Examining racial differences in substance use and HCV among birthing women in a midwestern prison

Abstract

Given limited data in incarcerated pregnant people, our study aimed to examine the rates of substance use in pregnancy, medications for opioid use disorder, mood disorders, and HCV of Black and White incarcerated women. We conducted a retrospective chart review of women from Michigan’s state prison who had a live hospital birth from January 1st, 2010 through May 31st, 2019. Trinity Health provides all delivery care for incarcerated women in Michigan. Rates of maternal substance use and HCV were determined. Comparisons were completed using Fisher’s exact test. Two hundred and eight women delivered in the study period. Racial distribution was Black (n=77) and White (n=131). Rates of drug use in pregnancy were higher among White women (35.1% vs 16.9%, p < 0.01), as was opioid use (24.4% vs 9.1%, p< 0.05) and medications for opioid use disorder (MOUD) (14.5% vs 2.6%, p < 0.05). Of the 21 women who received MOUD, 17 received methadone and four received buprenorphine. All patients who received buprenorphine were White. White women also had higher rates of HCV (23.7% vs 2.6, p< 0.001). Sixty-four (30.8%) and eleven (5.3%) women used tobacco and alcohol respectively in pregnancy, with no statistical difference by race. Among those who gave birth while incarcerated in Michigan, White women had higher rates of drug and opioid use, MOUD, and HCV than Black women. Additionally, no Black women received buprenorphine. Further research investigating the impact of societal-level conditions including racism, poverty, and geographical sentencing patterns on pregnant people is needed. Targeted interventions must be anti-racist and address pre-incarceration factors as well as justice in care.