"It's gotta be really hard to be a mom inside right now:" a qualitative analysis on the impacts of COVID-19 on perinatal support programs for people in prison.

Background: Prisons are well understood to be hotspots of the COVID-19 pandemic. Yet, little is known about the impacts the COVID-19 pandemic has had on pregnant and postpartum people in prison. We conducted a secondary analysis of 63 semi-structured qualitative interviews (December 2021-May 2023) with subject matter experts, primarily perinatal program staff working in prisons, to better understand how perinatal support programs for people in prison were impacted by the COVID-19 pandemic.

Results: We identified nine themes in interviews as impacting perinatal support programming for incarcerated pregnant and postpartum people during the COVID-19 pandemic: 1) prison COVID-19 preventative practices and their influences on perinatal support programs; 2) COVID-19 quarantine and confinement of pregnant and postpartum people; 3) changes in the pregnant and postpartum population and reentry support; 4) changes to birth support during incarceration; 5) lack of communication and inconsistency between the DOC and perinatal support programs; 6) DOC staffing and staff turnover; 7) lack of access to volunteer-led programming and visiting; 8) relationships between perinatal support programs and DOC healthcare providers; and 9) relationships between perinatal support programs and hospitals. Results were organized into a modified socioecological model, allowing us to view different spheres of influence, how they interact and overlap, and as we describe in the discussion section, where practitioners and policy-makers might intervene. In particular, we focused on the organizational, relational, and structural levels, with multiple themes organized into each level. All of these themes, together, help provide information on how the COVID-19 pandemic impacted perinatal support programs in prisons.

Conclusions: The COVID-19 pandemic had drastic impacts on prison operations and perinatal support programs, with cascading influences on the health and wellbeing of pregnant and postpartum people who are incarcerated. We conclude with a series of recommendations, developed by the research team and a community research council of formerly incarcerated individuals, that aim to address pandemic-related health disparities and promote health equity among those disproportionately impacted by the COVID-19 pandemic.