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The number of children in the United States whose parents are incarcerated is widely acknowledged to be a very large number, but the exact number is unknown, as no entity is specifically responsible for tracking an exact count.

Statistics
As of 1999, the number of children with incarcerated mothers was simply an estimation found by “counting the number of incarcerated women, estimating the percentage who were mothers, and multiplying by the average number of children as found in large scale self-report data.”

Differences in these estimations – of both children whose mothers are incarcerated and children whose mothers and/or fathers are incarcerated – vary widely. For example, a U.S. Department of Justice estimate from 2008 reported approximately 1.7 million minor children had a parent in prison in 2007. An report from the Center for Children of Incarcerated Parents in 2006 estimated that in 2005 closer to 2.8 million children had a parent in prison or jail. A large portion of these estimates represent children whose fathers are imprisoned. But another calculation from the Bureau of Justice Statistics in 2008 indicated that approximately 150,000 minor children had mothers in prison; 131,000 of these had mothers in a state prison and 16,400 had mothers in federal prison.

Certain groups of children are more likely than others to be affected by the criminal justice system. African American children, for example, have an incarcerated parent at a rate "that is seven and a half times greater than that for white children, and Hispanic children experience parental incarceration at nearly three times the rate that while children do."

Trauma during pregnancy and delivery
There are a variety of ways that having a mother in prison is traumatic for children. The first of these is a certain trauma that is uniquely associated with having a mother in prison versus a father - being born in prison. A lack of attention to the intersection of the necessities of pregnant women and substance abusers in recovery negatively affect the quality of life for mother and child from pregnancy through delivery.

Pregnancies and prison
An estimated 4.1 percent of state prison inmates and 2.9 percent of federal prison inmates are pregnant upon arrival. These pregnancies – and ultimately the births that occur – tend to deviate strongly from the Lamaze International's Care Practices – principles and guidelines for a healthy, optimal pregnancy and birth. These practices include six major guidelines: labor must not be forced, mothers should change position throughout labor, loved ones or doulas should provide continuous labor support, interventions that are not medically necessary must be avoided, mothers should avoid giving birth on their backs and push spontaneously, and perhaps most important in the study of prisons, mothers must keep their babies with them and provide unlimited opportunities for breastfeeding. Not allowing pregnant inmates to adhere to these principles combined with a lack of medical, nutritional, and educational care and prison programs can have long term consequences, both for the women and for their babies.

Demographic of female prisoners
Findings of a 1998 study, Defusing the Time Bomb conducted by Leslie Acoca, concluded that though the frequency of pregnant inmates in the United States is on the rise, prisons nationwide are still providing inadequate pre and postnatal care for its pregnant inmates. The study also suggests that prisons do not consider the needs of the demographic of women that are incarcerated. The women imprisoned in the United States generally come from very similar walks of life that can be characterized by the following descriptors: low income, minority status, possible chronic substance dependency, and HIV/STD carriers. These descriptors demand very specific care to be remedied. When these conditions are in tandem with the intricacies that come with being pregnant, a certain level of care is required for a safe delivery of a child that prisons today are simply not providing.

Barriers to effective healthcare and its origins
Marginalized populations experience a high rate of poverty, particularly women. Included in this demographic are the 6 to 10 percent of women who are pregnant during their sentencing process (FN). With this in mind, consider access to medical preventive exams, specialized healthcare, effective self-care, and general treatment. Because of their financial status on the streets, the majority of women do not have the mobility to seek out regular medical attention. This leads to women entering prisons and re-entering society with sickness that may or may not have been properly diagnosed and treated. From the perspective of prisons, their inadequate systems of medical attention ultimately disservices women and lulls them into a false sense of security because the inadequate health care that they are receiving is more than they have ever had access to.

In U.S prisons, there tends to be a dearth of family planning services offered to the inmates. In Acoca’s 1998 study, she reports that in prisons throughout the country there was not a prominent focus on dialogue surrounding family planning post delivery. Researchers Meda Chesney-Lind and Russ Immarigeon have also considered and added to this finding in their 1994 study, “Women’s Prisons: Overcrowded and Overused”, in which they address the effects of the War on Drugs on the demographic of incarcerated women, specifically those of color. The study reports incarcerated women of color being imprisoned at two times the rates of their male counter parts. This increase, as Immarideon and Chesney-Lind reports, in female prisoners of color is a result of the side effects of the  “Get tough on Crime” and “War on Drugs” rhetoric and policies produced during the presidencies of Richard Nixon, Gerald Ford, and Jimmy Carter. The rhetoric created during this time period lead to an increase in surveillance and arrests in impoverished neighborhoods across the country, which composes majority of the prison demographic. As it relates to the reentry of incarcerated mothers, the rhetoric and policies created during this time period effectively separated millions of families by sending one, or both, parents to prison.

Health problems and needs
Leslie Acoca, executive director and founder of the National Girls Health and Justice Institute, centers her study Defusing the Time Bomb on the special health problems and needs of incarcerated women. She critiques the treatment of substance abuse by reporting an absence of methadone maintenance for opiate dependent mothers. Though this critique addresses a specific demographic of inmates, this problem is indicative of a larger neglect of sufficient treatment for substance dependent inmates.

Later in her report she addresses the shortcomings of the prisons in regards to providing adequate care for pregnant inmates. Acoca begins by emphasizing that the importance of pre and post-natal care. In the same vein, pregnant inmates are also not getting a sufficient amount of calories that a pregnant woman should, putting women and their children at risk for malnutrition. This information is cited in the 1996 study conducted by Acoca and partner J. Austin.

Separation after birth
In the same study, Acoca and her partner address the lack of preparation that inmates receive prior to the separation that occurs directly after delivery. As she reports, in most cases, newborns of incarcerated mothers are placed in foster care within 24 hours of delivery in the mother’s home county. In some cases, this separation occurs not even hours after the mother has given birth. In other cases, the baby is allowed to stay for one or two days before separation. [9] Of course, this disrupts both the child's attachment to the mother and the mother's attachment to the child. In doing so, a critical bonding period for the child's future development is broken.

Often, the mother will not be able to see the child due to the geographic distance between the prison and their home county. In addition to the lack of counseling for inmates’ pre-delivery, they do not receive counseling for the physical aspect of being a mother. Acoca cites the 1996 study as reporting that incarcerated mothers are not provided with the necessary medication to dry up their breast milk, leaving their breasts engorged without a way to dispose of the milk. Their engorged breasts not only cause physical pain, but can also be psychologically damaging, leading to a greater sense of loss and depression.

Themes of re-entry in literature
In the “Ex-Prisoner’s Dilemma,” written by professor of Sociology Andrea M Leverentz, she tackles the process of re-entry for female offenders from a different perspective. Using the sociological method of symbolic interactionist approach to report a different perspective on the findings related to this field. Through several in depth and spread out interviews with female ex-offenders and others related to them, she provides a more humanistic retelling of many themes involved in the re-entry process.

Religion
The rhetoric used in various desistance programs generally has their foundation in religion and religious traditions. From halfway houses to 12 step programs, religion, generally Christianity is imperative to the guidelines that the various programs expect offenders to abide by. Throughout the accounts that compose Leverentz’s study, religion is a major contributor to the successful reintegration of female ex-offenders. Their dependency on God granted many participants a sense of purpose besides their desistance efforts. For some offenders, religion was a crucial aspect of their desistance efforts.

Familial relationships
The entire group of participant’s in Leverentz’s study reported that their children and family were the biggest motivation that they had to get clean, resist re-offending or both. Family members often provided non-custodial care for children of the offenders throughout their incarceration, relapses, and their desistance efforts. The pressure that female ex-offenders often experience stems from the timeline enforced on them by legislation in regards to reuniting with their children. Leverentz analyzes the policies more in-depth in the conclusion section of her study. Sociologist Ann L. Jacobs, in her study, “Give 'Em a Fighting Chance: Women Offenders Reenter Society”, reports the expectations of re-entering women to give a more comprehensive perspective of the objectives that women are expected to prioritize as soon as they are released. Among these, the most important is to make an attempt to continue their role as a caregiver in whatever capacity they served prior to incarceration.

Attachment disruption
Another possible trauma for children with mothers in prison is the disruption of their mother/child attachment. This disruption can be a traumatic experience regardless the age of the child, but it may be especially harmful to infants and toddlers. Such disruption is also particularly difficult for children whose mothers previously lived with them, supported them, and met their emotional and material needs. The key variable here is the mother's level of engagement, a construct that was explored at great length by John Bowlby. Bowlby was a developmental researcher who advanced a model of attachment that categorized mother child bonds as either securely attached or insecurely attached. These insecure attachments, themselves categorized on three levels (anxious resistant insecure attachment, anxious avoidant insecure attachment, and disorganized/disoriented insecure attachment), Bowlby considered considered problematic for the child's future development.

In Bowlby's attachment model, the mother/child bond was given particular importance; Bowlby argued that attachment to one's mother forms a model that one uses in forming future attachments.Having a secure attachment that is violated or having any form of insecure attachment, he proposed, can shape children's future attachment patterns for the worse.

Children with incarcerated mothers generally have a high rate of insecure attachment. In a 2005 study, researchers found that in a sample of 54 young children whose mothers were currently incarcerated, 63% were classified as having insecure attachment with their mothers and caretakers. This suggests that the mother's incarceration may contribute to insecure attachment, even if children previously were securely attached.

In some cases, incarcerated mothers have insecure attachments with their children prior to incarceration. These children often do not live with their mothers, and thus their mother's incarceration does not hold the same level of disruption that it may to those living with their mothers before she was arrested.

Active participation
There are three categories of child participation within their mother's arrest: children are absent from the situation, observers in the situation, or participants to the situation. In a study conducted by Jane Siegel, most often children were absent from the arrest; they were at school or the mother was away from the house. Those who were at school would either be left waiting at school or return to an empty house. Particularly for children of engaged mothers, this experience left children with a lot of sadness and anxiety. Children who are observers directly witness their mothers being handcuffed and taken away by the police. Although these children do not experience the same uncertainty and anxiety about where their mothers are, the event is often still frightening. This fear can be exacerbated by how the police behave - both towards the mothers and towards the children themselves. Active participation occurs when police call upon the children to help them find their mother; in these cases, children must choose between compliance with an authority figure or loyalty to their mothers. When their mothers subsequently do get arrested, children often feel somewhat responsible and are angry with those perceived responsible for the arrest.

Risk factors for children
Parental imprisonment is a risk factor for developmental, psychological, emotional, and economic problems, including antisocial personality behavior, depression, alcohol and drug abuse, and unemployment. The children of incarcerated mothers are at a higher risk for developing a high ACE score, a score designed to measure ten types of childhood trauma. And it is proven that childhood trauma affects health across the lifetime, by affecting brain development, decreasing life expectancy, and increasing the risk of heart disease and lung cancer. Risk factors for this trauma can be divided into three sections: contextual, incarceration related, and intergenerational incarceration patterns. Contextual and sociodemographic factors include the mother's lack of education, living in a single parent home, past and current poverty, substance abuse, sexual abuse, and mental illness. Children of incarcerated parents may be more likely to be exposed to such factors. According to a 2006 study, around 25% of the 20,000 inmates who participated were likely to have a history of mental illness - over double the estimated rate for the general population. Incarceration related risk factors specifically have to do with parents being in prison or jail. These include exposure to regular drug use, being separated from siblings, and being placed in non-familial care. Finally, it is important to understand intergenerational incarceration patterns - cycles of incarceration passed down by family members. When exposed to such patterns, children may become habituated to crime and view criminal and drug related behavior as normative.

Importantly, children with mothers in prison may be more likely to be affected by these risk factors than children with fathers in prison. Female inmates are more likely than male inmates to have a history of mental illness. And the children of incarcerated mothers are significantly more likely to be identified as suffering from mental health problems, even after factors such as parental mental illness and exposure to violence are taken into account.

In addition, female inmates are more likely than male inmates to be imprisoned for drug related crimes. Mothers' drug dependency is a high risk factor for future incarceration. And in fact, there is evidence that children of incarcerated mothers are 2.5 times more likely than those of incarcerated fathers to end up incarcerated themselves, exacerbating the cycle of imprisoned mothers.

Furthermore, a study conducted with children in the 1990s found that the negative educational consequences for children with incarcerated mothers was greater and more significant statistically than those with incarcerated fathers in four of six comparisons. These educational consequences were held at both the individual level and at the school level. As stated, "the damaging effects not only affect the children of imprisoned mothers but also spill over to children of non-incarcerated mothers in schools with elevated levels of maternal incarceration. [They found] a 15 percent reduction in college graduation rates in schools where as few as 10 percent of other students' mothers are incarcerated."

Contact
One of the biggest challenges in maternal incarceration is maintaining a parent/child relationship during separation. This is especially hard to do given the distance that often separates mother and child, often as much as 600 miles. Even when mothers are a short distance away, financial constrains limit the children from being able to visit. When visits do occur, children often must share their time with the adult who brought them, meaning that child and mother do not get to spend much time interacting. Another possibility for staying connected is through the phone. However, inmates must share a public pay phone and are only able only place calls, leaving children dependent on their mothers to call them. And here too, money plays a large roll on how often inmates are able to communicate with their children; for many, even short phone calls are unaffordable. According to a 2007 survey of state and federal prisoners, only 42% of parents in state prisons and 55% of parents in federal prisons received visits from their children. 38% maintained at least monthly phone calls, and 52% maintained monthly contact.

Prison nurseries
A variety of programs that attempt to foster the bond between mother and child while teaching the mother the necessary skills for parenting exist. Perhaps the the oldest and most well known of these programs are prison nurseries, where babies born to pregnant inmates are housed in the prison along with their mothers until they reach a certain age - most often until they reach 12 to 18 months. Prison nurseries have existed in the United States for over one hundred years, with the oldest operating nursery founded in Bedford Hills, New York around 1900. However, during the 1940s prison nurseries began to disappear throughout the country due to costs along with the belief that infants should be placed in homes rather than spend the first year of their lives behind bars. Today, only ten states (New York, California, Illinois, Indiana, Ohio, Nebraska, South Dakota, Washington, West Virginia, and Wyoming) have prison nurseries. The debate about where infants are best suited continues to this day; the most salient argument against prison nurseries is that they lack sufficient medical care, both to mothers and babies alike. Advocates of prison nurseries cite evidence that they have the potential to not only increase a mother's bond with her child but also increase stability in both the child and the mother's lives, while reducing the mother's recidivism rate. For example, one study conducted found that mothers who cooperated with the nursery prison program had a 16.8 percent recidivism rate, whereas mothers who did not had a 50 percent recidivism rate.

However, not all offenders - or babies - are eligible to participate in these programs, and there is a series of guidelines that participants must follow. For example, only those who have committed nonviolent offenses may participate in the program, and children born prior to one's sentencing/incarceration are not eligible to participate. Women who participate in the program are not only required to take care of their own child and ensure that disruptive behavior does not occur, but are also required to enroll in parenting courses. These courses provide structure and guidance for the mothers in taking care of their children both at prison and once they are released.

At times, the amount of structure the prison provides - along with the restricted circumstances of incarceration - can create tension. According to a 2011 study, many women believed that prisons did not allow them to be autonomous decision makers. "The prison policies that restrict their decision-making include such matters as parking their baby strollers, selecting their children's food, deciding on the amount of time their baby could lie in one position, decorating the walls of their cells, deciding who could touch their children, contacting the doctor, and choosing the bed their child slept in." The women are then placed in the conflicting position of wishing to fulfill their own expectations of motherhood and the rules and regulations imposed. In addition, there are limited opportunities for mothers to respond to their children's individual needs.

Despite this, findings suggest that children who spend their first 1 - 18 months in prison nurseries have significantly better anxious/depressed scores as preschoolers than those who were separated from their mothers because of incarceration. And it appears that prison nurseries are widely successful at achieving their goal of increasing mother/child connection; according to one study in Nebraska, 95 percent of the women believed they had a better relationship with their child due to the program. Another study in 2010 found that "children residing in prison nurseries can be as securely attached to their mothers as children who reside outside the prison with their mothers."

Doula support birth program
Less well known programs, typically issued state by state, also exist with the goals of providing support to pregnant inmates. One such program is the Doula Support Birth Program, introduced Schroeder and Bell in 2005. Here, doulas aim provide physical and emotional support to women during and after pregnancy and birth. In addition to providing continuous support, doulas provide educational training and assess the women's knowledge of pregnancy and birth. The program appears to be successful; when offered a doula as a part of a 2008 study, not one inmate turned the program down.