A Call to Action: Person-Centered Care Aligned with Reproductive Justice for Incarcerated Pregnant People with Substance Use Disorders

Although research has proven that jails and prisons are ineffective in preventing or reducing substance use among pregnant people, the USA continues to rely heavily on the criminal legal system as its intervention. Pregnant people with an opioid use disorder are more likely to experience incarceration than pregnant people without an opioid use disorder. In some states, pregnant people are transported from jail to prison through the process of safekeeping in order to receive physical or mental health care that the jail does not provide, despite conviction status. When pregnant and postpartum safekeepers with an opioid use disorder experience incarceration, they face barriers related to continuity of physical and behavioral health care, have limited access to maternal-infant attaching opportunities at delivery, and are at risk for an opioid-related overdose upon release. This commentary describes clinical care challenges that impact the reproductive health needs of pregnant safekeepers with an opioid use disorder and offers solution-focused innovations to reduce harm. Such solutions include uninterrupted optimal dosing of medication and integrated prenatal clinics, specialized substance use disorder treatment, and opportunities to integrate lactation programs and perinatal dyadic-focused services.

Keywords:Pregnancy; Opioid use disorder; Person-centered care; Carceral settings; Jail; Prison; Breast feeding; Chest feeding