Mothering and Incarceration: A Conceptual Model Supporting Maternal Identity

Abstract

Current literature expounds on community and personal factors contributing to the rapidly growing number of women involved in the criminal justice system. Contributing factors are complex and interwoven, leaving women with life patterns of trauma exposure, mental illness, and substance use disorders. Consequences of these life patterns and incarceration have a significant impact on maternal role attainment. The conceptual model Mothering and Incarceration organizes the multifaceted life patterns of incarcerated women and the influences on a woman's ability to mother her children during and following incarceration. The model has the potential to provide direction to program developers, researchers, and correctional systems to tailor programs for women. The most significant implication of the conceptual model is ending the intergenerational influences of incarceration on children.

Introduction

Current literature expounds on community and personal factors contributing to the rapidly growing number of women involved in the criminal justice system. Contributing factors are complex, interwoven life patterns of trauma exposure, mental illness, substance use disorders, and lack of community resources (Hayes, 2015). Consequences of these life patterns coupled with experiences of incarceration have a significant impact on maternal identity and long-term outcomes for children. Maternal identity is as simple as a mother knowing her child's needs, physical or emotional; being able to meet those needs; and adapting as the child grows and matures, forming a unique and lasting attachment that is critical to well-being of the woman and her children. Women who do not feel successful in the role of mother experience depression and anxiety, whereas women who feel confident in the maternal role flourish and in turn nurture their children (Rubin, 1984). Incarceration disrupts the woman's ability to function and flourish in the role of mother. The early and formative years of child development influence one's ability to develop secure and trusting relationships with others (Greenberg, 2007; Hayes, 2015). Finally, incarcerating mothers contributes to intergenerational cycles of incarceration. Data demonstrate a correlation between incarcerated parents and higher levels of substance abuse, domestic violence, and poverty, providing further evidence of the collateral harms of incarceration (Phillips & Dettlaff, 2009).

Background

Maternal identity is foundational to nurturing and caring for children (Mercer, 2004; Rubin, 1984). In the sentinel study by Rubin, cognitive processing of subjective experiences that begin during pregnancy and become more complex after birth was described and organized into four interdependent tasks that include seeking safe passage for self and child, ensuring acceptance of the child by significant others, binding-in to the unknown child, and learning to give of self (Rubin, 1984). After birth, mothers and their infants create a dynamic and complex relationship wherein mothers gain confidence in their ability to care for the newborn. Mothers benefit from the relationship as they experience satisfaction in the role; the newborn benefits from the relationship as basic needs for nutrition, comfort, safety, and attachment are met (Mercer, 2004). Women who feel confident in the maternal role flourish and in turn nurture their children (Rubin, 1984). In most cases, incarceration separates mother and child and disrupts the woman's ability to function and flourish in the role of mother, negatively impacting her ability to nurture the child and negatively influencing long-term emotional growth and development of the child.

Women are the fastest growing group of U.S. citizens under the supervision of federal, state, and local criminal justice systems. Currently, >225,000 women are under the supervision of state or federal prisons; 75% are of reproductive age with ∼4% entering prison pregnant (Bronson & Carson, 2019; Gotsch, 2018; Sufrin et al., 2019). Incarcerating women places significant burden on children, families, and communities. Furthermore, incarceration of a parent is considered an adverse childhood experience or ACE and critically influences health, well-being, and growth and development of children regardless of age (Phillips & Dettlaff, 2009).

To understand the influence of incarceration on women, we must understand psychological development of women. Relational–cultural theory was groundbreaking work in the 1970s describing women's development as different from men's and the importance of relationships in women's lives. In 1976, Miller wrote Toward a New Psychology of Women describing the power of context, the importance of sociopolitical forces on psychologic development, and the role of relationships in women's lives (Jordan, 2008; Miller, 1976). Before Miller's study, psychological development was described as a movement from childlike dependence to mature independence to become self-sufficient and autonomous. Miller proposed that women develop differently and are motivated by the need to develop connections with others and develop their sense of self and self-worth through connections with others. Connections are crucial to development, and disconnections or violations in relationships can negatively affect a woman's well-being (Covington, 1998). In the relational model, relationships are (1) interactions that create a sense of being in tune with self and others, (2) about being understood and valued, and (3) mutually empathic, creative, and empowering connections (Covington, 1998).

Mutuality, an additional component of a relationship is a fluid phenomenon of feelings, thoughts, and perceptions that allows the individual and the relationship to change over time while remaining responsive to the needs of the individual and the relationship (Covington, 1998). Empathy, a complex highly developed ability, allows one to join another at a cognitive and affective level without losing connection with one's own authentic self. A growth-fostering relationship includes mutual empathy wherein both parties mutually connect emphatically (Covington, 1998). Mutually empathic relationships create a sense of power with others, not power over others, leading to constructive and creative communities and families.

Method

A conceptual model provides a framework for interpretation of research, identifies relationships between concepts, guides future research, and provides intellectual and sociohistorical context for the topic (Radwin & Fawcett, 2002). The conceptual model, Mothering and Incarceration, was developed based on Miller's relational–cultural theory describing the role of relationships and importance of connections with others contributing to a woman's sense of self and self-worth. The model organizes experiences and influences over the life course that contribute to incarceration and the long-term consequences of incarceration. The conceptual model also incorporates the important role of trauma-informed care and maternal identity in the lives of incarcerated mothers. See Table 1 for definitions of concepts included in the model.

Table 1.

Definitions of Concepts Included in Mothering and Incarceration: A Conceptual Model Supporting Maternal Identity

Concept	Definition
Health disparities	Preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health (CDC, 2013).
Intergenerational incarceration	Risks associated with parental incarceration affecting relationships with family and social networks contributing to difficult behaviors (Shlafer & Poehlmann, 2010).
Trauma exposure	Experiencing abuse and/or neglect including but not limited to emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect (Moog et al., 2016).
Substance use disorder	Recurrent use of alcohol and/or drug use causing clinically significant impairment, including health problems, disability, and failure to meet major responsibilities at work, school, or home (SAMHSA, 2020).
Mental health disorder	For someone over the age of 18 years, in the past year a diagnosable mental, behavioral, or emotional disorder that causes serious functional impairment that substantially interferes with or limits one or more major life activities (SAMHSA, 2020).
Neurobiology of women	Unique response by women to somatic, neurologic, and psychiatric diseases based on the mechanisms that mediate gender differences (Panagiotakopoulos & Neigh, 2014).
Gender responsive	Creating an environment that reflects an understanding of the realities of women's lives and addresses issues including site, staff, program development, content, and materials (Bloom et al., 2003).
Trauma informed	Care that acknowledges the role of victimization in the life of survivors (Harner & Burgess, 2011).
Evidence-based practices	A problem-solving approach to care that integrates the best evidence from well-designed studies, data, and experts designed to improve outcomes (Melnyk et al., 2010).
Well-being	A complex and multifactorial construct that includes psychological, social, and spiritual aspects based on cognitive and affective judgments individuals make about their lives (Trudel-Fitzgerald et al., 2019).
Resiliency	The ability to withstand interpersonal, financial, work, or health challenges due to characteristics such as social skills or flexibility (Grabbe & Miller-Karas, 2018).
Social support	Actual or perceived resources, formal or informal, that are provided by nonprofessionals (Clone & Dehart, 2014).

A critical review of literature was conducted to provide an immersion in the topic, a method often used to develop a hypothesis or model (Grant & Booth, 2009). A critical review includes analysis and synthesis of material from diverse sources, providing an opportunity to organize and conceptualize previous work and resolve competing schools of thought (Grant & Booth, 2009). The critical review was conducted by a primary search of the literature using the keyword “incarcerated mothers”; studies included were conducted in the United States and published between the years of 2010 and 2020 in English language only publications. Databases searched included PubMed, CINAHL, and PsychoINFO. In the primary literature search, 263 references were found. After review of abstracts for references addressing factors contributing to incarceration or outcomes of incarcerated women or their children, 63 references remained. Common broad themes emerged that included well-being, trauma exposure, and recidivism. Within the themes, reoccurring conditions contributing to incarceration were identified; these included substance use disorders and mental health, biological and psychological influence of trauma exposure, mothering or role attainment, and challenges of reentry. References were a combination of quantitative and qualitative work from the disciplines of nursing, psychology, psychiatry, and criminology. The model was reviewed by researchers and professionals working with population of interest from the disciplines of nursing, psychology, and criminology; recommendations from reviewers were incorporated as appropriate.

The final model organizes four major themes or influences that contribute to the cyclic experience women encounter related to incarceration.

Conceptual Model

A conceptual model provides a cohesive and organized demonstration of relationships between factors contributing to a phenomenon. Conceptual models also provide a framework for testing and operationalizing theory, can guide decision making and policy development, and are useful for evaluating outcomes (Creswell, 2014). The conceptual model Mothering and Incarceration draws on the theories of maternal identity, relational–cultural theory, and how social and community issues common among incarcerated women influence the experience of mothering. Significant influences include trauma exposure, poverty, mental health conditions, and substance use disorders. The carceral experience has the potential to change the life course of women and mothers through gender-responsive trauma-informed care that is based on evidence.

Mothering and Incarceration: A Conceptual Model

The Mothering and Incarceration model focuses on four areas of influence for women who experience incarceration: the community before incarceration, individual characteristics, carceral experience, and the postrelease community for reentry and reunification of the family (see Fig. 1). Foundational to the four areas of influence, the studies of Reva Rubin (1984) describing maternal role identity and Miller (1976) describing relational–cultural theory are incorporated throughout the model to describe how the areas of influence are shaped and experienced by mothers who are incarcerated.

Fig. 1.

Mothering and Incarceration.

Community Influences

Much has been written about poverty and health disparities among incarcerated persons and their communities. Incarcerated persons of all genders, races, and ethnicities are more likely to have been homeless and unemployed and to have received public assistance in the year before incarceration than nonincarcerated persons of similar ages (Executive Office, 2016). In addition, women are more likely to be the primary caregiver for young children and experience a greater burden of poverty than men (Rabuy & Kopf, 2015). Poverty increases the likelihood that women become homeless; are involved in unstable relationships; experience abuse, violence, and trauma; and become involved in prostitution, drug trafficking, and child protective services (Hayes, 2015; Phillips & Dettlaff, 2009; Solinas-Saunders & Stacer, 2017). The majority of incarcerated women in the United States are serving sentences for nonviolent crimes of survival including shoplifting, forgery, or theft, or for drug-related crimes. In addition, they often come from communities of significant poverty and high crime that provide little opportunity for substantial employment or successful reentry after incarceration (Bronson & Carson, 2019; Callahan et al., 2016).

High rates of infectious diseases, mental health disorders, substance use disorders, and chronic health conditions are common among incarcerated women. Rates of sexually transmitted infections and HIV are reported as three to five times that of the general population (de la Flor et al., 2017) and 75% of incarcerated women report a history of mental health conditions or treatment or currently demonstrate symptoms (Arditti & Few, 2008; Sufrin et al., 2019).

Life conditions experienced by incarcerated women negatively impact their children. Poverty, homelessness, exposure to violence, substance abuse in the home, and poor mental health conditions experienced by parents negatively impact a child's home stability, success in school, and well-being. In addition, witnessing the arrest of a parent, displacement when mothers are incarcerated, and limited access to mothers while incarcerated negatively impacts a child's life course and is thought to increase the likelihood of intergenerational incarceration (Arditti, 2016; Foster & Hagan, 2015).

Individual Influences

Appreciating individual influences and life experiences of incarcerated women can provide insight into the life course contributing to criminal justice involvement. Incarcerated women consistently report childhood trauma including physical, emotional, and sexual abuse; substance use disorders; and mental illness (Hayes, 2015). Emerging science is providing evidence that trauma exposure and substance abuse are often related experiences for women, are experienced differently for women than men, and can significantly influence life choices and patterns for women.

Trauma exposure is experienced differently by women and uniquely affects the neuroendocrine system. Women who have traumatic life events are at risk for chronic stress and post-traumatic stress disorders that are associated with epigenetic changes in the hypothalamic-pituitary-adrenocortical (HPA) axis, the body's stress response system. The HPA axis is responsible for homeostatic processes to manage stress and for growth and repair of the neuroendocrine system. Under conditions of stress, the HPA axis produces cortisol, a stress hormone responsible for shifts in metabolic processes and resources to manage threats to the body, more commonly known as the fight or flight response (Kertes et al., 2016). During pregnancy, stress and activation of the HPA axis influence the developing fetal brain as cortisol freely crosses the placenta producing epigenetic changes in the fetal HPA axis that will influence the next generation's response to stress (Kertes et al., 2016; Moog et al., 2016).

Trauma exposure is pervasive among incarcerated women. Trauma exposure often begins in early childhood and includes physical, emotional, and sexual abuse; neglect; and witnessing violence against others in the home and community. Children who are exposed to violence and lack stable homes and nurturing mothers are at significant risk for a lifetime of chaotic relationships, substance use/abuse, difficult emotional regulation, and mental health conditions (Konecky & Lynch, 2019). Traumatic experiences of violence and abuse disrupt and distort a woman's ability to form and maintain growth-fostering relationships, contributing to lifelong patterns of chaotic and abusive relationships (Emerson & Ramaswamy, 2015; Miller, 1976; Hayes, 2015). In addition, traumatic experiences influence one's ability to regulate emotional experiences and manifest as impulsive behaviors (Konecky & Lynch, 2019). More specifically, emotional regulation is the awareness and ability to experience diverse emotions and manage impulsive behaviors and is associated with mental health conditions (Konecky & Lynch, 2019).

Substance use disorders and addiction are experienced differently by women than by men. Numerous studies document that women progress through the stages of addiction faster and are more susceptible to addiction and relapse than men, and addiction is often a means to manage the influences of trauma exposure and mental health conditions (Bobzean et al., 2014; Thomas & Becker, 2019; Westenbroek et al., 2019; Winter et al., 2016). The effect of estrogen on dopamine is primarily responsible for the differences in addiction patterns between men and women (Bobzean et al., 2014). Further research is needed to better understand the neurobehavioral differences between men and women related to substance use disorders.

Carceral Experiences

The very nature of the authoritarian correctional setting often replicates abusive relationships and past traumatic events women have experienced and increases the risk of retraumatizing women (Emerson et al., 2019). Carceral systems were designed for men and frequently do not consider the relational nature of women, past histories of trauma exposure, and importance of the maternal identity in the woman's overall well-being. In addition, carceral systems frequently do not adequately prepare women for return to the community where they often experience more shame, stigma, and disadvantage than men, resulting in high rates of recidivism (Few-Demo & Arditti, 2014).

In response to the growing number of women under the supervision of correctional settings and the importance of gender responsive care, the National Institute of Corrections (NIC) published guidelines for gender-responsive practices based on research and evidence (Bloom et al., 2003). The guidelines address gender responsiveness as creating an environment that reflects an understanding of the realities of women's lives and addresses the issues of women. Although broad in scope, the guidelines acknowledged for the first time differences in managing women offenders. The NIC guidelines first sought to understand pathways for women into the criminal justice system and thereby improve outcomes (Bloom et al., 2003).

The relational–cultural theory postulates that a healthy sense of self depends more on building and maintaining supportive relationships than developing a sense of self as independent and self-reliant. Based on the relational–cultural theory, for the carceral experience to be growth fostering for women, it should be gender responsive and consider how women base their self-concept and moral identity on responsibilities within relationships. Incorporating a relational perspective in carceral settings enhances a supportive community, diminishes isolation and stigmatization, builds a source of personal strength, and respects women's individual experience (Emerson et al., 2019). Providing gender-responsive communities and programs in the carceral setting based on relational theory can positively influence construction and healing for women who then have the resources to be successful when returning to the community (Emerson et al., 2019).

The importance of gender-responsive policies is becoming more well understood. Numerous legislative efforts across the United States addressing a range of topics specific to incarcerated women have gained attention and been written into law in recent years. Gender-responsive legislative efforts include eliminating the practice of shackling pregnant and laboring women, limiting pat- and strip-search procedures, expanding commissary items (specifically health and personal care items used by women) and allowable personal property, and efforts to address care specific to labor, birth, and breastfeeding (Ferszt et al., 2018). Seemingly minor changes in policy and practices that are supportive, growth fostering, and nontraumatic have the potential to change lives for this group of women.

Reentry and Reunification

Successful reentry is most often defined by recidivism rates (Heidemann et al., 2016), with limited attention given to well-being, self-esteem, and reunification with family and communities. In the most current Bureau of Justice Statistics report, 2018, among the 401,288 persons released from state prisons, 44% were arrested within the first year of release and 10.7% of those arrested were women (Alper et al., 2018). Recidivism rates are difficult to interpret due to inconsistent data collection, but recidivism is consistently associated with poverty, homelessness, and unemployment (Prison Policy Initiative, 2020). Mothering is altered dramatically by incarceration and the collateral influences of incarceration, likely has a profound influence on a woman's identity as a mother with lasting influences on family and relationships after incarceration (Arditti & Few, 2006). Efforts to maintain contact with children during incarceration is often key to successful reentry and reunification of a mother and her children.

Successful return to the community after incarceration is different for women than for men. It is multifaceted and influenced by family support, discrimination, stigma, and shame. The conditions that often contributed to incarceration including poverty, poor mental health, family violence, and substance abuse have significant influence on reentry and overall success (Arditti & Few, 2006; Few-Demo & Arditti, 2014; Solinas-Saunders & Stacer, 2017). Gendered stigma and shame are unique to formerly incarcerated women and often experienced by women as a violation of social norms and moral principles of womanhood, subsequently resulting in social exclusion (Heidemann et al., 2016). The stigma, shame, and exclusion formerly incarcerated women experience have negative consequences on their self-esteem and well-being and are counter to the relational nature of women (Heidemann et al., 2016).

Resiliency is the ability to withstand interpersonal, financial, work, or health challenges due to limited social skills or coping (Grabbe & Miller-Karas, 2018). Resiliency is influenced by family, environment, genetic, and environmental factors that mediate neurotransmitter and molecular pathways that influence how individuals cope with stress, trauma, loss, and a multitude of circumstances (Grabbe & Miller-Karas, 2018). Resiliency is key to successful reentry as it facilitates opportunities for stable employment, housing, childcare, and access to education (Heidemann et al., 2016; Wesely & Dewey, 2018).

Arditti and Few (2008) described an experience of maternal distress that contributes to poor adaptation after incarceration. Using grounded theory analysis of interviews conducted with formerly incarcerated women, the phenomenon of maternal distress was conceptualized. Arditti and Few described maternal distress as a unique form of psychological distress, often presenting as depression, which includes relational and situational aspects of distress. Relational distress develops from unresolved losses that occurred in relation to incarceration, maternal guilt from substance abuse and incarceration, and/or difficult relationships with intimate partners (Arditti & Few, 2008). Maternal distress and factors contributing to maternal distress directly influence self-esteem and well-being, crucial to successful reentry in the community. Arditti and Few (2006) conclude that personal resiliency and social support are among the factors that mitigate and enhance reentry.

Just as chaotic and negative relationships influence rates of incarceration, social support from family and friends helps women navigate incarceration and reentry to the community. Social support has many forms including perceived or actual support, instrumental and/or expressive, and formal versus informal. Sources include communities, friends, family, and/or partners (Heidemann et al., 2014). Social support is foundational to the sense of self and self-worth described in the relational theory, creates interdependent systems of obligation, and is often key to behavior that contributes successful reintegration and prevention of recidivism (Covington & Bloom, 2007; Heidemann et al., 2014).

Discussion

The conceptual model Mothering and Incarceration organizes current research and provides a framework for interpretation of the multiple social and biologic factors contributing to mass incarceration of women. Influences from the community, the individual and the carceral experience described in the literature demonstrate the connectedness and cyclic nature of a life course many women and mothers experience contributing to incarceration. Programing during incarceration should be evidence based and teach life skills and be a growth-fostering experience that promotes healing from past harms while imparting resources of resiliency including education, health, and well-being.

The carceral setting was designed for men and structured on a violence-prevention model (Bloom et al., 2003). Only recently have prisons taken into consideration that incarcerated women are typically nonviolent offenders; have significant histories of abuse, poverty, mental health conditions, and substance use disorders; and are the mother of minor age children (Bloom et al., 2003). Separation from children is described as the most difficult aspect of a woman's incarceration (Miller et al., 2014). Therefore, maintaining healthy mother–child connections during incarceration is vital to the incarcerated mother's well-being, the child's well-being, and the long-term relationship between mother and child. Programs provided during incarceration should be based on trauma-informed practices and focus on supporting mother–child contact and relationships during incarceration, parenting skills, and preparing women for transition back to the community and reunification with children. Planning for release and transition back into the community should also address basic needs of housing, employment, relationships with family, and managing shame and stigma women encounter after incarceration (Arditti & Few, 2006; Emerson & Ramaswamy, 2015; Miller et al., 2014).

Prison programming that is gender focused on women's needs and based on trauma-informed practices should address three critical areas: education attainment, health, and well-being. Education is a key to successful employment after incarceration. All incarcerated women should have the opportunity to earn a high school diploma, college education, or obtain job skills that can, upon release, support a woman and her family. Furthermore, prison programs should include women's health education that ranges from prenatal education for pregnant women to women's health across the life span. Parenting programs can contribute to successful mothering for women who often grew up without consistent parenting or role models. Knowledge of contraception and how to access it in the community is a key to successful reentry. Providing women with evidence-based knowledge of contraception is empowering and a step toward taking control of reproductive and overall health. Health care should also include access to substance use and mental health treatment. No woman should leave the carceral setting with untreated mental health or substance use conditions and plans for follow-up in the community.

The third component of prison programming and possibly the most challenging is improving the well-being of this group of women. Most incarcerated women report histories of sexual abuse that started in childhood, poverty, homelessness, and intergeneration incarceration that resulted in fragile families, foster care placement, promiscuous behavior at young ages, and interaction with the juvenile justice system. Programing that is trauma informed and incorporates Miller's relational model empowers women and builds self-esteem, preparing women for reentry and return to their family and community. Programming that supports visitation and interaction during incarceration between mothers and children is crucial to the development and maintenance of attachment and fosters maternal identity. Maternal role development occurs only when the mother and child interact, experience the give and take of a relationship, and build a trusting relationship (Rubin, 1984). Attachment and confidence in the ability to care for children are crucial to a woman's successful return to the community. Efforts for women to stay involved and informed and to participate in decision making about their children while incarcerated build self-esteem and foster development of maternal identity and the mother–child relationship.

One might argue that addressing the needs of mothers is not the responsibility of the carceral system. However, for most incarcerated women, their criminal experience is not related to violence but to crimes of survival, substance abuse, and/or poor mental health. Engaging women during a period of incarceration in gender-responsive growth-fostering programs that address histories of abuse, violence, and substance use disorders has the greatest potential to interrupt the cycle of poverty, violence, and victimization. Changing the carceral experience has the potential to improve well-being, self-esteem, and resiliency, thereby interrupting patterns of recidivism and intergenerational incarceration (Figure 1).

Conclusion

The Mothering and Incarceration conceptual model organizes the multifaceted and chaotic life patterns of incarcerated women who often contribute to incarceration and recidivism (Fig. 1). The model combines evidence from numerous disciplines, establishing a framework for programs in the carceral setting focused on women returning to the community resilient and prepared to care for their children and ending the cyclic nature of justice involvement experienced by so many women today. The model can be used to develop and support legislative and policy topics, measure outcomes describing return to the community after incarceration, influence staff training in carceral settings, and garner sustainable research support to measure and improve outcomes for women who experience incarceration. The Mothering and Incarceration model demonstrates the role of evidence-based care and programs in the carceral setting that promote recovery and well-being, crucial to successful reentry and the role of mother.

Author Disclosure Statement

No competing financial interests exist.

Funding Information

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