"Is that a policy thing or is that a guard thing?": A qualitative study of providers' experiences supporting pregnant individuals incarcerated in Ontario, Canada.

Abstract

Background: Incarcerated pregnant individuals face barriers to perinatal care and health disparities when compared to the general population. Social and healthcare providers serving incarcerated pregnant clients are uniquely positioned to identify systemic barriers which hinder clients' access to care and service delivery. This study explores the experiences of providers and the systemic challenges they encounter while delivering perinatal health and social services to individuals incarcerated in Ontario, Canada.

Methods: We conducted a qualitative study using a descriptive design. We administered virtual, semi-structured interviews with social service and healthcare providers. Participants were recruited through purposeful and snowball sampling based on their experience delivering services to at least one individual who was pregnant while incarcerated in Ontario, Canada. All interviews were conducted individually to facilitate discussions and ensure confidentiality. We employed thematic analysis to identify and develop themes and subthemes.

Results: Twenty-three participants (15 social service providers and eight healthcare providers) were interviewed. Participants explained how overlapping systems shaped their ability to deliver care, which we conceptualized as the carceral perinatal care system, composed of carceral, clinical, and community subsystems. Through thematic analysis, we also identified five themes, visually depicted as three concentric circles to reflect providers' layered and compounding experiences. The outermost circle, divided into three segments, represents the main challenges providers encountered when delivering perinatal care: (1) operating within a fragmented system, (2) knowing too little, and (3) witnessing dehumanization. These challenges contribute to the middle circle theme of (4) feeling powerless, which culminates in the centre circle theme of (5) enduring occupational stress.

Conclusion: Participants provided insights about the challenges involved in delivering perinatal care to incarcerated individuals. This study underscores the multifaceted, systemic barriers providers encounter, enhancing our understanding of the complexities surrounding perinatal care in carceral settings. The knowledge generated forms a foundation for developing policies, guidelines, and training resources tailored to the carceral context. Such interventions may strengthen providers' capacity to deliver equitable care, improving perinatal experiences and health outcomes of pregnant individuals and their infants. Future research should explore perinatal care from incarcerated individuals' perspectives to inform evidence-based solutions and guide comprehensive reforms.