New research reveals that women incarcerated in Ontario are less likely to receive prenatal care that meets international standards.

A research team led by McMaster University used linked correctional and health administrative data to compare prenatal care indicators for women in Ontario with experience of incarceration and women in the general population during pregnancies between 2005 and 2015.

In contrast with the general population group, women who were incarcerated for any period of time during pregnancy and women who had ever experienced incarceration were less likely to have received care that met international standards.

The study, published in JAMA Network Open, is available at https://bit.ly/JAMANetworkOpen. It looked at the care for 626 pregnancies during time in prison; 2,327 pregnancies in women who had previously been incarcerated and, 1.3 million pregnancies of women in Ontario during that time period.

“Regular prenatal care visits provide important opportunities for health-care providers to monitor the mother’s and foetal wellbeing and to develop positive rapport with patients,” said study author Dustin Costescu, physician and associate professor of the Department of Obstetrics and Gynecology of the Michael G. DeGroote School of Medicine at McMaster.

The study found only 48% of women who were imprisoned during pregnancy, and 59% of ever-incarcerated women received the recommended eight or more prenatal visits over the course of their pregnancy, in contrast with 85% of pregnant women in the general population.

In addition, 38% of women who were imprisoned during pregnancy, and 48% of ever incarcerated women, had prenatal care visits during their first trimester, compared with 80% of pregnant women in the general population.

“The first trimester is a critical time during foetal development, and a visit with a health-care provider facilitates screening and treatment for a variety of serious parental and fetal health conditions,” said Costescu.

“Prenatal care plays a critically important role in supporting the health of women and children. This study found that a substantial proportion of women who experience imprisonment miss out on this care.

“This may explain, at least in part, why women who experience incarceration have worse obstetrical outcomes than those in the rest of the population.”

The study was funded by the Regional Medical Associates of Hamilton and received in kind support from ICES.

Alison Carter Ramirez, previously a resident in the Department of Obstetrics and Gynecology, was the first author of the paper, and Fiona Kouyoumdjian in the Department of Family Medicine was the principal investigator. Other McMaster authors include Alice Cavanagh in the MD/PhD program.