":"York","year":"1993","journal-title":"Public Heal. Nurs."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/19\/7331\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:17:19Z","timestamp":1760177839000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/19\/7331"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,8]]},"references-count":70,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2020,10]]}},"alternative-id":["ijerph17197331"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17197331","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,8]]}}}