# Structural and Policy Determinants of Access to Medications for Opioid Use Disorder Among Pregnant People in U.S. Jails

## TL;DR

This study explores how jail policies and infrastructure affect access to opioid treatment for pregnant people in U.S. jails, highlighting the need for better care.

## Contribution

The study quantifies structural and policy factors influencing medication access for opioid use disorder in incarcerated pregnant people.

## Key findings

- MOUD provision is more likely in Democrat-won states and jails with telemedicine and community provider access.
- Restrictive policies and misconceptions about fetal harm limit treatment initiation and continuation.
- Fewer than half of jails continue MOUD for pregnant individuals already in treatment.

## Abstract

Public health relevance—How does this work relate to a public health issue?

Pregnant people in U.S. jails experience elevated rates of opioid use disorder, yet access to evidence-based medications for opioid use disorder during incarceration remains inconsistent.This study examines how jail policies, treatment infrastructure, and political context shape access to perinatal OUD treatment in carceral settings.

Public health relevance—How does this work relate to a public health issue?

Pregnant people in U.S. jails experience elevated rates of opioid use disorder, yet access to evidence-based medications for opioid use disorder during incarceration remains inconsistent.

This study examines how jail policies, treatment infrastructure, and political context shape access to perinatal OUD treatment in carceral settings.

Public health significance—Why is this work of significance to public health?

Using national jail data, this analysis identifies modifiable structural and policy factors, such as telemedicine capacity and community provider availability, associated with MOUD provision during pregnancy.Findings extend prior descriptive work by quantifying system-level drivers of treatment access for a high-risk, underserved perinatal population.

Public health significance—Why is this work of significance to public health?

Using national jail data, this analysis identifies modifiable structural and policy factors, such as telemedicine capacity and community provider availability, associated with MOUD provision during pregnancy.

Findings extend prior descriptive work by quantifying system-level drivers of treatment access for a high-risk, underserved perinatal population.

Public health implications—What are the key implications or messages for practitioners, policy makers, and/or researchers?

Expanding telemedicine and strengthening community MOUD treatment networks may substantially improve continuity of perinatal care for incarcerated pregnant people.Standardizing jail policies around perinatal MOUD provision is critical to advancing health equity and aligning correctional practice with public health and clinical guidelines.

Public health implications—What are the key implications or messages for practitioners, policy makers, and/or researchers?

Expanding telemedicine and strengthening community MOUD treatment networks may substantially improve continuity of perinatal care for incarcerated pregnant people.

Standardizing jail policies around perinatal MOUD provision is critical to advancing health equity and aligning correctional practice with public health and clinical guidelines.

Pregnant people in U.S. jails experience high rates of opioid use disorder (OUD), yet access to medications for opioid use disorder (MOUD) remains inconsistent. This mixed-methods study examines how jail policies, treatment infrastructure, and political context shape MOUD provision for pregnant incarcerated individuals. We conducted a secondary analysis of a national survey of 2885 U.S. jails (analytic sample = 836). Logistic regression models assessed associations between MOUD provision and telemedicine capacity, community MOUD availability, state Medicaid expansion, and 2020 presidential voting outcomes. Qualitative responses characterized barriers to care. Findings confirm that MOUD access for pregnant incarcerated individuals remains limited and structurally patterned. Fewer than half of jails continued methadone or buprenorphine for pregnant individuals already in treatment, and initiation was uncommon. MOUD provision was more likely in Democrat-won states, jails with telemedicine capacity, and jails located in communities with MOUD providers, while limited community availability reduced odds of provision. Qualitative themes highlighted restrictive jail policies, provider discretion, diversion concerns, and misconceptions regarding fetal harm. These findings underscore persistent structural barriers to evidence-based perinatal OUD treatment in carceral settings and highlight the importance of telemedicine expansion, community treatment capacity, and standardized correctional policies to advance perinatal health equity.