Prenatal Healthcare After Sentencing Reform

"Our examination of the effects of Pennsylvania’s criminal sentencing reform showed that after the policy was implemented, early prenatal care increased on average and inadequate prenatal care declined. Our fixed effects interrupted time series design used multiple points of comparison to assess whether reductions in incarceration improved racial and socioeconomic health equity. First, we found the benefits for prenatal care were largely limited to counties where prison admission rates declined the most after the policy. Second, we found that improvements were primarily observed among groups that are more likely to be affected by prison admissions, Black birthing people and those with lower levels of education, thus decreasing prenatal care inequities across these dimensions. Both points of comparison bolster confidence in the conclusion that changes in prenatal care were due to the policy and not to secular trends that affected these groups equally.

"These findings underscore the importance of contextual conditions of incarceration for preventative health care access and utilization. Prior research has largely examined individual or household-level effects of incarceration on prenatal care, [21] but prenatal care has not been examined in the prior epidemiologic literature on incarceration as a contextual effect across geographies. Moreover, previous research on incarceration as a contextual predictor of adverse birth outcomes [20, 31] has thus far not tested criminal justice reform policies as potential interventions to reduce exposure to high rates of incarceration in communities.

"Our findings also shed light on how criminal justice reforms may have spillover effects for healthcare utilization and health equity. However, the uneven implementation of the policy across counties underscores that incremental changes to criminal justice policy are unlikely to have broad effects for health equity. Several factors likely contributed to the heterogeneous implementation of the Pennsylvania’s policy, including judicial discretion and adherence to the revised sentencing guidelines. Indeed, policies like the one in Pennsylvania have been critiqued for making a small or negligible reduction in incarceration rates, and for further investing in criminal justice institutions instead of community-based services [28]. Moreover, even in counties where prison admissions declined the most, the magnitude of many of these improvements was small."