Publications by authors named "Carolyn Sufrin"

47 Publications

COVID-19 vaccine prioritization of incarcerated people relative to other vulnerable groups: An analysis of state plans.

PLoS One 2021 15;16(6):e0253208. Epub 2021 Jun 15.

Johns Hopkins School of Medicine, Baltimore, MD, United States of America.

Background: Carceral facilities are epicenters of the COVID-19 pandemic, placing incarcerated people at an elevated risk of COVID-19 infection. Due to the initial limited availability of COVID-19 vaccines in the United States, all states have developed allocation plans that outline a phased distribution. This study uses document analysis to compare the relative prioritization of incarcerated people, correctional staff, and other groups at increased risk of COVID-19 infection and morbidity.

Methods And Findings: We conducted a document analysis of the vaccine dissemination plans of all 50 US states and the District of Columbia using a triple-coding method. Documents included state COVID-19 vaccination plans and supplemental materials on vaccine prioritization from state health department websites as of December 31, 2020. We found that 22% of states prioritized incarcerated people in Phase 1, 29% of states in Phase 2, and 2% in Phase 3, while 47% of states did not explicitly specify in which phase people who are incarcerated will be eligible for vaccination. Incarcerated people were consistently not prioritized in Phase 1, while other vulnerable groups who shared similar environmental risk received this early prioritization. States' plans prioritized in Phase 1: prison and jail workers (49%), law enforcement (63%), seniors (65+ years, 59%), and long-term care facility residents (100%).

Conclusions: This study demonstrates that states' COVID-19 vaccine allocation plans do not prioritize incarcerated people and provide little to no guidance on vaccination protocols if they fall under other high-risk categories that receive earlier priority. Deprioritizing incarcerated people for vaccination misses a crucial opportunity for COVID-19 mitigation. It also raises ethical and equity concerns. As states move forward with their vaccine distribution, further work must be done to prioritize ethical allocation and distribution of COVID-19 vaccines to incarcerated people.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0253208PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8205184PMC
June 2021

Access to treatment for pregnant incarcerated people with opioid use disorder: Perspectives from community opioid treatment providers.

J Subst Abuse Treat 2021 Jul 25;126:108338. Epub 2021 Feb 25.

Johns Hopkins University School of Medicine, Department of Gynecology and Obstetrics, Johns Hopkins Bayview Hospital, 4940 Eastern Ave, A121, Baltimore, MD 21224, United States; Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 24 N. Broadway, Hampton House 737, Baltimore, MD 21205, United States. Electronic address:

Background And Aims: Many jail facilities provide limited access to medications for opioid use disorder (MOUD) for pregnant people with opioid use disorder (OUD), despite it being the standard of care. We aim to explore the perspectives of opioid treatment providers (OTPs) on access to MOUD for pregnant people while incarcerated and postincarceration.

Methods: We conducted 16 semistructured phone interviews with providers and administrators representing 16 unique OTPs in various U.S. states with high maternal opioid use rates. We developed the interview guide using the Consolidated Framework for Implementation Research, and we analyzed interview transcripts using a direct content analysis.

Results: Nine participants reported having an arrangement with a carceral facility to provide care for pregnant people with OUD; however, others described how their local jail offered no OUD treatment for incarcerated pregnant people. Even if participants' clinics had arrangements to provide MOUD in a jail, most participants described significant barriers to continuity of care between jails and community providers as patients transition between jails and community settings. OTPs described their belief of how postincarceration, pregnant people experience barriers to OUD care such as lack of access to childcare, preparing for the baby, feeling unwell, in addition to the barriers that nonpregnant patients experience, such as transportation, housing, and financing.

Conclusions: OTPs perceive that pregnant people with OUD experience significant barriers to accessing treatment while incarcerated and in community settings due to discrimination, difficulties in continuity of care, and lack of treatment access while incarcerated. The implementation of evidence-based MOUD treatment for pregnant people in jail and continuation of treatment upon release is crucial to reduce health disparities.
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http://dx.doi.org/10.1016/j.jsat.2021.108338DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8197773PMC
July 2021

Health care and social justice implications of incarceration for pregnant people who use drugs.

Int Rev Psychiatry 2021 Jun 7:1-15. Epub 2021 Jun 7.

Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA.

The experiences of and care for pregnant, incarcerated people with substance use disorders represent a convergence of numerous clinical, historical, racialized, legal, and gendered factors. Understanding how these forces shape how they became enmeshed in the criminal legal system as well as the context of the care they do or do not receive while in custody is essential for promoting equitable maternal health care. In this review, we describe the prevalence of SUD among pregnant people behind bars, the health care landscape of incarceration, access to treatment for opioid use disorder for incarcerated pregnant and postpartum people, and nuances of providing such treatment in an inherently coercive setting. Throughout, we highlight the ways that the child welfare system and mass incarceration in the U.S. have had a unique and discriminatory impact on pregnant and parenting people, and have done so in distinctly racialized ways. Situating the clinical care of incarcerated pregnant people who use drugs in this context sheds light on fundamental social justice and health care intersections.
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http://dx.doi.org/10.1080/09540261.2021.1887097DOI Listing
June 2021

The Compendium of U.S. jails: creating and conducting research with the first comprehensive contact database of U.S. jails.

Health Justice 2021 May 19;9(1):12. Epub 2021 May 19.

Krieger School of Arts & Sciences, Johns Hopkins University, Baltimore, MD, USA.

Background: Millions of people pass through U.S. jails annually. Conducting research about these public institutions is critical to understanding on-the-ground policies and practices, especially health care services, affecting millions of people. However, there is no existing database of the number, location, or contact information of jails. We created the National Jails Compendium to address this gap. In this paper, we detail our comprehensive methodology for identifying jail locations and contact information. We then describe the first research project to use the Compendium, a survey assessing jails' treatment practices for incarcerated pregnant people with opioid use disorder.

Results: This study sent surveys electronically or in paper form to all 2986 jails in the Compendium, with 1139 surveys returned. We outline the process for using the Compendium, highlighting challenges in reaching contacts through case examples, cataloging responses and non-responses, and defining what counts as a jail.

Conclusion: We aim to provide tools for future researchers to use the Compendium as well as a pathway for keeping it current. The Compendium provides transparency that aids in understanding jail policies and practices. Such information may help devise interventions to ensure humane, evidence-based treatment of incarcerated people.
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http://dx.doi.org/10.1186/s40352-021-00137-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8136186PMC
May 2021

Care for Incarcerated Patients Hospitalized with COVID-19.

J Gen Intern Med 2021 Jul 5;36(7):2094-2099. Epub 2021 May 5.

Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

The COVID-19 pandemic has reshaped health care delivery for all patients but has distinctly affected the most marginalized people in society. Incarcerated patients are both more likely to be infected and more likely to die from COVID-19. There is a paucity of guidance for the care of incarcerated patients hospitalized with COVID-19. This article will discuss how patient privacy, adequate communication, and advance care planning are rights that incarcerated patients may not experience during this pandemic. We highlight the role of compassionate release and note how COVID-19 may affect this prospect. A number of pragmatic recommendations are made to attenuate the discrepancy in hospital care experienced by those admitted from prisons and jails. Physicians must be familiar with the relevant hospital policies, be prepared to adapt their practices in order to overcome barriers to care, such as continuous shackling, and advocate to change these policies when they conflict with patient care. Stigma, isolation, and concerns over staff safety are shared experiences for COVID-19 and incarcerated patients, but incarcerated patients have been experiencing this treatment long before the current pandemic. It is crucial that the internist demand the equitable care that we seek for all our patients.
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http://dx.doi.org/10.1007/s11606-021-06861-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8099390PMC
July 2021

Breastfeeding in Incarcerated Settings in the United States: A National Survey of Frequency and Policies.

Breastfeed Med 2021 Apr 8. Epub 2021 Apr 8.

Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

: To assess the existence of prison and jail policies and practices that allow incarcerated women to breastfeed while in custody, and prevalence of women in custody who pumped human milk for their infants. : We surveyed 22 state prison systems and 6 county jails from 2016 to 2017 about policies related to breastfeeding and other programs for pregnant and parenting women in custody. In addition, 11 prisons and 5 jails reported 6 months of monthly, prospective data on the number of women pumping human milk, as well as information on placement of infants born to women in custody. Eleven prisons and five jails had policies that supported the practice of expressed milk, either through pumping or breastfeeding. Over 6 months at these sites that allowed lactation, there were 207 women who gave birth in the prisons and an average of 8 women/month who pumped human milk; at the jails, there were 67 women who gave birth and an average of 6 women/month who pumped human milk. Most infants born to women in custody were placed in the care of a family member. Breastfeeding and the provision of human milk are critical public health issues. Our data show inconsistent implementation of policies and practices supportive of breastfeeding in prisons and jails. However, there are institutions in the United States that are supportive of incarcerated women's breastfeeding and lactation needs. Further research is needed to identify the barriers and facilitators associated with implementing supportive breastfeeding policies and practices in the carceral system.
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http://dx.doi.org/10.1089/bfm.2020.0410DOI Listing
April 2021

Society of Family Planning clinical recommendations: Management of individuals with bleeding or thrombotic disorders undergoing abortion.

Contraception 2021 Aug 22;104(2):119-127. Epub 2021 Mar 22.

Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, United States.

Individuals who have bleeding disorders, thrombophilias, a history of venous thromboembolism (VTE), or who are taking anticoagulation medication for other reasons may present for abortion. Clinicians should be aware of risk factors and histories concerning for excessive bleeding and thrombotic disorders around the time of abortion. This document will focus on how to approach abortion planning in these individuals. For first-trimester abortion, procedural abortion (sometimes called surgical abortion) is generally preferred over medical management for individuals with bleeding disorders or who are on anticoagulation. First-trimester procedural abortion in an individual on anticoagulation can generally be done without interruption of anticoagulation. The decision to interrupt anticoagulation for a second-trimester procedure should be individualized. Individuals at high risk for VTE can be offered anticoagulation post-procedure. Individuals with bleeding disorders or who are anticoagulated can safely be offered progestin intrauterine devices. Future research is needed to better assess quantitative blood loss and complications rates with abortion in these populations.
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http://dx.doi.org/10.1016/j.contraception.2021.03.016DOI Listing
August 2021

Oral sedation for pain with cervical dilator placement: a randomized controlled trial.

Contracept X 2021 7;3:100053. Epub 2021 Jan 7.

Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Bayview Medical Center, A Building, Room 121, 4940 Eastern Ave., Baltimore, MD 21224.

Objective: Assess oral sedation versus placebo for pain control with cervical dilator placement.

Study Design: We randomized participants presenting for dilation and evacuation to lorazepam 1 mg/oxycodone 5 mg or placebo 45 min before cervical dilator placement. Our primary outcome was median visual analog scale (VAS) pain score after dilator placement using a 100-mm VAS. We used our outcome data to calculate median pain score changes from baseline to better reflect pain score differences between study groups. Planned sample size was 30 participants per group, for a total of 60.

Results: We randomized 27 participants; 9 received sedation and 11 placebo. Median pain score increase from baseline to last dilator placement was 20 [interquartile range (IQR) 8-29] and 31 (IQR 15-81) in the oral sedation and placebo groups, p = .16.

Conclusion: We were unable to enroll our desired sample size, and our sample is underpowered to make any conclusions. Our results suggest that oral sedation may provide some benefit for pain relief with dilator insertion and indicate that further research might be worthwhile especially in settings that do not routinely provide these analgesics.

Implications: We had difficulty with study recruitment because many patients desired oral sedation for pain management for cervical dilator placement and declined randomization. Randomized trials of pain management with a placebo arm may find recruitment challenging especially if default clinical care already includes a pain management option that patients would have to opt out of.
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http://dx.doi.org/10.1016/j.conx.2020.100053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7815458PMC
January 2021

Pregnancy Prevalence and Outcomes in 3 United States Juvenile Residential Systems.

J Pediatr Adolesc Gynecol 2021 Aug 21;34(4):546-551. Epub 2021 Jan 21.

Brigham and Women's Hospital, Department of Medicine, and Harvard Medical School, Department of Medicine, Boston, Massachusetts.

Study Objective: To describe the number of admissions of pregnant adolescents to US juvenile residential systems (JRS) and the outcomes of pregnancies that ended while in custody.

Design: Prospective study.

Setting: Three nonrandomly selected JRS in 3 US states.

Participants: Designated reporter at each JRS reporting aggregate data on various pregnant admissions, outcomes, and systems' policies.

Interventions: None.

Main Outcome Measures: Monthly number of pregnant people admitted, pregnant people at the end of the month, births, preterm births, cesarean deliveries, miscarriages, induced abortions, ectopic pregnancies, maternal and newborn deaths, and administrative policies.

Results: There were 71 admissions of pregnant adolescents reported over 12 months from participating JRS. At the time of the census, 6 of the 183 female adolescents (3.3%) were pregnant. Eight pregnancies ended while in custody. Of these, 1 pregnancy was a live full-term birth, 4 were miscarriages, and 3 were induced abortions. There were no newborn deaths or maternal deaths. Administrative policies and services varied among the JRS. For example, all JRS had a prenatal care provider on-site, whereas 2 JRS helped cover the costs of abortions.

Conclusion: To our knowledge, this study is the first to report the estimates of pregnancy and pregnancy outcomes among justice-involved youth in JRS. Our findings indicate that there are pregnant adolescents in JRS and most return to their communities while pregnant, highlighting the importance of continuity of care. More work is needed to understand the complexities of health care needs of justice-involved pregnant youth during and after their incarceration.
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http://dx.doi.org/10.1016/j.jpag.2021.01.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8277661PMC
August 2021

Health Care in the Age of Mass Incarceration: A Selective Course for Medical Students in Their Preclinical Years.

MedEdPORTAL 2020 11 12;16:11014. Epub 2020 Nov 12.

Assistant Professor, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine; Associate Director, Fellowship in Family Planning, Johns Hopkins School of Medicine.

Introduction: While medical school curricula increasingly address health disparities, content regarding health care for persons impacted by incarceration is a persistent and notable gap. There is a high burden of disease among incarcerated populations, and health care challenges continue postincarceration. We developed a course to introduce medical students to the current landscape of mass incarceration in the US and implications for health and health care delivery to people impacted by this system.

Methods: We developed a 3.5-hour elective course taken by 19 first-year medical students in its first year and 20 students in its second. The course utilized lecture, case-based discussion, and guest speaker modalities to introduce students to the history of mass incarceration, health care delivery within the carceral system, and challenges in accessing care during and following incarceration.

Results: Students received two surveys after completing the course. In the first, 100% of respondents reported , , or levels of satisfaction with various elective components, including organization, learning activities, and student discussion. The second found significant increases in knowledge about mass incarceration and incarceration health issues, in addition to significant increases in interest in advocating or providing health care for incarcerated populations.

Discussion: Given current mass incarceration practices, students will encounter patients impacted by this system. This elective course sought to better prepare students to effectively care for these patients. We were limited by time availability, and future directions include incorporating a standardized patient exercise, trauma-informed care principles, and providers working within the carceral system.
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http://dx.doi.org/10.15766/mep_2374-8265.11014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7666831PMC
November 2020

Care for Incarcerated Pregnant People With Opioid Use Disorder: Equity and Justice Implications.

Obstet Gynecol 2020 09;136(3):576-581

University of California San Francisco School of Medicine, San Francisco, California; the Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, and the Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; and the Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.

With the simultaneous rise in maternal opioid use disorder (OUD) and the incarceration of pregnant people in the United States, we must ensure that prisons and jails adequately address the health and well-being of incarcerated pregnant people with OUD. Despite long-established, clear, and evidence-based recommendations regarding the treatment of OUD during pregnancy, incarcerated pregnant people with OUD do not consistently receive medication treatment and are instead forced into opioid withdrawal. This inadequate care raises multiple concerns, including issues of justice and equity, considerations regarding the legal and ethical obligations of the provision of health care, and violations of the medical and legal rights of incarcerated people. We offer recommendations for improving care for this often-ignored group.
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http://dx.doi.org/10.1097/AOG.0000000000004002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7483637PMC
September 2020

Maternal Health Equity and Justice for Pregnant Women Who Experience Incarceration.

JAMA Netw Open 2020 08 3;3(8):e2013096. Epub 2020 Aug 3.

Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland.

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http://dx.doi.org/10.1001/jamanetworkopen.2020.13096DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8084254PMC
August 2020

Rethinking "Elective" Procedures for Women's Reproduction during Covid-19.

Hastings Cent Rep 2020 May;50(3):40-43

Common hospital and surgical center responses to the Covid-19 pandemic included curtailing "elective" procedures, which are typically determined based on implications for physical health and survival. However, in the focus solely on physical health and survival, procedures whose main benefits advance components of well-being beyond health, including self-determination, personal security, economic stability, equal respect, and creation of meaningful social relationships, have been disproportionately deprioritized. We describe how female reproduction-related procedures, including abortion, surgical sterilization, reversible contraception devices and in vitro fertilization, have been broadly categorized as "elective," a designation that fails to capture the value of these procedures or their impact on women's overall well-being. We argue that corresponding restrictions and delays of these procedures are problematically reflective of underlying structural views that marginalize women's rights and interests and therefore threaten to propagate gender injustice during the pandemic and beyond. Finally, we propose a framework for triaging reproduction-related procedures during Covid-19 that is more individualized, accounts for their significance for comprehensive well-being, and can be used to inform resumption of operations as well as subsequent restriction phases.
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http://dx.doi.org/10.1002/hast.1130DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7362104PMC
May 2020

Pregnancy Prevalence and Outcomes in U.S. Jails.

Obstet Gynecol 2020 05;135(5):1177-1183

Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, and the Departments of Health, Behavior and Society and Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; and the Guttmacher Institute, New York, New York.

Objective: To describe the number of admissions of pregnant people to U.S. jails and the outcomes of pregnancies that end in custody.

Methods: We prospectively collected pregnancy data from six U.S. jails, including the five largest jails, on a monthly basis for 12 months. Jails reported de-identified, aggregate numbers of pregnant people admitted, births, preterm births, cesarean deliveries, miscarriages, induced abortions, ectopic pregnancies, and maternal and newborn deaths.

Results: There were 1,622 admissions of pregnant people in 12 months in the selected jails. The highest 1-day count of pregnant people at a single jail was 65. The majority of these admissions involved the release of a pregnant person. Of the 224 pregnancies that ended in jail, 144 (64%) were live births, 41 (18%) were miscarriages, 33 (15%) were induced abortions, and four were ectopic (1.8%). One third of the births were cesarean deliveries and 8% were preterm. There were two stillbirths, one newborn death, and no maternal deaths.

Conclusion: About 3% of admissions of females to U.S. jails are of pregnant people; extrapolating study results to national female jail admission rates suggests nearly 55,000 pregnancy admissions in 1 year. It is feasible to track pregnancy statistics about this overlooked group.
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http://dx.doi.org/10.1097/AOG.0000000000003834DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7183903PMC
May 2020

Opioid use disorder incidence and treatment among incarcerated pregnant women in the United States: results from a national surveillance study.

Addiction 2020 11 18;115(11):2057-2065. Epub 2020 Mar 18.

Rhode Island Department of Corrections, Rhode Island Department of Corrections, Cranston, RI, USA.

Background And Aims: The established standard care in pregnancy is medication for opioid use disorder (MOUD); however, many institutions of incarceration do not have MOUD available. We aimed to describe the number of incarcerated pregnant women with opioid use disorder (OUD) in the United States and jails' and prisons' MOUD in pregnancy policies.

Design: Epidemiological surveillance study of 6 months of outcomes of pregnant, incarcerated women with OUD and cross-sectional survey of institutional policies.

Setting: United States.

Participants: Twenty-two state prison systems and six county jails.

Measurements: The number of pregnant women with OUD admitted and treated with methadone, buprenorphine or withdrawal; policies on provision of MOUD and withdrawal in pregnancy.

Findings: Twenty-six per cent of pregnant women admitted to prisons and 14% to jails had OUD. One-third were managed through withdrawal. The majority who were prescribed MOUD were on methadone (78%, prisons; 81%, jails), not buprenorphine. While most sites (n = 18 prisons, n = four jails) continued pre-incarceration MOUD in pregnancy, very few initiated in custody (n = four prisons; n = two jails). Two-thirds of prisons and three-quarters of jails providing MOUD in pregnancy discontinued it postpartum.

Conclusions: In this sample of US prisons and jails, one-third required pregnant women with opioid use disorder to go through withdrawal, contrary to medical guidelines. More women were prescribed methadone than buprenorphine, despite the fewer regulatory barriers on prescribing buprenorphine. Most sites stopped medication for opioid use disorder postpartum, signaling prioritization of the fetus, not the mother. Pregnant incarcerated women with opioid use disorder in the United States frequently appear to be denied essential medications and receive substandard medical care.
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http://dx.doi.org/10.1111/add.15030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7483586PMC
November 2020

Does distance decrease healthcare options for pregnant, incarcerated people? Mapping the distance between abortion providers and prisons.

Contraception 2020 04 23;101(4):266-272. Epub 2020 Jan 23.

Johns Hopkins School of Medicine, Department of Gyn/Ob, 4940 Eastern Ave, Baltimore, MD 21224, USA. Electronic address:

Objectives: Pregnant, incarcerated people retain the constitutional right to abortion, but evidence suggests that many cannot access abortion services. State and federal prisons are often located in remote areas and there is a known shortage of abortion providers across the U.S., particularly in remote areas. The goal of this study was to determine the proximity of state and federal prisons to the nearest abortion clinic.

Study Design: We used publicly available information to identify and geocode abortion clinics in the U.S., as well as state and federal prisons that house at least 10 females. We then determined the shortest distance between each prison and the abortion clinics within that state using the Google distance matrix API. For each state, we identified the minimum distance from a state or federal prison to an abortion clinic.

Results: We georeferenced 643 abortion clinics, 75 state prisons and 20 federal prisons. The farthest minimum distance between a state prison and abortion clinic was 383 miles; the shortest was 2.2 miles. The farthest minimum distance between a federal prison and abortion clinic was 117 miles; the shortest was 0.49 miles. There were 8 states in which the minimum distance between any prison and an abortion clinic was above 75 miles.

Conclusion: State and federal prisons are not located in close proximity to abortion clinics. This may pose an additional barrier pregnant incarcerated people face when they need abortion care.

Implications: Distance between prisons and abortion clinics may contribute to the many barriers that incarcerated people face when seeking an abortion. Policies and laws that exacerbate the burden of distance further impair incarcerated people's abilities to access abortion and prisons' constitutional obligation to provide access to abortion.
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http://dx.doi.org/10.1016/j.contraception.2020.01.005DOI Listing
April 2020

Stigma and US Nurses' Intentions to Provide the Standard of Maternal Care to Incarcerated Women, 2017.

Am J Public Health 2020 01;110(S1):S93-S99

Lorie S. Goshin, D. R. Gina Sissoko, and Lorraine Byrnes are with the Hunter-Bellevue School of Nursing, Hunter College, City University of New York, New York. Kristi L. Stringer is with the Social Intervention Group, Columbia University School of Social Work, Columbia University, New York, NY. Carolyn Sufrin is with the Department of Gynecology and Obstetrics and the Department of Health, Behavior and Society, Johns Hopkins University School of Medicine, Baltimore, MD.

To examine relationships among actionable drivers and facilitators of stigma and nurses' intentions to provide the standard of maternal care recommended by the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN) for incarcerated women. We conducted a Web-based survey of perinatal nurses in the United States (n = 665; participation rate 98.0%; completion rate 95.3%) in July through September 2017. We used multivariable logistic regression to predict higher than median intentions to provide the standard of care. Lower stigmatizing individual attitudes and institutional norms and higher perceived autonomy when caring for an incarcerated woman were significantly associated with higher care intentions. Knowledge of the AWHONN position statement on the standard of care or their own state's shackling laws was not associated with higher care intentions. We documented significant associations among actionable drivers and facilitators of stigma and the intentions of a key health care provider group to deliver the standard of maternal care to incarcerated women. Individual- and institutional-level stigma-reduction interventions may increase the quality of maternal care and improve perinatal outcomes for women who give birth while incarcerated.
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http://dx.doi.org/10.2105/AJPH.2019.305408DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6987942PMC
January 2020

Reproductive Justice Disrupted: Mass Incarceration as a Driver of Reproductive Oppression.

Am J Public Health 2020 01;110(S1):S21-S24

Crystal M. Hayes is a PhD candidate with the School of Social Work, University of Connecticut School, Storrs. Carolyn Sufrin is with the Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, and the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Jamila B. Perritt is an independent reproductive health and family planning specialist, Washington, DC.

We describe how mass incarceration directly undermines the core values of reproductive justice and how this affects incarcerated and nonincarcerated women.Mass incarceration, by its very nature, compromises and undermines bodily autonomy and the capacity for incarcerated people to make decisions about their reproductive well-being and bodies; this is done through institutionalized racism and is disproportionately done to the bodies of women of color. This violates the most basic tenets of reproductive justice-the right to have a child, not to have a child, and to parent the children you have with dignity and in safety.By undermining motherhood and safe pregnancy care, denying access to abortion and contraception, and preventing people from parenting their children at all and by doing so in overpoliced, unsafe environments, mass incarceration has become a driver of forms of reproductive oppression for people in prison and jails and in the community.
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http://dx.doi.org/10.2105/AJPH.2019.305407DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6987912PMC
January 2020

Tough Choices: Exploring Decision-Making for Pregnancy Intentions and Prevention Among Girls in the Justice System.

J Correct Health Care 2019 10;25(4):351-361

University of California, San Francisco, CA, USA.

Despite California's declining teen pregnancy rate, teens in the juvenile justice system have higher rates than their nonincarcerated counterparts. This study explored domains that may shape decision-making for pregnancy prevention in this group. Twenty purposively selected female teens with a recent incarceration participated in hour-long semistructured interviews about their future plans, social networks, access to reproductive health services, and sexual behavior. Transcripts revealed that, contrary to literature, desire for unconditional love and lack of access to family planning services did not mediate decision-making. Lack of future planning, poor social support, and limited social mobility shaped youths' decisions to use contraceptives. Understanding this group's social location and the domains that inform decision-making for pregnancy intentions and prevention provides clues to help programs predict and serve this population's needs.
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http://dx.doi.org/10.1177/1078345819880307DOI Listing
October 2019

Access to Reproductive Health Care in Juvenile Justice Facilities.

J Pediatr Adolesc Gynecol 2020 Jun 9;33(3):296-301. Epub 2019 Nov 9.

Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

Study Objective: The juvenile justice system houses adolescents with unique and unmet reproductive needs, including family planning. The purpose of this study was to identify access to contraceptive counseling and methods for young women in the juvenile justice system.

Design: We administered a cross-sectional survey that was used to examine services related to reproductive health care, including contraceptive counseling, and ability to initiate or continue contraceptive methods in custody.

Setting: Juvenile justice systems in the United States.

Participants: State-level health care administrators in juvenile justice systems.

Interventions And Main Outcome Measures: We analyzed responses to determine the ability of young women in custody to continue or initiate specific contraceptive methods, in addition to other measures of reproductive health access.

Results: Twenty-one respondents representing systems in 20 US states were included in analysis. All participating sites provided contraceptive counseling and all allowed at least 1 form of preincarceration contraception to be continued. Eighty-one percent (17/21) of systems enabled young women to initiate contraception while in custody, with the most common method available on-site being birth control pills. Twenty percent (4/20) of sites provided long-acting reversible contraceptive methods.

Conclusion: This study shows that it is feasible to provide contraception in this setting. However, there exists considerable variability in availability of methods across the United States. Continued work is needed in increasing access to contraception and standardization of care in the juvenile justice system.
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http://dx.doi.org/10.1016/j.jpag.2019.11.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7210053PMC
June 2020

Patient perceptions of immediate postpartum long-acting reversible contraception: A qualitative study.

Contraception 2020 01 23;101(1):21-25. Epub 2019 Oct 23.

Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Hospital, 4940 Eastern Ave, Rm A121, Baltimore 21224, MD, USA. Electronic address:

Objectives: The objective of this study was to explore perceptions and experiences of immediate postpartum long-acting reversible contraception (LARC) counseling and decision-making, with a focus on reproductive autonomy. We aimed to assess the potential for reproductive coercion.

Study Design: This was a qualitative study using semi-structured interviews with Spanish and English speaking women who received an intrauterine device or contraceptive subdermal implant immediately postpartum. They were recruited before discharge from two hospitals in Baltimore, MD. We analyzed interviews using directed content analysis.

Results: We interviewed a diverse group of 17 women. Participants praised the convenience of LARC and the ease of immediate postpartum placement. Some women reported feeling pushed by providers during counseling and were critical of their experiences. Women expressed a desire for comprehensive, objective information early and often during antepartum contraceptive counseling, and some valued counseling from multiple providers. They wanted autonomy in their contraceptive decision-making and described making internally motivated decisions based on their life goals and individual priorities.

Conclusions: Some women felt pressured to choose immediate postpartum LARC, while others expressed enthusiasm for immediate postpartum LARC. Our data suggest that providers should start contraceptive counseling early in prenatal care and readdress it at multiple visits. Patients may benefit from speaking with multiple providers.

Implications: Our study supports immediate postpartum LARC as a favorable contraceptive option for some women when discussed during prenatal care. Providers should take care to avoid coercion during counseling and focus on delivering comprehensive, objective information about all contraceptive methods, including side effects and removal options.
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http://dx.doi.org/10.1016/j.contraception.2019.09.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7137099PMC
January 2020

RE: Expanding Contraceptive Access for Women With Substance Use Disorders: Partnerships Between Public Health Departments and County Jails.

J Public Health Manag Pract 2019 Nov/Dec;25(6):E10-E11

Johns Hopkins University Baltimore, Maryland Virginia Commonwealth University Richmond, Virginia Founder and CEO SisterReach Memphis, Tennessee University of California, San Francisco San Francisco, California.

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http://dx.doi.org/10.1097/PHH.0000000000001078DOI Listing
December 2019

Perspectives on Patient-Centered Family Planning Care from Incarcerated Girls: A Qualitative Study.

J Pediatr Adolesc Gynecol 2019 Oct 10;32(5):491-498. Epub 2019 Jun 10.

Department of Family and Community Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, California.

Study Objective: We applied a patient-centered care (PCC) framework to explore incarcerated girls' experiences of and preferences for family planning (FP) care.

Design: We conducted qualitative semistructured interviews with incarcerated girls to explore domains of PCC: access to care, patient preferences, information and education, emotional support, family and friends, physical comfort, coordination of care, and continuity and transition.

Setting: A juvenile detention center (JDC) in an urban California county.

Participants: Girls incarcerated during the study period.

Interventions And Main Outcome Measures: Transcripts were analyzed using directed content analysis to identify themes related to PCC and additional overarching themes.

Results: Twenty-two participants completed interviews. Overarching themes of stigma and autonomy emerged as influential in girls' experiences and preferences for FP care. Participants described stigma related to incarceration, sexual activity, and lack of contraception use. Participants' desire for autonomy contributed to concerns around FP care. Despite this, most desired access to FP care while incarcerated. Many valued relationships they had with JDC providers, reporting more trust and familiarity with JDC providers than those in the community. Constraints of incarceration decreased availability of emotional supports and decreased involvement of family in health-related decision-making, which worsened girls' experiences with FP care and enhanced their sense of autonomy. Difficulties with care coordination and transitions between the JDC and community often resulted in fragmented care.

Conclusion: Providing patient-centered FP care in JDCs is desirable but complex, and requires prioritizing patient preferences while recognizing the strengths and limitations of providing FP care within JDCs.
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http://dx.doi.org/10.1016/j.jpag.2019.05.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6878150PMC
October 2019

Pregnant Women in Prison and Jail Don't Count: Data Gaps on Maternal Health and Incarceration.

Public Health Rep 2019 May/Jun;134(1_suppl):57S-62S

2 Johns Hopkins University School of Medicine, Baltimore, MD, USA.

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http://dx.doi.org/10.1177/0033354918812088DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6505318PMC
October 2019

Pregnancy Outcomes in US Prisons, 2016-2017.

Am J Public Health 2019 05 21;109(5):799-805. Epub 2019 Mar 21.

Carolyn Sufrin and Lauren Beal are with the Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD. Carolyn Sufrin is also with the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health. Jennifer Clarke is with the Rhode Island Department of Corrections, Cranston. Rachel Jones is with the Guttmacher Institute, New York, NY. William D. Mosher is with the Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health.

Objectives: To collect national data on pregnancy frequencies and outcomes among women in US state and federal prisons.

Methods: From 2016 to 2017, we prospectively collected 12 months of pregnancy statistics from a geographically diverse sample of 22 state prison systems and the Federal Bureau of Prisons. Prisons reported numbers of pregnant women, births, miscarriages, abortions, and other outcomes.

Results: Overall, 1396 pregnant women were admitted to prisons; 3.8% of newly admitted women and 0.6% of all women were pregnant in December 2016. There were 753 live births (92% of outcomes), 46 miscarriages (6%), 11 abortions (1%), 4 stillbirths (0.5%), 3 newborn deaths, and no maternal deaths. Six percent of live births were preterm and 30% were cesarean deliveries. Distributions of outcomes varied by state.

Conclusions: Our study showed that the majority of prison pregnancies ended in live births or miscarriages. Our findings can enable policymakers, researchers, and public health practitioners to optimize health outcomes for incarcerated pregnant women and their newborns, whose health has broad sociopolitical implications.
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http://dx.doi.org/10.2105/AJPH.2019.305006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6459671PMC
May 2019

Making mothers in jail: carceral reproduction of normative motherhood.

Authors:
Carolyn Sufrin

Reprod Biomed Soc Online 2018 Nov 13;7:55-65. Epub 2018 Nov 13.

Johns Hopkins University, Baltimore, MD, USA.

The over-reliance on incarceration in the USA is a racialized phenomenon which has affected millions of families - disproportionately people of colour - reconfiguring kinship around the criminal legal system. Mass incarceration, then, disrupts conventional modes of reproduction and threatens reproductive justice, separates families and funnels children into foster care, diverts funds from social services into prisons, restricts women's access to abortion and adequate pregnancy care, shackles women in childbirth, and incarcerates people during their prime reproductive years. Beyond these obvious disruptions to reproduction, incarceration also cultivates certain ways of being a parent. Much of the critical literature on mass incarceration focuses on men, largely because of fewer women and masculinist assumptions of the carceral system. This paper looks specifically at how women's reproduction is experienced and managed by carceral institutions, and how mass incarceration itself is a reproductive technology. Based on ethnographic fieldwork at a women's jail, I explore pregnancy and motherhood behind bars. Certain types of mothering are foreclosed, while an idealized version of maternal identity is simultaneously promoted. For many incarcerated women, jail is the only place where they can experience this form of motherhood, as forces of structural violence outside of jail often limit their ability to parent, such as involvement of child welfare institutions, addiction and homelessness. The myriad ways in which incarcerated women's reproduction is suppressed and enabled is a critical lens through which to understand how institutions and forces of racial oppression reinforce idealized notions of motherhood while making them categorically unattainable.
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http://dx.doi.org/10.1016/j.rbms.2018.10.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6356046PMC
November 2018

Best Practices for Pregnant Incarcerated Women With Opioid Use Disorder.

J Correct Health Care 2019 01 7;25(1):4-14. Epub 2019 Jan 7.

4 Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Pregnant women represent a unique population for correctional facilities to care for. The incarcerated pregnant population is at an increased risk of concurrent opioid use disorder (OUD) that requires specialized care. The evidence-based best practice and standard of care for pregnant women with OUD is medication-assisted treatment (MAT) with methadone or buprenorphine pharmacotherapy. Correctional facilities that house women must be prepared to provide this care in a timely manner upon intake in order to address the serious medical needs of the pregnant woman and her fetus. Providing MAT in the incarceration setting has distinctive logistics that must be considered. This article recommends strategies to optimize the care of pregnant incarcerated women with OUD, emphasizing the importance of appropriate counseling and treatment with opioid agonist pharmacotherapy.
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http://dx.doi.org/10.1177/1078345818819855DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6543816PMC
January 2019

Perinatal Nurses' Experiences With and Knowledge of the Care of Incarcerated Women During Pregnancy and the Postpartum Period.

J Obstet Gynecol Neonatal Nurs 2019 01 7;48(1):27-36. Epub 2018 Dec 7.

Objective: To describe perinatal nurses' experiences of caring for incarcerated women during pregnancy and the postpartum period; to assess their knowledge of the 2011 position statement Shackling Incarcerated Pregnant Women published by the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN); and to assess their knowledge of their states' laws regulating nonmedical restraint use, or shackling, of incarcerated women.

Design: Cross-sectional survey.

Setting: Online across the United States.

Participants: AWHONN members who self-identified as antepartum, intrapartum, postpartum, or mother-baby nurses (N = 923, 8.2% response rate).

Methods: A link to an investigator-developed survey was e-mailed to eligible AWHONN members (N = 11,274) between July and September 2017.

Results: A total of 74% (n = 690) of participants reported that they cared for incarcerated women during pregnancy or the postpartum period in hospital perinatal units. Of these, most (82.9%, n = 566) reported that their incarcerated patients were shackled sometimes to all of the time; only 9.7% reported ever feeling unsafe with incarcerated women who were pregnant. "Rule or protocol" was the most commonly endorsed reason for shackling. Only 17.0% (n = 157) of all participants knew about the AWHONN position statement, and 3% (n = 28) correctly identified the conditions under which shackling may ethically take place (risk of flight, harm to self, or harm to others). Only 7.4% (n = 68) of participants correctly identified whether their states had shackling laws.

Conclusion: Our results suggest critical gaps in nurses' knowledge of professional standards and protective laws regarding the care of incarcerated women during pregnancy. Our findings underscore an urgent need for primary and continuing nursing education in this area.
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http://dx.doi.org/10.1016/j.jogn.2018.11.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6547812PMC
January 2019