Determinants of infant mortality for children of women prisoners: a longitudinal linked data study

Caitlin McMillen Dowell, Gloria C. Mejia, David B. Preen, Leonie Segal

There is limited information on the determinants of infant mortality outcomes for the children of women prisoners. This study aimed to explore determinants of infant mortality for Indigenous and non-Indigenous children, with a specific focus on maternal imprisonment during pregnancy as a risk factor. Using linked administrative data we obtained a longitudinal sample of 42,674 infants born in Western Australia between October 1985 and June 2013. Data were analysed by maternal contact with corrective services, including; (i) imprisonment during pregnancy, (ii) imprisonment before (but not during) pregnancy, (iii) imprisonment after birth, (iv) community-based correctional orders (but no imprisonment), and (v) no corrections record. Infant mortality rates were calculated. Univariate and multivariate log-binomial regression was undertaken to identify key demographic and pregnancy-related risk factors for infant mortality. Risk factor prevalence was calculated for infants by maternal corrections history. 430 Indigenous and 116 non-Indigenous infants died aged 0-12 months. For singletons, infant mortality rates were highest in Indigenous infants with mothers imprisoned during pregnancy (32.1 per 1000) and non-Indigenous infants whose mothers were first imprisoned after birth (14.2 per 1000). For all Indigenous children, the strongest determinants of infant mortality were: abruptio placentae and other placental disorders (RR = 2.85; 95%CI 1.46-5.59; p = 0.002), maternal imprisonment during pregnancy (RR = 2.55; 95%CI 1.69-3.86; p < 0.001), and multiple gestation (RR = 2.29; 95% CI1.51-3.46; p < 0.001). Indigenous and non-Indigenous infants with mothers imprisoned at any time, and particularly before or during pregnancy, experienced higher prevalence of key pregnancy risk factors. This is the first comprehensive study of the determinants of infant mortality for children of women prisoners. Infants with any maternal corrections history, including community-based orders or imprisonment outside of pregnancy, had increased infant mortality. Indigenous infants whose mothers were imprisoned during pregnancy were at particular risk. There was a low incidence of infant death in the non-Indigenous sample which limited the investigation of the impact of the specific aspects of maternal corrections history on infant mortality. Non-Indigenous Infants whose mothers were imprisoned before or during pregnancy experienced higher prevalence of pregnancy risk factors than infants of mothers first imprisoned after birth.