Pregnancy management for incarcerated individuals with substance use disorder: Insights from North Carolina jails.

BACKGROUND

Pregnancy and substance use disorders (SUD) for incarcerated individuals often overlap, but their management varies greatly between jails. A better understanding of pregnancy management across jails is needed to better guide policy and practice recommendations.

OBJECTIVES

To examine the current state of pregnancy management across North Carolina jails, including current practices, challenges, and gaps in pregnancy management in jails.

DESIGN

This is a qualitative analysis within a mixed-methods study assessing the scope of perinatal incarceration and the capacity of North Carolina jails to manage perinatal SUD.

METHODS

We conducted in-depth interviews with North Carolina jail staff using a semi-structured interview guide between October 2022 and September 2023. We used the ideal-type analysis approach to systematically compare pregnancy management and SUD management practices across facilities.

RESULTS

We completed 26 interviews with jail staff. Pregnancy management approaches were unevenly distributed across three ideal types: (1) exclusive use of internal prenatal care resources (n = 2), (2) exclusive use of external prenatal care resources (n = 16), and (3) hybrid use of both internal and external prenatal care resources (n = 8). Within ideal types, SUD management was highly variable.

CONCLUSION

The heavy reliance on external resources for prenatal and SUD care highlights the chronic underfunding and staffing challenges faced by these facilities. There is an urgent need for standardized policies governing prenatal care in jail facilities to help reduce disparities in care quality and ensure that all pregnant individuals receive adequate support, regardless of the jail's resources. Alternatives to incarceration during pregnancy should be prioritized.