Health Equity| Volume 33, ISSUE 1, P97-104, January 2023

Jail Provision of Pregnancy and Sexual Health Services in Four Midwestern States

Published:September 09, 2022DOI:



      Women incarcerated in local jails have pregnancy and sexual health needs, yet little information is available about what services are provided and how jail administrators prioritize this care. Our objective was to document jails’ provision of pregnancy and sexual health services in four states in the Midwest.


      We invited all jail administrators (N = 347) in Kansas, Missouri, Iowa, and Nebraska to participate in a web-based survey conducted from November 2017 to October 2018. We asked administrators which pregnancy and sexual health services they offered and to rate the importance of offering services. Results were analyzed using descriptive statistics and logistic regression.


      The survey response rate was 55% (192/347). Jails most often provided pregnancy testing (n = 116 [60%]) and distribution of prenatal vitamins (n = 85 [44%]). Sexually transmitted infection treatment was offered at 23% of jails (n = 45). Larger, accredited jails located in urban areas and with high numbers of clinical providers on staff were more likely to provide sexual health services. Jails with privately contracted health care were more likely to provide pregnancy services compared with other entities providing medical care. The most prioritized sexual health service was sexually transmitted infection testing, with 39% of administrators believing it was important. Only 6% of administrators responded that contraception was important.


      Local jails in the Midwest do not meet the basic reproductive and sexual health needs of women. Provision of these services is not a priority for jail administrators. Appropriate partnerships could engage administrators and increase the availability of services to meet the needs of women in jail.
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      Ashlyn Lipnicky, MPH, was a Research Assistant on the Sexual Health Empowerment team at University of Kansas School of Medicine. She began medical school in summer 2021.


      Sierra Stites, MPH, is a Research Associate on the Sexual Health Empowerment team at University of Kansas School of Medicine.


      Carolyn Sufrin, MD, PhD, is an Assistant Professor of Gynecology and Obstetrics at Johns Hopkins School of Medicine. She is author of the book Jailcare and a long-time researcher of women's health in jails.


      Jennifer K. Bello, MD, MS, is an Assistant Professor of Family Medicine at Saint Louis University School of Medicine. She is a reproductive health researcher and physician in jails and substance abuse treatment facilities.


      Rebecca Shlafer, MD, MPH, is an Assistant Professor of Pediatrics at the University of Minnesota Medical School who has expertise in doula care for women in jails and prisons in the United States.


      Patricia J. Kelly, PhD, MPH, APRN, Professor of Nursing at Thomas Jefferson University, has been a family health nurse practitioner for 30 years, and spent 25 years working as a jail health researcher.


      Megha Ramaswamy, PhD, MPH, is a Professor of Population Health at University of Kansas School of Medicine, where she leads the Sexual Health Empowerment team (; she is principal investigator of this project.