PROJECT ABSTRACT The number of women incarcerated in the United States has increased more than 600% over the past three decades. At last count, more than 225,000 women – a majority of whom were of reproductive age – were behind bars. As the number of incarcerated women has risen, so too has the need for prisons to address women’s health needs, including pregnancy, childbirth, and postpartum care. Providing incarcerated pregnant women with enhanced pregnancy and postpartum supports may improve both maternal and neonatal outcomes. One promising approach is to use doulas to provide this comprehensive support. As non-medical companions, doulas provide an array of supports and have been shown to reduce labor length and obstetric complications, improve maternal satisfaction, and promote breastfeeding initiation among low-income women. Several state prisons are now partnering with local organizations to offer enhanced pregnancy and postpartum support; yet, key questions that are critical to successful program expansion remain. The overall objective of this project is to conduct a multi-state study of enhanced pregnancy and postpartum support programs for women incarcerated in six geographically-diverse prisons, with the overall goal to provide valuable, practical, and actionable information to prisons about how to implement pregnancy and postpartum support programs to promote maternal and neonatal health. We will accomplish this goal by pursuing the three specific aims: 1) identify facilitators and barriers to implementation of pregnancy, childbirth, and postpartum support programs for women in prison, 2) evaluate the pregnancy and birth outcomes of program participants, and 3) evaluate the postpartum outcomes of program participants. Results from this study will fundamentally advance our understanding of pregnancy and postpartum support programs and the maternal and neonatal outcomes among program participants. Identifying key modifiable factors across prisons that facilitate program implementation and sustainability and documenting the outcomes of participants across sites will directly inform ongoing program expansion. Ultimately, this work will yield critical information to address the complex health needs of pregnant women in prison, reduce health disparities, and promote health equity among justice- involved women and their infants.

PROJECT NARRATIVE Incarcerated pregnant women experience numerous sociodemographic and behavioral risks, which can compromise their health and the health of their infants. The proposed project is likely to have high public health impact by identifying key facilitators and barriers to implementing pregnancy and postpartum support programs in prisons, and documenting the outcomes among incarcerated women who receive these services. The project is relevant to the NICHD’s mission to ensure that every person is born healthy and that women suffer no harmful effects from reproductive processes.