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Conjugal Visit Laws by State 2024

California refers to these visits as contact visits. Conjugal visits have had a notorious past recently in the United States , as they were often not allowed to see their family unless it was for brief contact or to speak with them on the phone. Conjugal visits began as a way for an incarcerated partner to spend private time with their domestic partner, spouse, or life partner. Historically, these were granted as a result of mental health as well as some rights that have since been argued in court. For example, cases have gone to the Supreme Court which have been filed as visits being considered privileges instead of rights.

The right to procreate, religious freedom, marital privacy and to abstain from cruel and unusual punishment has been brought up and observed by the court. Of course, married spouses can't procreate if one is incarcerated, and this has been a topic of hot debate in the legal community for years. Although the rules have since been relaxed to allow more private time with one's family, especially to incentivize good behavior and rehabilitation, it is still a controversy within social parameters.

In 1993, only 17 states had conjugal visit programs, which went down to 6 in 2000. By 2015, almost all states had eliminated the need for these programs in favor of more progressive values. California was one of the first to create a program based around contact visits, which allows the inmate time with their family instead of "private time" with their spouses as a means of forced love or procreation.

Washington and Connecticut

Connecticut and Washington have similar programs within their prison systems, referring to conjugal visits as extended family visits. Of course, the focus has been to take the stigma away from conjugal visits as a means of procreation, a short time, and a privilege as a result of good behavior. Extended family visits are much more wholesome and inclusive, giving relatively ample time to connect with one's family, regardless if they have a partner or not. Inmates can see their children, parents, cousins, or anyone who is deemed to have been, and still is, close to the prisoner.

Of course, there are proponents of this system that say this aids rehabilitation in favor of being good role models for their children or younger siblings. Others feel if someone has committed a heinous crime, their rights should be fully stripped away to severely punish their behavior.

On a cheerier note, New York has named its program the "family reunion program", which is an apt name for the state that holds the largest city in America by volume, New York City. NYC's finest have always had their handful of many different issues, including organized crime. The authorities are seeking a larger change in the incarceration system and want to adopt a stance that focuses more on the rehabilitation of the inmate that shows signs of regret, instead of severe punishment for punishment's sake.

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Conjugal Visits

Why they’re disappearing, which states still use them, and what really happens during those overnight visits..

Although conjugal, or “extended,” visits play a huge role in prison lore, in reality, very few inmates have access to them. Twenty years ago, 17 states offered these programs. Today, just four do: California, Connecticut, New York, and Washington. No federal prison offers extended, private visitation.

Last April, New Mexico became the latest state to cancel conjugal visits for prisoners after a local television station revealed that a convicted killer, Michael Guzman, had fathered four children with several different wives while in prison. Mississippi had made a similar decision in January 2014.

A Stay at the “Boneyard”

In every state that offers extended visits, good prison behavior is a prerequisite, and inmates convicted of sex crimes or domestic violence, or who have life sentences, are typically excluded.

The visits range from one hour to three days, and happen as often as once per month. They take place in trailers, small apartments, or “family cottages” built just for this purpose, and are sometimes referred to as “ boneyards .” At the MacDougall-Walker Correctional Institution in Connecticut, units are set up to imitate homes. Each apartment has two bedrooms, a dining room, and a living room with a TV, DVD player, playing cards, a Jenga game, and dominoes. In Washington, any DVD a family watches must be G-rated. Kitchens are typically fully functional, and visitors can bring in fresh ingredients or cooked food from the outside.

In California, inmates and their visitors must line up for inspection every four hours throughout the weekend visit, even in the middle of the night. Many prisons provide condoms for free. In New Mexico, before the extended visitation program was canceled, the prisoner’s spouse could be informed if the inmate had tested positive for a sexually transmitted infection. After the visit, both inmates and visitors are searched, and inmates typically have their urine tested to check for drugs or alcohol, which are strictly prohibited.

What Everyone Gets Wrong

Conjugal visits are not just about sex. In fact, they are officially called “family visits,” and kids are allowed to stay overnight, too. In Connecticut, a spouse or partner can’t come alone: the child of the inmate must be present. In Washington, two related inmates at the same facility, such as siblings or a father and son, are allowed to arrange a joint visit with family members from the outside. Only about a third of extended visits in the state take place between spouses alone.

The Insider’s Perspective

Serena L. was an inmate at the Bedford Hills Correctional Facility in New York from 1999 to 2002. During that time, she qualified for just one overnight trailer visit. Her 15-year-old sister, who lived on Long Island, persuaded a friend to drive her to the prison. “I remember her coming through the gate, carrying two big bags of food, and she said, ‘I got your favorite: Oreos!’ ” Serena says. “It was like a little slumber party for us. When I was first incarcerated, we had tried to write to each other and talk to each other by phone, but there was lots we weren’t really emotionally able to come to terms with until we had that private space, without a CO watching, to do it.”

The (Checkered) History

Conjugal visits began around 1918 at Parchman Farm, a labor camp in Mississippi. At first, the visits were for black prisoners only, and the visitors were local prostitutes, who arrived on Sundays and were paid to service both married and single inmates. According to historian David Oshinsky, Jim Crow-era prison officials believed African-American men had stronger sex drives than whites, and would not work as hard in the cotton fields if they were not sexually sated. The program expanded in the 1940s to include white, male inmates and their wives, and in the 1970s to include female inmates.

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Reckoning with the South

This couple wants you to know that conjugal visits are only legal in 4 states

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Editor's note: This story was co-written by inside-outside couple Steve Higginbotham and Jordana Rosenfeld, weaving together Jordana's personal experience and reporting with letters from Steve. Together, they examine popular myths around conjugal visits, their decreasing availability, and the punitive logic behind the state's policing of sex and intimacy that stifles relationships like theirs.   Jordana's words appear below in the orange boxes on the right; Steve's are in the purple on the left.

The other day, when I told my grandmother I was researching the history of conjugal visits for an essay, she said, "Oh, like in my stories?" 

You can't talk about conjugal visits without talking about television, because television is pretty much the only place where conjugal visits still exist. A wide variety of TV shows either joke about or dramatize conjugal visits, from popular sitcoms that have little to nothing to do with prison life, like The Simpsons , Family Guy , and Seinfeld, to prestige dramas like Prison Break and Oz that purport to offer "gritty" and "realistic" prison tales. Conjugals loom large in public imagination about life in prison, which leaves people under the unfortunate impression that they are in any kind of way widespread or accessible.

Their availability has been in steady decline for more than 25 years. The mid-to-late 1990s are the often-cited high point of conjugal visits , with 17 states offering some kind of program. (Federal and maximum security prisons do not allow conjugals.) This means that at their most widespread, conjugal visits were only ever permitted in one-third of all states. 

There are only four U.S. states that currently allow conjugal visits, often called "extended" or "family" visits: California, Connecticut, New York, and Washington. Some people say Connecticut's program doesn't count though, when it comes to conjugals—and the Connecticut Department of Corrections agrees. Their family visit program is explicitly intended for the benefit of children and requires that the incarcerated person receiving visitors be a parent. Their child must attend . 

My boyfriend has been in prison for 28 years. He was 18 during the high point of conjugal visit programs. That's when the state of Missouri decided to lock him up for the rest of his natural life, effectively sentencing him to a lifetime of deep loneliness and sexual repression, not just because Missouri doesn't offer conjugal visits, but because when you are incarcerated, your body belongs to the state in every possible way—from your labor to your sex life. 

Every prison riot ever could have been prevented with some properly organized fucking.

That's my boyfriend, Steve.

Not being able to physically express love—or even lust—builds frustration that boils over in unintended ways. 

Intimacy is policed rigidly in prison, and it has certainly worsened over the years. For most people with incarcerated lovers, intimacy happens not on a conjugal visit, but in the visiting room. Visits now may start and end with a brief embrace and chaste kiss. Open mouth kissing has been outlawed. These rules are enforced with terminated visits and even removing a person from the visiting list for a year or more.

Steve and I have kissed a total of six times.

We have also hugged six times, if you don't count us posing with his arm over my shoulder three times for pictures. The kisses were so brief that I'm not sure I remember what they felt like. He told me later on the phone that he knew he had to be the one to pull away from the kiss before we gave the COs in the bubble reason to intervene because I wouldn't. He knew this, somehow, before he ever kissed me. He was right. 

When I last visited him in Jefferson City Correctional Center, Steve told me about a real conjugal visit from '90s Missouri.

Years ago, people used to mess around in the visiting room at Potosi [Correctional Center]. Everyone knew to keep their sensitive visitors away from a certain area, because there was frequent sex behind a vending machine. I can neither confirm nor deny that cops were paid to turn a blind eye to it. I met a guy recently in my wing at JCCC who said he had heard of me, and that maybe I knew his father. I did know his father. I didn't have the heart to tell him that I probably saw his conception behind a Coke machine back in 1995.

The increasing restriction of physical touch—the expanded video surveillance of visiting spaces, the use of solitary confinement for the smallest infractions, and the withering of both in-person and conjugal visit programs—reflects the punitive logic that consensual human touch is a privilege that incarcerated people do not deserve.

This is an evil proposition, and it's one that is at the core of the ongoing dehumanization of millions of people in U.S. prisons, and the millions of people like me who love them. 

One woman with an incarcerated partner put it to researchers this way: "The prison system appears to be set up to break families up." And she's right. For the duration of his incarceration, I will never be closer to Steve than the state of Missouri is. I'm reminded during each of our timed kisses: His primary partner is the state. 

The most difficult part for me about a romantic relationship with a free woman is that I feel selfish. A lot of self-loathing thoughts creep in. I want the best for her and often question if I am that "best." However, an added benefit is that we can truly take things slowly and explore each other in ways that two free people don't often experience nowadays. We write emails daily. And these are important. We vent. And listen. We continue to build, whereas many free people stop building at consummation. 

But these are the realities rarely captured in media portrayals of romantic relationships between free world and incarcerated partners. Conjugals on TV are so disconnected from what it's actually like to be in a romantic relationship with an incarcerated person: Trying to schedule my life around precious 15 minute phone calls, paying 25 cents to send emails monitored by correctional officers, finding ways to symbolically include Steve in my life, like leaving open the seat next to me at the movies. Instead, television shows depict implausible scenarios of nefarious rendezvous that often parrot law enforcement lies. When they do so, they undermine the public's ability to conceptualize that love and commitment fuel relationships like ours. 

Although contraband typically enters prisons through staff , not visitors , television shows often present conjugal visits as a cover for smuggling, like in the earliest TV plot I could find involving a conjugal visit, from a 1986 Miami Vice episode. After his girlfriend is killed, Tubbs gets depressed enough to agree to go undercover at a state prison to bust some guards selling cocaine. In his briefing on the issue, Tubbs asks how the drugs are getting into the prison. Conjugal visits and family visits are the first two methods named by the prison commissioner, never mind that I have yet to find any evidence that Florida ever allowed those kinds of visits. 

Often, the excuse for policing visits so strictly is that drugs can be exchanged. But I know that lie is used for every type of control in prison. For over a year we had NO CONTACT visits because of the pandemic. During that time, dozens of inmates [at my facility] still overdosed and had drug-related episodes that caused them to need medical attention. Those drugs certainly didn't arrive through visits. They strip search and X-ray me going to and from visits anyway.

Everything in prison now is on camera. When a drug overdose occurs, the investigators track back over footage from visiting room cameras. One officer told me that while they were investigating drugs allegedly passing through the visiting room, they saw a guy covertly fingering his wife. This has happened on more than one occasion, but most guards will have enough of a heart not to bother with violations for some covert touching that wasn't caught until the camera review. Most. Sometimes, a rare asshole will just have to assert his power and write a CDV (conduct violation).

Write-ups or CDVs are given by staff at their discretion. The threat of solitary confinement is always looming in prison. It's another clever way of withholding physical interactions with other human beings as a form of torture. Solitary confinement for anywhere from 10 days to three months is a favorite punishment for "[nonviolent] sexual misconduct. " 

There's also a persistent media narrative that prison systems offer conjugal visit programs out of genuine concern for human welfare. A brief glance at the origins of conjugal visits in the U.S. prison system quickly disproves that theory, showing that conjugal visit programs were conceived as a tool of exploitation and social control. 

Conjugal visits originated in Mississippi at the infamous prison plantation, Mississippi State Penitentiary, or Parchman Farm. Mississippi state officials opened Parchman in the early 1900s, writes historian David Oshinsky in his book Worse than Slavery: Parchman Farm and the Ordeal of Jim Crow Justice, in order to ensnare free Black people into forced labor. Mississippi, like other Southern states during Reconstruction, passed "Black Codes" that assigned harsh criminal penalties to minor "offenses" such as vagrancy, loitering, living with white people, and not carrying proof of employment—behaviors that were not considered criminal when done by white people. Using the crime loophole in the relatively new 13th Amendment, Mississippi charged thousands of Black people with crimes and forced them to work on the state's plantation. 

Parchman officials started offering sex to Black prisoners as a productivity incentive, "because prison officials wanted as much work as possible from their Negro convicts, whom they believed to have greater sexual needs than whites," Oshinsky writes.

"I never saw it, but I heard tell of truckloads of whores bein' sent up from Cleveland at dusk," said a Parchman prison official quoted by Oshinsky. "The cons who had a good day got to get 'em right there between the rows. In my day, we got civilized—put 'em up in little houses and told everybody that them whores was wives. That kept the Baptists off our backs." 

A certain kind of sexual morality has been instilled in the minds of many people with conservative religious upbringings. They naturally force this morality on people they consider children. That is how many guards see prisoners: as children.

Many states did not begin to join Mississippi in offering conjugal visits until much later in the century, when conservative governors like California's Ronald Reagan would determine in 1968 that allowing some married men to have sex with their wives was the best way to reduce " instances of homosexuality " in prisons. 

Abolitionists who wrote the book Queer (In)Justice , consider how concerned prison administrations have historically been and continue to be about queer sex in prisons. The book exposes both the deep fear of the liberatory potential of queer sexuality, and a broader reality that prisons are inherently queer places since prisons' "denial of sexual intimacy and agency is a quintessential queer experience." 

Beyond behavioral control, the rules that determine conjugal visit eligibility are always also about enforcing criminality, since the state decides what kind of charges render someone ineligible to wed or to have an extended visit. Even in the four states that allow these visits, most people with "violent" charges are only allowed to hold their lover's hand and briefly embrace at the beginning and end of visits.

We don't even have enough privacy to masturbate. 

I can be written up if anyone sees my dick, especially in the act of masturbation. I could face solitary confinement, loss of job, visits, religious programs, treatment classes, recreation, canteen spend, and school for getting written up. Conversely, I can be strip-searched at any given time and be forced to show everything.  

Living in this fishbowl has taught me there is no hiding. Too many bored eyes in the same small area to miss anything. Guards may come knocking on the door at any moment. My cellmate is often inches away from me, and it takes coordination to manage time away from each other because we eat, sleep, go to yard, and do just about everything on the same schedule. 

I choose to skip a meal occasionally and embrace the hunger, because it is much less painful than persistent relentless desire. After years of self-release in showers, in a room with snoring cellmates, or as quickly as possible when a brief moment of privacy occurs, my sex drive is all shook up. Current turn-ons could be said to include faucets running and/or snoring men.

Ultimately, this article is not about the right to conjugal visits. It's about the ways that punitive isolation and deprivation of loving physical contact have always been tactics of the U.S. prison system. 

Regardless of the quality of the representations, the prevalence of conjugal visits in movies and TV allows people to avoid thinking too hard about what it's like to be deprived of your sexual autonomy, maybe the rest of your life.

I have been locked up since I was 18, and I am 47 now. To be horny in prison for decades is painful. To the body and soul. 

There is justice as well as pleasure at stake here, and the difference between the two is slight. 

People who love someone in prison live shorter and harder lives. That we do it anyway shows the significance, centrality, and life-affirming nature of intimate relationships to those on both sides of the wall. Maybe it even points to the abolitionist power of romantic and sexual love between incarcerated and "free" people.

So, I guess we start with that thought and work from there to find a way to tear down the system.

As part of Scalawag's 3rd annual Abolition Week,  pop justice  is exclusively featuring perspectives from currently and formerly incarcerated folks and systems-impacted folks.

More in pop justice:.

'It's not a story—it's a life:' A look at Snapped, from the inside

Come on Barbie, give us nothing!

Barbie: Pretty Police

"Pull up your pants or go to jail!"

Related stories:, steve higginbotham & jordana rosenfeld.

Steve Higginbotham is a writer who spent many years narrating and transcribing materials into braille for the Missouri Center for Braille & Narration Production . He is serving a death by incarceration sentence in Jefferson City, Missouri. Jordana Rosenfeld is a journalist in Pittsburgh, Pennsylvania. More of her work can be found at jordanarosenfeld.com .

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• legal questions
• 11 Min Read
• 15th April 2016

Conjugal Visits: Rules and History

The phrase is well known in popular culture – conjugal visits means private alone time with a significant other while in prison. We all understand the connotation of conjugal visits, but allow me to spell it out. Yes, inmates are permitted to engage in sexual relations with their spouse during conjugal visits . However, many times these visitations are not used for intimacy at all. A lot of prisoners who earn this right choose to have family members come to see them, in an effort to remain close with those who matter most. In New York, 52 percent of these visits did not involve spouses.

Where Are Conjugal Visits Allowed?

States That Allow Conjugal Visits

As recently as 1995, 17 states had conjugal visit programs, although federal prisons never allowed it.

Today, only four states still allow conjugal visits:  California, Connecticut, New York and Washington. 

New Mexico and Mississippi cancelled their programs within the past two years.

How Did the Conjugal Visit Program Start?

Parchman Farm

The very first prison to allow conjugal visits was  Parchman Farm (now  Mississippi State Penitentiary ).  Parchman farm began as a labor prison camp for black men in Mississippi which was a blatant attempt to keep slavery alive 50 years after the end of the Civil War.

Prison authorities believed that if black men were allowed to have sexual intercourse, they would be more productive. 

They also believed that black men had stronger sex drives. Therefore, every weekend, women would be driven in by the bus load to fraternize with the prisoners. There was no state control or legal status, the visits were simply thought to encourage surviving a six day work week of harsh labor and conditions, not to mention racist guards.

Over the years, conjugal visits evolved to spending more time with family. Even the aforementioned Parchman Farm had cleaned up the act by the 1960s; visits were sanctioned, furlough programs had begun, and cabins were built so inmates could spend time alone with their significant other. The prison would even provide toys for the family.

Following their model, conjugal visit programs saw a steady and fast rise in use. It was touted as a model of rehabilitation after a reporter paid a visit to Parchman Farm and declared it, “the wave of the future.”

Conjugal Visit Rules

Good behavior is an obvious requirement for earning family and conjugal visitation rights, but there’s a bit more to it than that. For the most part, the rules surrounding family visits are the same; they must be in medium security or lower prisons, and they must not have been convicted of sexual assault . However, each state has their own protocol for selecting which inmates have earned the privilege of family visitation:

• Connecticut : Inmates cannot be level 4 or above in close custody (levels are on a scale of 1-5 and refers to how much they are monitored by guards on a day-to-day basis). They cannot be a member of a gang, be on restrictive status, or class A or class B disciplinary offenses within the past 12 months prior to requesting involvement. The spouse cannot come alone ; other eligible family members must participate.
• New York : This state and California are the only ones that allow visitation for same-sex couples. Proof of marriage must also exist. Here are the guidelines for New York’s Extended Family Visit Program .
• California : Inmates and visiting family members are subject to a search every four hours . See: California Extended Family Visit guidelines. 
• Washington : There are a long list of requirements that inmates and visitors alike must meet before being allowed to participate in the visitation program. There are a slew of disallowed crimes, along with minimum time served, active participation in a reentry program, and housing status rules to qualify. If there are two family members in the same prison, joint visits can be arranged pending approval.

The length of the visit varies from six hours to an entire weekend, which is determined by the supervisor of the prison on a case by case basis. And just as there are eligibility requirements for prisoners, the same can be said for those who wish to visit them. Apart from the verification of the relationship, visitors must also be free of crime.

• If a family member other than a spouse, such as brother or sister, wishes to visit, it will be scrutinized closely.
• If a child is participating, a birth certificate showing that the inmate is their biological father is required.
• If the inmate is a step-father, he must have been present during the child’s formative years (ages 7-12). There must also be consent from the child’s legal guardian.
• The visitor cannot be on parole, or subject to criminal drug charges.

On top of these requirements is a good deal of paperwork which needs to be filled out. With all of the supervision and background checks, it would be extremely difficult for anything sinister to happen. To inmates and their family, visitation is purely about spending time with the one’s they love. So why are so many states stopping it?

Why Have Visitation Programs Been Discontinued?

As previously stated, there were 17 states with visitation programs 20 short years ago; today there are only four. The reasons for this have varied slightly, one of which being public opinion. People just don’t think criminals should have access to anything, much less time with family members. Some even get upset when they learn inmates have access to health care . Most of these people probably fail to realize that those convicted of violent crimes are not allowed to participate in family visitation programs.

Another reason is claims of contraband being snuck in and babies being conceived during these visits. But no numbers are given to back up these claims, and they appear unfounded at best as a result. The Corrections Commissioner for Mississippi even stated that they provide inmates with contraception during their visits. While there are no numbers to back up these claims, they try to use others to convince everyone that it’s too expensive.

The main reason widely given is budget cuts. That was the fallback for Mississippi and New Mexico when they cancelled their programs. In New Mexico, the program cost $120,000 a year . Their 2016 budget totals $6.2 billion . The cost of keeping the program active amounts to less than one-five hundredth of one percent of the state budget. The median household income in New Mexico is $43,782, which means that, divided evenly amongst the average taxpayer, everyone would only contribute about two cents each to a family visitation program. Yet somehow, the benefits don’t outweigh the cost.

Why Should Visitation Programs Continue?

At a rate of approximately $32,000 per year for each inmate, it’s been well documented how much it costs to keep someone in prison. Overcrowding is also a huge problem, which has many causes. But where family visitation comes into the picture is its documented ability to reduce recidivism, which show that 76 percent of those released from state prisons are arrested again within five years. Initial studies have found that visitation programs are responsible for lowering parole violations by 25 percent , but it could be higher than that according to an older study, which suggests recidivism was decreased by 67 percent because of visitation programs.

Conjugal and family visits also reduce occurrences of sexual violence in prisons by 75 percent .

This is a number too large to ignore, because the snowball effect here is that it also drastically lowers the rate of sexually transmitted diseases between prisoners. Then there is evidence that is hard to quantify. Prison guards have stated that prisoners who have access to visitation are generally happier, and are encouraged to keep up their good behavior in order to keep earning visitation privileges, or perhaps even early release. This is why prisons in the four states that still allow it have changed the name from “conjugal visits” to “family visits.” There is more to it than just intimacy; there is connection that these families are trying to maintain. If the prisoner is able to interact with the person or people for whom he will be responsible upon release, it will only motivate them to work harder to never put them through it again.

Lifers in state of California eligible for conjugal visits as well? due gov. Jerry brown recent signed off?

To Phavy do we know what disqualifies a lifer from getting conjugal visits besides being a sex offender and/or domestic violence. I have my husband in a state prison in CA and he has been in prison for 20 years but we needed to find out what qualifies him or disqualifies him from getting visits. Please advise, thank you in advance

The program is allowed for those who have a release date. Unfortunately it is not available for inmates serving life sentences.

If the offender has two non-sexual violent felony strikes in Ca but he has a release date and the visitor was a co defendant on an old case, can the offender get conjugal visits with the visitor if they get married?

Very great article! As much as I advocate conjugal visitation, early justifications are shocking to me. I still hope that in future, the trend will go back to the use of extended visits in more than just 4 states. It also does not appear too expensive, particular since some prisons even charge visitors a fee per night.

Do lifers get conjugal visits if they are in prison for non violence on woman???

It would depend on where they are sentenced and what exactly the offense is, along with how they have conducted themselves while in prison.

I pray they go back to the old way,, but with different intentions I have a question my husband was convicted of corporal punishment on a spouse does he qualify for conjugal visit yes he has a release date

Is there any way a state like FL could reconsider “family visits” I mean my boys miss their father and he was only sentenced 10 years. I was thinking of a petition but I doubt people will view it how you and I do. Just being able to watch a movie together and hang out like we use to would mean so much I can wait for sex but the joy it brings to my boys is much more fulfilling. I mean it’s so backed up in FL they could be making more money if they charged family visits.

Marilyn Wiggins

Amber I will sign a petition if it’s started. The sanctity of family is important.

karen lea pollard-mills

I WOULD SIGN A PETITION ALSO! LETS START ONE NATIONWIDE! NOT JUST FOR EACH STATE!

I believe this would be great. Even if there was a price tag many people would pay it. That would help lower the cost of prisons.

Does anyone know what prisons in New York allow conjugal visits?

In the post, there is a link to the guidelines for New York’s Extended family visit program. Click it to see all the guidelines and how to apply for them. Good luck.

Leslie L Miller

My husband is serving life without! He was convicted at 19, you know they are taking every form of human contact away from human beings and expecting them to just lay down be good and wither away slowly! Why? My husband is now 37, he is not the same person he was , we have been married 12 years together 15, never consummated our marriage! To some of us it’s a religious right if only one time! Changes need to be made in our system! It’s broken if we don’t rethink alot of things all we are going to create is detached MONSTERS, with no concept of real feelings or emotions!

I couldn’t agree more! The love of my life is serving life w/o parole and was 19 also. He’s served 15 years now and has changed, grown up and matured. Have you read about the science that states teens are not fully matured until their mid 20’s and should not be given life w/o parole at such a young age? 11 men were released on this science and more states need to follow suit and parole those who have changed and matured and will not repeat their mistakes! They deserve a 2nd chance. There is a video on this called second chance kids also! Good Luck with your husband!

Jacquelyne Garza

What year where the conjugal visits taken away in California, I think it was 1994 or 1995 or 1996 which one was it ??? Please tell me.

The article plainly states that CA is one of the remaining states allowing such visitation. I’ve also seen them taking place on MSNBC’s Lock Up.

Will inmates who have prior rules violations for drug smuggling into the prison be permitted conjugal visits?

does anyone know the list of things you can take into your conjugal visit?

Go to the prison website

So inmates who have life without the possibility of parole can’t have conjugal visits at all? My guy has been transferred to a level 3 prison now. Does that mean anything?

lizy vicent

I believe anybody that owns 100% of your heart is worth fighting for. Yes, I am boasting because I never adhered to some negative advice from my parents when I was about getting married. There was a war between our two family then my husband was his mothers puppy, his family members used him a lot that he cant make any decision without consulting them. What surprised me most was the moment a 36-year-old man seeks his parent and some family members consent before dating anyone, the worst happened when he was instructed to bring me along to their country home in Rampart, New Orleans, it was risky to accept such invitation.The war between our families started when he finally proposed (that was about 4 years ago), his family gave some conditions if he must wife me (we have to live with them), I was in shock when my husband accepted and was happy with their conditions (so crazy). My family wagged and demanded I should breakup with him immediately.I decided to give him the last shot as a man whom has already taken over 100% of my heart, I took a risk to go spiritual with them by consulting Priest Udene via [email protected] , I dont know how but the spiritual father already knew I was going to consult him. He first of all told me the danger I was into and how my husband has been enslaved since birth, how they keep brain washing him to do their wills.Like the quote that says a person sees clearly only with the heart, I realized that nobody saw what I saw in my husband and thats why I used the help of PRIEST UDENE to put him out of his misery. His eyes where opened by PRIEST UDENE for the first time, his family fell in love with me and granted every of our request, our families have known peace since after the love spell.It is over 2 years after the love spell and my husband has continued to improve every day without interference from his family. I have waited too long to share this amazing piece. Thanks for your time and also to PRIEST UDENE. I knew him through reading some amazing testimonies on blogs.

Tracey Duffy

Are the visits during the weekend or weekdays, usually?

Patricia Monteiro

Me and my fuance plan to marry soon. He is serving a 15 to life sentence and has been in nearly 4 years now. He does not have a release date. He is single celled in a level 4 prison. He has a history of violence. Will he be eligible for conjucal visits upon marriage ?

does patton state hospital allow family visits?

mariah clifton

hi…me and boyfriend are trying to get married in the california state prison but he has a prior domestic abuse charge on him from years ago with his babymomma does that stop us from conjugal visits once we are married?

jackie larbi

Thank god that we do not allow this to happen in are prisons.

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Controversy and Conjugal Visits

Conjugal visits were first allowed as incentives for the forced labor of incarcerated Black men, the practice expanding from there. Is human touch a right?

“The words ‘conjugal visit’ seem to have a dirty ring to them for a lot of people,” a man named John Stefanisko wrote for The Bridge, a quarterly at the Connecticut Correctional Institution at Somers, in December 1963 . This observation marked the beginning of a long campaign—far longer, perhaps, than the men at Somers could have anticipated—for conjugal visits in the state of Connecticut, a policy that would grant many incarcerated men the privilege of having sex with their wives. Conjugal visits, the editors of The Bridge wrote, are “a controversial issue, now quite in the spotlight,” thanks to their implementation at Parchman Farm in Mississippi in 1965. But the urgency of the mens’ plea, as chronicled in The Bridge and the Somers Weekly Scene , gives voice to the depth of their deprivation. “Perhaps we’re whistling in the wind,” they wrote, “but if the truth hits home to only a few, we’ll be satisfied.”

The men at Somers wrote of conjugal visits as something new, but in fact, Parchman had adopted some version of the practice as early as 1918. Parchman, then a lucrative penal plantation , sought to incentivize Black prisoners, who picked and hoed cotton under the surveillance of armed white guards, by allowing them to bring women into their camp. The visits were unofficial, and stories from the decades that followed are varied, ranging from trysts between married couples to tales of sex workers, bussed in on weekends. The men built structures for these visits out of scrap lumber painted red, and the term “ red houses ” remained in use long after the original structures were gone. The policy was mostly limited to Black prisoners because white administrators believed that Black men had stronger sexual urges then white men, and could be made more pliable when those urges were satisfied.

This history set a precedent for conjugal visits as a policy of social control, shaped by prevailing ideas about race, sexual orientation, and gender. Prisoners embraced conjugal visits, and sometimes, the political reasonings behind them, but the writings of the men at Somers suggest a greater longing. Their desire for intimacy, privacy and, most basic of all, touch, reveals the profound lack of human contact in prison, including but also greater than sex itself.

Scholar Elizabeth Harvey paraphrases Aristotle, who described the flesh as the “medium of the tangible,” establishing one’s “sentient border with the world.” Touch is unique among the senses in that it is “dispersed throughout the body” and allows us to experience many sensations at once. Through touch we understand that we are alive. To touch an object is to know that we are separate from that object, but in touching another person, we are able to “form and express bonds” with one another. In this context, Harvey cites the French philosopher Maurice Merleau-Ponty, who described all touch as an exchange. “To touch is also always to be touched,” she writes.

When Parchman officially sanctioned conjugal visits in 1965 after the policy was unofficially in place for years, administrators saw it as an incentive for obedience, but also a solution to what was sometimes called the “ Sex Problem ,” a euphemism for prison rape . Criminologists of the era viewed rape in prison as a symptom of the larger “ problem of homosexuality ,” arguing that the physical deprivations of prison turned men into sexual deviants—i.e., men who wanted to have sex with other men. In this context, conjugal visits were meant to remind men of their natural roles, not merely as practitioners of “ normal sexuality ,” but as husbands. (Framing prison rape as a problem of ‘homosexuals’ was commonplace until Wilbert Rideau’s Angolite exposé Prison: The Sexual Jungle revealed the predation for what it was in 1979.)

Officials at Parchman, the sociologist Columbus B. Hopper wrote in 1962 , “consistently praise the conjugal visit as a highly important factor in reducing homosexuality, boosting inmate morale, and… comprising an important factor in preserving marriages.” Thus making the visits, by definition, conjugal, a word so widely associated with sex and prison that one can forget it simply refers to marriage. Men—and at the time, conjugal visits were only available to men—had to be legally married to be eligible for the program.

But for the men at Somers, the best argument for conjugal visitation was obvious—with one telling detail. The privacy afforded by the red houses at Parchman, Richard Brisson wrote “preserve some dignity to the affair,” creating “a feeling of being a part of a regular community rather than … participating in something that could be made to appear unclean.” For lovers secluded in bedrooms, “[t]here is no one about to mock them or to embarrass them,” he wrote. This observation suggests the ubiquity of surveillance in prison, as well as its character.

Carceral institutions are intended to operate at a bureaucratic remove; prisoners are referred to by number and were counted as “ bodies .” Guards must act as ambivalent custodians of these bodies, even when the nature of their job can be quite intimate. Prisoners are routinely strip-searched and frisked; they must ask permission to exercise any movement, to perform any bodily function. This is as true today as it was in Somers, where men frequently complained that they were treated like children. “You are constantly supervised, just as if you were a one-year-old child,” Ray Bosworth wrote in 1970 .

But guards are not parents, and the tension between dutiful ambivalence and intimate supervision often manifests as disgust. On a recent visit to Bedford Hills Correctional Facility, a maximum-security women’s prison in upstate New York, prisoners complained of being ridiculed during strip searches, and hearing guards discussing their bodies in the corridors.

This attitude extends to rules regulating touch between prisoners and visitors. Writing about San Quentin State Prison in California in the early 2000s, the ethnographer Megan L. Comfort described a common hierarchy of visits , each with its own allowable “degree of bodily contact.” Death Row cage visits allowed for hugs in greeting and parting, while a contact visit allowed for a hug and a kiss. The nature of the kiss, however, was subject to the discretion of individual guards. “We are allowed to kiss members of our families, hello and goodbye, but the amount of affection we may show is limited by the guard,” James Abney wrote for the Somers Weekly Scene in 1971.  “If he feels, for instance that a man is kissing his wife too much or too passionately, then he may be reprimanded for it or the visit may be ended on the spot.”

When Somers held its first “ Operation Dialogue ,” a “mediated discussion” among prisoners and staff in May 1971, conjugal visits were a primary concern. By then, California (under Governor Ronald Reagan) had embraced the policy—why hadn’t Connecticut? Administrators argued that furloughs, the practice of allowing prisoners to go home for up to several days, were a preferable alternative. This certainly would seem to be the case. In August 1971, the Scene quoted Connecticut Correction Commissioner John R. Manson, who criticized the skeezy, “tar-paper shacks” at Parchman, concluding that furloughs were “ a less artificial way for inmates to maintain ties with their families .” But to be eligible for furloughs, men were required to be within three or four months of completing their sentence. In the wake of George H.W. Bush’s infamous “ Willie Horton ” campaign ad in 1988, a racially-charged ad meant to stoke fear and anti-Black prejudice in which a violent attack was blamed on Liberal soft-on-crime policies (specifically scapegoating Michael Dukakis for a crime committed on a prison furlough that predated his tenure as governor), prison furloughs were mostly abolished. They remain rare today, still looming in the shadow of the Horton ad.

Conjugal visits are considered a rehabilitative program because, as Abney wrote, it is in “society’s best interest to make sure that [a prisoner’s] family remains intact for him to return to.” Unspoken is the disregard for people serving long sentences, or life, making conjugal visits unavailable to those who might need them the most.

The campaign for conjugal visits continued throughout the 1970s. Then, in 1980, in a sudden and “major policy reversal ,” the state of Connecticut announced that it would instate a “conjugal and family visit” program at several prisons, including Somers. Subsequent issues of the Scene outline the myriad rules for application, noting that applicants could be denied for a variety of reasons at the discretion of prison administrators.

The earliest conjugal visits at Somers lasted overnight but were less than 24 hours in total. Men could have multiple visitors, as long as they were members of his immediate family. This change signaled a new emphasis on domesticity over sex. Visits took place in trailers equipped with kitchens, where families cooked their own meals. Describing a similar set-up at San Quentin more than two decades later, Comfort wrote that the trailers were meant to encourage “people to simulate an ordinary living situation rather than fixate on a hurried physical congress.”

By the early 1990s, conjugal visitation, in some form, was official policy in 17 states. But a massive ideological shift in the way society viewed incarcerated people was already underway. In a seminal 1974 study called “What Works?”, sociologist Robert Martinson concluded that rehabilitation programs in prison “ had no appreciable effect on recidivism .” Thinkers on the left saw this as an argument for decarceration—perhaps these programs were ineffective because of the nature of prison itself. Thinkers on the right, and society more broadly, took a different view. As (ironically) the Washington Post observed, the findings were presented in “lengthy stories appearing in major newspapers, news magazines and journals, often under the headline, ‘ Nothing Works! ’”

Martinson’s work gave an air of scientific legitimacy to the growing “tough-on-crime” movement, but the former Freedom Rider, who once spent 40 days at Parchman, spawned punitive policies he couldn’t have predicted. In 1979, Martinson officially recanted his position. He died by suicide the following year.

In Mistretta v. United States (1989), the court ruled that a person’s demonstrated capacity for rehabilitation should not be a factor in federal sentencing guidelines because, they wrote, studies had proved that rehabilitation was “an unattainable goal for most cases.” It effectively enshrined “nothing works” into law.

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“Nothing works” gave rise to harsher sentencing, and more punitive policies in prisons themselves. In 1996, the state of California drastically reduced its conjugal visitation program . At San Quentin, this meant conjugal visits would no longer be available for people serving life sentences. To have benefitted from the program, and then have it taken away, was a particular blow to prisoners and partners alike. One woman told Comfort that she was in “mourning,” saying: “To me, I felt that it was like a death. ”

We don’t know how the men at Somers might have felt about this new era, or the heyday of conjugal visits that came before it. There are no issues of the Weekly Scene available after 1981 in the American Prison Newspapers collection, which is just after the visits began. But their writing, particularly their poetry, offers some insight into the deprivation that spurred their request. In 1968, James N. Teel writes, “Tell me please, do you ever cry, / have you ever tried to live while your insides die? ” While Frank Guiso , in 1970, said his existence was only an “illusion.” “I love and I don’t, / I hate and I don’t / I sing and I don’t / I live and I don’t,” he writes. But for others, disillusionment and loneliness take a specific shape.

“I wish you could always be close to me,” Luis A. Perez wrote in a poem called “ The Wait ” 1974:

I will hold your strong hand in my hand, As I stare in your eyes across the table. Trying to think of the best things to say, I then notice how I will not be able. I will long for your tender embraces, For your long and most desirable kiss. As I sleep cold for warmth of your body, You my love, are the one I will miss…

Today, only four states—California, Connecticut, Washington and New York—allow conjugal visits. (Mississippi, where Parchman is located, ended conjugal visitation in 2014 .) Some argue that Connecticut’s Extended Family Visit (EFV) program, as it is now called, doesn’t actually count , because it requires a prisoner’s child to be there along with another adult . There is also some suggestion that Connecticut’s program, while still officially on the books, has not been operational for some time.

The COVID-19 pandemic gave further cause to limit contact between prisoners and visitors, engendering changes that don’t appear to be going away anytime soon.

Somers was reorganized as a medium-security facility and renamed the Osborn Correctional Institution in 1994. A recent notice on the facility’s visitation website reads: “​​Masks must be worn at all times. A brief embrace will be permitted at the end of the visit .”

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Conjugal Visits: Costly And Perpetuate Single Parenting?

Mississippi was the first state in the country to offer prisoners conjugal visits. Now the state is set to end the program, citing high costs as the main reason. Host Michel Martin speaks with Heather Thompson of Temple University about the history of conjugal visits and why prisoners' families are upset about the change.

MICHEL MARTIN, HOST:

This is TELL ME MORE from NPR News. I'm Michel Martin. Now we go to Mississippi where a change in prison conditions is set to take place next week. We're talking about conjugal visits, also known as extended family visits. Mississippi is one of only six states where these visits are still permitted for lower-level offenders. But now officials there say that the privilege is too expensive to maintain and they will end them. But this made us curious about the history of conjugal visits. So we called on Heather Thompson. She's an associate professor of History at Temple University and she's with us now. Welcome, Professor Thompson. Thanks so much for speaking with us.

HEATHER THOMPSON: Thanks for having me.

MARTIN: You were telling us that conjugal visits in the U.S. actually started in Mississippi in around 1918. What was the purpose of them?

THOMPSON: Well, it's an interesting history. After the Civil War when - many laws changed so that there was a much higher incarceration rate of African-Americans, primarily to staff and to labor the former plantations, there was a major increase of black labor in Mississippi penitentiaries, such as Parchman Farm. And unfortunately, the origins of this are quite insidious, which is that there was a belief at the time that - on part of white Mississippians - that African-Americans had stronger sexual desires than whites and that having sex provided for them would make them work harder as an incentive.

MARTIN: Wait. Was this explicit? I mean, were they - did they say, if you meet such and such a quota, then you get a conjugal visit?

THOMPSON: Well, certainly holding out the carrot of having sex was quite explicit. The historian that really writes the most about this, David Oshinsky, makes clear, though, that it was quite explicit also that this is what whites thought and that their bottom line desire was to get as much productivity as they could. And so they did so by carrots and sticks, and of course the sticks were much more frequent and much more brutal.

MARTIN: So has the attitude about it changed? Is it now believed to be, what - a way to keep family bonds intact?

THOMPSON: Well, eventually even Mississippi, I mean, Mississippi in the '30s extends this to white prisoners, and in 1972 extends it to women. And eventually, the various states that have it - the idea is to really keep families together. And it's really unfortunate that this focus has been on the sex and the conjugal part of this program because the idea is that this is about both the good of families on the outside as well as people on the inside.

MARTIN: But how does it actually work? I mean, is it that these are, what - trailers or there are facilities or buildings set aside on the prison grounds where families...

THOMPSON: Right, so...

MARTIN: ...Can, what? Stay for the weekend? How does it work?

THOMPSON: Each state has a slightly different arrangement, but basically these could be trailers or they could be small apartments. But, again, we need to understand that this is something that's given to people who are in medium to minimum-security facilities, with the idea being that it's very important for people to see their families because there's just so much evidence that shows that this is good for society in general.

MARTIN: Well, is there any data to show that it, in fact, has this benefit?

THOMPSON: Yes, indeed. I mean, there's been several studies - American Journal of Criminal Justice has a pretty important study in 2012. Yale Law School had a pretty important study in 2012, which makes it clear that these are both incentives for good behavior, but also that it's really good for reducing violence in the prison and so forth. But there's also just ancillary studies that show that people who connected with their family tend to do much better, tend to recidivate less, that is to go back to prison again, less frequently. And there's no question that the data for children shows that these are people who would keep these relationships with their children and their spouses that would benefit them on the other side, benefit everyone.

MARTIN: Well, you know, to that end, the Mississippi Department of Corrections Commissioner, Christopher B. Epps, said in a release that he is terminating these visits because of budgetary constraints. But he also said in a release that the decision was about decreasing the possibility that more children would be conceived who would then have to be raised by single parents. He says, quote, even though we provide contraception, we have no idea how many women are getting pregnant only for the child to be raised by one parent. And the implication here is that it's not...

THOMPSON: Right.

MARTIN: ...In the best interest for society to kind of create the conditions which would allow more children to be raised in single-parent households, at least for the duration of the incarceration. Do you think that - what is your assessment of that point of view?

THOMPSON: No, I think - I just think it's, you know, it is in some respects a ridiculous argument for a number of reasons. First of all, with regard to the cost, when Mississippi was pressed, there was really very little data on this. They couldn't really even explain how much it cost. You're talking about a program that is already so restrictive that last year it's my understanding that only a 155 people out of almost 23,000 people in the system even had access to this program. So there's very little evidence that this is immediately too costly. So that's number one. But the other issue has to do with this question of single parenting and children born out of wedlock. The data I've seen, first of all, shows that the pregnancy rate is not exorbitantly high and certainly not higher than in society in general. And the other thing I want to say about this - remember, you know, my point about - these are families who will be reunited. These are families who will be together. And so to make this argument that children that happened to be born out of these visits should not have been born is sort of ridiculous.

Think about the corollary. If we were to say that, for example, people that went to the military who had to go away for four years to Iraq should never have had children or shouldn't have children if they come home on leave - we would never say that. So what we're really saying is that we don't believe that prisoners, people who have offended, quote-unquote, should have the right to have children or have the right to parent their children.

MARTIN: I think that many people would disagree with your analogy, which leads me to my final question, which is that many people would say that that, you know, it's unfortunate for the families, but that is one of the - that's the price you pay for committing a crime. That you have...

THOMPSON: Exactly.

MARTIN: ...Privileges taken away from you. And one of the privileges, one of the most important privileges you have taken away from you is the ability to be fully present for your family. And...

MARTIN: ...That anything you do to make prison more comfortable, let me say, let me just put it that way - I know you would disagree with that, but just for the sake of argument, is not to be encouraged. And so...

MARTIN: ...I think their argument is that it is not analogous to the military in which people are in fact serving the country as opposed to having committed penalties or having transgressed the boundaries or the laws of the country. And those are completely different.

THOMPSON: Absolutely. That's exactly - that is exactly the argument that they would make. My counter to that would be not - I'm not equating even, I'm not necessarily equating people who are in prison with people in the military. That was not actually the point. The point is it has to do with the children on the outside. Children, for example, do better when they are connected with their parents, particularly assuming that these parents are not violent people.

Then we know that this would be, from a broader point of view, would be good for children. But it's also good in general because what we know from the data is that this benefits the society because people who are bound to community tend to do better when they come back to the community.

MARTIN: Are there other countries around the world where this practice is still in use?

THOMPSON: The closest example to us of course is Canada. And in Canada, inmates are allowed conjugal visits, not just with spouses and partners and their children, which is what we were talking about, but also their parents. Particularly this is important for young people in prison, even in-laws. And outside of this country it's my understanding that quite a few countries have this. I think Trinidad, there's some programs like this in Turkey, Costa Rica, my understanding Israel, Mexico and several Latin American countries.

So it - again, we have moved towards a much more punitive moment in our history. You know, it's not 'til 1974 actually, in a district court ruling out of the Ohio, that it's decided that inmates don't have a constitutional right to this.

MARTIN: You're saying that we're in a much more punitive moment when it comes to criminal justice. But we're also in a moment where political players on both the right and the left have been willing to revisit some of these issues in part because of the expense of high levels of incarceration. From your discussions of these issues, I mean, this is a research area of interest of yours, is there any move afoot to rethink this in other places?

THOMPSON: Absolutely. And what's actually quite interesting about this is that Mississippi I think is kind of an outlier in the way that they're thinking about this. To the right and to the left people are thinking that the system is broken, which it is, and that we need to de-incarcerate more, we need to think about criminal justice in a smarter way. And in fact, many programs are pushing back the other way which is to say we need stronger re-entry programs.

We need stronger programs for children of the incarcerated. We need stronger programs so that people do not come back to prison. Mississippi's decision to save money on a program that they can't even document was too expensive is actually an outlier I would say, in the direction we need to go.

MARTIN: Heather Thompson is an associate professor of History. She's also in the Department of African-American studies at Temple University. And she was kind enough to join us on the line from Philadelphia. Professor Thompson, thanks so much for speaking with us.

THOMPSON: Thanks so much.

Copyright © 2014 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

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How Do Conjugal Visits Work?

Maintaining close ties with loved ones while doing time can increase the chances of a successful reentry program. Although several studies back this conclusion, it’s widely logical.

While the conjugal visits concept sounds commendable, there’s an increasing call to scrap the scheme, particularly across US states. This campaign has frustrated many states out of the program, leaving only a handful. Back in 1993, 17 US states recognized conjugal visits. Today, in 2020, only four do.

The conjugal visit was first practiced in Mississippi. The state, then, brought in prostitutes for inmates. The program continued until 2014. The scrap provoked massive protests from different right groups and prisoners’ families. The protesters sought a continuance of the program, which they said had so far helped sustain family bonds and inmate’s general attitude to life-after-jail.

New Mexico, the last to scrap the concept, did so after a convicted murderer impregnated four different women in prison. If these visits look as cool as many theories postulate, why the anti-conjugal-visit campaigns in countries like the US?

This article provides an in-depth guide on how conjugal visits work, states that allow conjugal visits, its historical background, arguments for and against the scheme, and what a conjugal visit entails in reality.

What Is a Conjugal Visit?

A conjugal visit is a popular practice that allows inmates to spend time alone with their loved one(s), particularly a significant other, while incarcerated. By implication, and candidly, conjugal visits afford prisoners an opportunity to, among other things, engage their significant other sexually.

However, in actual content, such visits go beyond just sex. Most eligible prisoners do not even consider intimacy during such visits. In many cases, it’s all about ‘hosting’ family members and sustaining family bonds while they serve time. In fact, in some jurisdictions, New York, for example, spouses are not involved in more than half of such visits. But how did it all start?

History of Conjugal Visits

Conjugal visits origin dates back to the early 20 th century, in the then Parchman Farm – presently, Mississippi State Penitentiary. Back then, ‘qualified’ male prisoners were allowed to enjoy intimacy with prostitutes, primarily as a reward for hard work.

While underperforming prisoners were beaten, the well-behaved were rewarded in different forms, including a sex worker’s company. On their off-days, Sunday, a vehicle-load of women were brought into the facility and offered to the best behaved. The policy was soon reviewed, substituting prostitutes for inmates’ wives or girlfriends, as they wished.

The handwork-for-sex concept recorded tremendous success, and over time, about a quarter of the entire US states had introduced the practice. In no time, many other countries copied the initiative for their prisons.

Although the United States is gradually phasing out conjugal visits, the practice still holds in many countries. In Canada, for instance, “extended family visits” – a newly branded phrase for conjugal visits – permits prisoners up to 72 hours alone with their loved ones, once in few months. Close family ties and, in a few cases, friends are allowed to time alone with a prisoner. Items, like foods, used during the visit are provided by the visitors or the host – the inmate.

Over to Asia, Saudi Arabia is, arguably, one of the most generous countries when it comes to conjugal visits. Over there, inmates are allowed intimacy once monthly. Convicts with multiple wives get access to all their wives – one wife, monthly. Even more, the government foots traveling experiences for the visitors.

Conjugal visits do not exist in Great Britain. However, in some instances, prisoners incarcerated for a long period may qualify to embark on a ‘family leave’ for a short duration. This is applicable mainly for inmates whose records suggest a low risk of committing crimes outside the facility.

This practice is designed to reconnect the inmates to the real world outside the prison walls before their release . Inmates leverage on this privilege not just to reconnect with friends and family, but to also search for jobs , accommodation, and more, setting the pace for their reintegration.

Back to US history, the family visit initiative soon began to decline from around the ’80s. Now, conjugal visits only exist in California, New York, Connecticut, and Washington.

Is the Increasing Cancellation Justifiable?

The conjugal visit initiative cancellation, despite promising results, was reportedly tied around public opinion. Around the ’90s, increasing pressure mounted against the practice.

One of the arguments was that convicts are sent to jail as a punishment, not for pleasure. They fail to understand that certain convictions – such as convictions for violent crimes – do not qualify for conjugal visit programs.

The anti-conjugal visit campaigners claim the practice encouraged an increase in babies fathered by inmates. There are, however, no data to substantiate such claims. Besides, inmates are usually given free contraceptives during the family visits.

Another widely touted justification, which seems the strongest, is the high running cost. Until New Mexico recently scraped the conjugal visit scheme, they had spent an average of approximately $120,000 annually. While this may sound like a lot, what then can we say of the approximately $35,540 spent annually on each inmate in federal facilities?

If the total cost of running the state’s conjugal visit program was but equivalent to the cost of keeping three inmates behind bars, then, perhaps, the scrap had some political undertones, not entirely running cost, as purported.

Besides, an old study on the population of New York’s inmates postulates that prisoners who kept ties with loved ones were about 70 percent less likely – compared to their counterparts who had no such privilege – to become repeat offenders within three years after release.

Conjugal Visit State-by-State Rules

The activities surrounding conjugal visits are widely similar across jurisdictions. That said, the different states have individual requirements for family visitation:

California: If you’re visiting a loved one in a correctional facility in California, among other rules , be ready for a once-in-four-hours search.

Connecticut : To qualify, prisoners must not be below level 4 in close custody. Close custody levels – usually on a 1-to-5 scale – measures the extent to which correctional officers monitor inmates’ day-to-day activities.

Also, inmates should not be on restriction, must not be a gang member, and must have no records of disciplinary offenses in Classes A or B in the past year. Besides, spouse-only visits are prohibited; an eligible member of the family must be involved.

New York : Unlike Connecticut and Washington, New York’s conjugal visit rules –  as with California’s – allow same-sex partners, however, not without marriage proof.

Washington : Washington is comparatively strict about her conjugal visit requirements . It enlists several crimes as basis for disqualifying inmates from enjoying such privileges. Besides, inmates must proof active involvement in a reintegration/rehabilitation scheme and must have served a minimum time, among others, to qualify. 

However, the rule allows joint visits, where two relatives are in the same facility. Visit duration varies widely – between six hours to three days. The prison supervisor calls the shots on a case-to-case basis.

As with inmates, their visitors also have their share of eligibility requirements to satisfy for an extended family visit. For instance, visitors with pending criminal records may not qualify.

As complicated as the requirements seem, it can even get a bit more complex. For instance, there is usually a great deal of paperwork, background checks, and close supervision. Understandably, these are but to guide against anything implicating. Touchingly, the prisoners’ quests are simple. They only want to reconnect with those who give them happiness, love, and, importantly, hope for a good life outside the bars.

Conjugal Visits: A Typical Experience

Perhaps you’ve watched pretty similar practices in movies. But it’s entirely a different ball game in the real world. Besides that movies make the romantic visits seem like a trend presently, those in-prison sex scenes are not exactly what it is in reality.

How, then, does it work there? As mentioned, jurisdictions that still allow “extended family visits” may not grant the same to the following:

• Persons with questionable “prison behavior”
• Sex crime-related convicts
• Domestic violence convicts
• Convicts with a life sentence

Depending on the state, the visit duration lasts from one hour to up to 72 hours. Such visits can happen as frequently as once monthly, once a couple of months, or once in a year. The ‘meetings’ happen in small apartments, trailers, and related facilities designed specifically for the program.

In Connecticut, for example, the MacDougall-Walker correctional facility features structures designed to mimic typical home designs. For instance, the apartments each feature a living room with games, television, and DVD player. Over at Washington, only G-rated videos, that’s one considered suitable for general viewers, are allowed for family view in the conjugal facilities.

The kitchens are usually in good shape, and they permit both fresh and pre-cooked items. During an extended family visit in California, prisoners and their visitors are inspected at four-hour intervals, both night and day, till the visit ends.

Before the program was scrapped in New Mexico, correctional institutions filed-in inmates, and their visitors went through a thorough search. Following a stripped search, inmates were compelled to take a urine drug/alcohol test.

Better Understanding Conjugal Visits

Conjugal visits are designed to keep family ties.

New York’s term for the scheme – Family Reunion Program (FRP) – seems to explain its purpose better. For emphasis, the “R” means reunion, not reproduction, as the movies make it seem.

While sexual activities may be partly allowed, it’s primarily meant to bring a semblance of a typical family setting to inmates. Besides reunion, such schemes are designed to act as incentives to encourage inmates to be on their best behavior and comply with prison regulations.

Don’t Expect So Much Comf ort

As mentioned, an extended family visit happens in specially constructed cabins, trailers, or apartments. Too often, these spaces are half-occupied with supplies like soap, linens, condoms, etc. Such accommodations usually feature two bedrooms and a living room with basic games. While these provisions try to mimic a typical home, you shouldn’t expect so much comfort, and of course, remember your cell room is just across your entrance door.

Inmates Are Strip-Searched

Typically, prisoners are stripped in and out and often tested for drugs . In New York, for example, inmates who come out dirty on alcohol and drug tests get banned from the conjugal visit scheme for a year. While visitors are not stripped, they go through a metal detector.

Inmates Do Not Have All-time Privacy

The prison personnel carries out routine checks, during which everyone in the room comes out for count and search. Again, the officer may obstruct the visit when they need to administer medications as necessary.

Conjugal Visits FAQ

Are conjugal visits allowed in the federal prison system?

No, currently, extended family visits are recognized in only four states across the United States –  Washington, New York, Connecticut, and California.

What are the eligibility criteria?

First, conjugal visits are only allowed in a medium or lesser-security correctional facility. While each state has unique rules, commonly, inmates apply for such visits. Prisoners with recent records of reoccurring infractions like swearing and fighting may be ineligible.

To qualify, inmates must undergo and pass screenings, as deemed appropriate by the prison authority. Again, for instance, California rules say only legally married prisoners’ requests are granted.

Are gay partners allowed for conjugal visits?

Yes, but it varies across states. California and New York allow same-sex partners on conjugal visits. However, couples must have proof of legal marriage.

Are conjugal visits only done in the US?

No, although the practice began in the US, Mississippi precisely, other countries have adopted similar practices. Saudi Arabia, Brazil, Venezuela, Colombia, and Canada, for example, are more lenient about extended family visits.

Brazil and Venezuela’s prison facilities, for example, allow weekly ‘rendezvous.’ In Columbia, such ‘visits’ are a routine, where as many as 3,500 women troop in weekly for intimacy with their spouses. However, Northern Ireland and Britain are entirely against any form of conjugal programs. Although Germany allows extended family visits, the protocols became unbearably tight after an inmate killed his supposed spouse during one of such visits in 2010.

Benefits of Conjugal Visits

Once a normal aspect of the prison system, conjugal visits and the moments that prisoners have with their families are now an indulgence to only a few prisoners in the system. Many prison officials cite huge costs and no indications of reduced recidivism rates among reasons for its prohibition.

Documentations , on the other hand, say conjugal visits dramatically curb recidivism and sexual assaults in prisons. As mentioned earlier, only four states allow conjugal visits. However, research shows that these social calls could prove beneficial to correctional services.

A review by social scientists at the Florida International University in 2012 concludes that conjugal visits have several advantages. One of such reveals that prisons that allowed conjugal visits had lower rape cases and sexual assaults than those where conjugal visits were proscribed. They deduced that sex crime in the prison system is a means of sexual gratification and not a crime of power. To reduce these offenses, they advocated for conjugal visitation across state systems.

Secondly, they determined that these visits serve as a means of continuity for couples with a spouse is in prison. Conjugal visits can strengthen family ties and improve marriage functionality since it helps to maintain the intimacy between husband and wife.

Also, it helps to induce positive attitudes in the inmates, aid the rehabilitation process, and enable the prisoner to function appropriately when reintroduced back to society. Similarly, they add that since it encourages the one-person-one partner practice, it’ll help decrease the spread of HIV. These FIU researchers recommend that more states should allow conjugal visits.

Another study by Yale students in 2012 corroborated the findings of the FIU researchers, and the research suggests that conjugal visits decrease sexual violence in prisons and induces ethical conduct in inmates who desire to spend time with their families.

Expectedly, those allowed to enjoy extended family visits are a lot happier. Besides, they tend to maintain the best behaviors within the facility so that they don’t ruin their chances of the next meeting.

Also, according to experts, visitations can drop the rate of repeat prisoners, thus making the prison system cost-effective for state administrators. An academic with the UCLA explained that if prisoners continue to keep in touch with their families, they live daily with the knowledge that life exists outside the prison walls, and they can look forward to it. Therefore, these family ties keep them in line with society’s laws. It can be viewed as a law-breaking deterrence initiative.

For emphasis, conjugal visits, better termed extended family visits, are more than for sex, as it seems. It’s about maintaining family ties, primarily. The fact is, away from the movies, spouse-alone visits are surprisingly low, if at all allowed by most states’ regulations. Extended family visits create healthy relationships between prisoners and the world outside the bars. It builds a healthy start-point for an effective reentry process, helping inmates feel hope for a good life outside jail .

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Establishing a Positive Pediatrician-Family Relationship, a Crucial Part of the Patient-Centered Medical Home

Information from the prenatal and family history, anticipatory guidance and enhanced parenting skills; social determinants of health, positive parenting, connections to community resources, delivery and nursery routines, thoughts on feeding the newborn infant, circumcision, infant visit routines and care offered at the office, emotions in the newborn infant, emotions in the parents, decreasing the risk of serious illness and effective response to medical problems should they occur, information sharing with the family, types of prenatal visits, the full prenatal visit, the brief visit to get acquainted, the basic contact or telephone call, no prenatal contact, recommendations, examples of questions to use in the prenatal visit 66  , lead authors, committee on psychosocial aspects of child and family health, 2015–2016, the prenatal visit.

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.

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Michael Yogman , Arthur Lavin , George Cohen , COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH , Keith M. Lemmon , Gerri Mattson , Jason Richard Rafferty , Lawrence Sagin Wissow; The Prenatal Visit. Pediatrics July 2018; 142 (1): e20181218. 10.1542/peds.2018-1218

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A pediatric prenatal visit during the third trimester is recommended for all expectant families as an important first step in establishing a child’s medical home, as recommended by Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Fourth Edition . As advocates for children and their families, pediatricians can support and guide expectant parents in the prenatal period. Prenatal visits allow general pediatricians to establish a supportive and trusting relationship with both parents, gather basic information from expectant parents, offer information and advice regarding the infant, and may identify psychosocial risks early and high-risk conditions that may require special care. There are several possible formats for this first visit. The one used depends on the experience and preference of the parents, the style of the pediatrician’s practice, and pragmatic issues of payment.

As the medical specialty that is entirely focused on the health and well-being of the child, embedded in the family, pediatric care ideally begins before pregnancy, with reproductive life planning of adolescents and young adults, and continues during the pregnancy, with an expectant mother and father of any age. This clinical report is an updated revision of the original clinical report from the American Academy of Pediatrics (AAP) on the prenatal visit. 1 Although survey results show that 78% of pediatricians offer a prenatal visit, only 5% to 39% of first-time parents actually attend a visit. 2 The prenatal visit offers the opportunity to create a lasting personal relationship between parents and the pediatrician, one of the most important values in all ongoing pediatric care. The AAP has put forward the rationale and standards for the prenatal visit for pediatricians in Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Fourth Edition (Bright Futures), 3 as well as for parents and families ( www.healthychildren.org ). 4 This clinical report augments these approaches to making the prenatal visit an important part of the practice of pediatrics.

Less than 5% of urban poor pregnant women see a pediatrician during the prenatal period although they are at higher risk of adverse pregnancy outcomes; pregnant women in rural areas may have even more difficulty accessing a prenatal visit. 5 , 6 To attempt to reduce disparities in pregnancy outcomes, encouraging nonresident prospective fathers to attend the prenatal visit along with expectant mothers is particularly important, albeit challenging. 7  

Prenatal contact with a pediatrician may begin with a contact from a prospective parent to the pediatrician’s office to ask whether the practice is accepting new patients and to inquire about hours, fees, hospital affiliation, health insurance accepted, and emergency coverage. These questions may be answered by a member of the office staff or the pediatrician, and this exchange establishes an initial relationship between the office and the parent. During this conversation, the expectant parent can be encouraged to schedule a prenatal visit with the pediatric health care provider, and both parents can be encouraged to attend. The prenatal visit can be enhanced if the parents come prepared with questions. Optimally, this visit should occur at the beginning of the third trimester of pregnancy.

A prenatal visit with the pediatrician is especially important for first-time parents or families who are new to the practice; single parents; women with a high-risk pregnancy or who are experiencing pregnancy complications or multiple gestations; and parents whose previous pregnancies had a complication such as preterm delivery, an infant with a congenital anomaly, a prolonged course in the NICU, or a perinatal death. Same-sex couples and parents expecting via surrogacy may have questions unique to their circumstance. This visit also can be particularly valuable to parents who are planning to adopt a child, because they may have had previous experience with pregnancy complications and/or be sensitized to special vulnerabilities in their infant (see the AAP clinical report The Pediatrician’s Role in Supporting Adoptive Families at http://pediatrics.aappublications.org/content/130/4/e1040 ). If adoption occurs or is to occur across states or internationally, review of records, need for waiting periods, scheduling of initial visits, concerns about potential fetal exposure (eg, maternal substance use or fetal alcohol spectrum disorders), and additional recommended screenings and/or tests can be discussed. 8 , 9 If needed, pediatricians can consult experts in international adoption or the AAP Council on Foster Care, Adoption, and Kinship Care. 10  

The most comprehensive prenatal visit is a full office visit, during which a trusting relationship can be established and expectant parents can have time to express their needs, interests, and concerns and receive initial anticipatory guidance. Most pediatricians believe that the prenatal visit is helpful in establishing a relationship with families that is essential for the medical home. Because they may not be able to initiate these visits, pediatricians can discuss the concept with referring obstetricians, family physicians, and internists, who can, in turn, encourage their patients to contact pediatricians for a prenatal visit. Office Web sites and social media can also be used to advertise this service to expectant parents.

The following objectives for a prenatal visit are suggested as important topics to be addressed. 2 The actual range of topics covered can be determined by the preference of the provider, the interest of the expectant parent(s), or the presence of an existing complication with the pregnancy or the fetus. Topics not covered prenatally can be presented to parents during the newborn or first postnatal visit.

To provide a foundation on which to build a positive family-pediatric professional partnership, a crucial part of the patient-centered medical home.

To access pertinent aspects of the past obstetric and present prenatal history; to review family history of genetic or chromosomal disorders and to review fetal exposure to substances that may affect the infant.

To introduce anticipatory guidance about early infant care and infant safety practices.

To identify psychosocial factors (eg, perinatal depression) that may affect family function and family adjustment to the newborn (eg, social determinants of health, adverse child experiences, and promoting healthy social-emotional development and resiliency).

The prenatal period is an ideal time to start building the health care alliance that may last for many years, commonly until the patient reaches adulthood. 11 The prenatal visit often is an opportunity for the family to determine whether their relationship and their mutual philosophies will form the basis of a positive relationship.

The prenatal visit is also an opportunity for parents to invite other supportive adults, including grandparents, 12 , 13 to establish a relationship with the pediatrician and to encourage them to come to future visits and support the new parent(s). A prenatal visit can be used to introduce parents to the concept of a medical home for the child’s health and development needs. Parental familiarity with the pediatric health care provider prenatally may be helpful if a referral or transfer of care occurs because of perinatal complications or the newborn infant’s medical condition. 14 Adolescent parents 15 and older first-time parents may benefit from the opportunity to share their specific concerns with a knowledgeable professional.

Gathering information about pregnancy complications, parental depression, and family medical and social history (especially social determinants of health) is helpful as a background to the context of the pregnancy. This inquiry also conveys to parents an interest in the broader psychosocial environment of the infant, including areas in which support would be most useful, especially if there is any risk of domestic violence. 16 , – 18 Answering parents’ questions about the approach to pediatric care also is helpful. This is a good opportunity to review how the practice uses the tools of social media and e-mail to communicate with families.

Additional topics that may be addressed include:

developmental dysplasia of the hip, early urinary tract infections, asthma, lipid disorders, cardiac disease, sickle cell disease, substance abuse, psychiatric illness, domestic violence, chronic medical conditions, and ongoing medications;

plans for feeding, circumcision, child care, work schedules, and support systems;

parents’ plans regarding child care and expectations about work-life balance;

cultural beliefs, values, and practices related to pregnancy and parenting;

concerns regarding tobacco, alcohol, and other drug use 19 , 20 and exposure to environmental hazards; and

parents’ attitudes about and use of complementary and alternative medications and health care.

If there are other children in the family, pediatricians can provide helpful advice about managing the older sibling’s adjustment. Managing parental expectations about their child is important in laying the foundation for positive attachment. Questions useful to consider as the pediatrician approaches the prenatal visit are listed in the chapter on the prenatal visit in Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Fourth Edition . 3  

The prenatal visit offers an opportunity to discuss a range of concerns that may be of great interest to the expectant parents and pediatric provider. The following areas for discussion are meant to be a helpful reference. The conversation, the specific concerns of the parents, and time allowed will define which of these issues are discussed at the prenatal visit. The prenatal visit also offers an opportunity for assessment of family risk factors and connections to key evidence-based and other early learning, health, and development programs in the community.

One of the pediatrician’s tasks is to provide guidance to mothers, fathers, and other supportive adults to become more competent caregivers. This can begin with discussion of the parents’ concerns, planned strategies, and cultural and family beliefs and values. Advice can be offered about shared roles in parenting, such as diapering, bathing, nighttime care, and helping with feeding. Pregnancy and delivery make the central importance of the mother in the newborn infant’s life clear, but it is important to talk about the special role fathers and same-sex partners play in good outcomes for children as well. 21 A key goal of positive parenting is the reliable provision of the infants’ basic needs—food, shelter, love, and care—and in doing so, fostering the development of trust. 22 , 23 The adverse effects of poverty on child health have been well documented. 22 , 24 Optimal use of supports and resources (eg, the Special Supplemental Nutrition Program for Women, Infants, and Children [WIC]) can be discussed and information about access can be provided. Positive parenting also includes providing a steady emotional climate in which reasonable expectations are sustained consistently. 25 Avoiding and/or buffering adverse childhood experiences, such as parental postpartum depression, increasingly is seen as an evidence-based part of pediatric care, and this can begin by identifying prenatal risk factors. 26 It is important to share evidence-informed online information sources and other local resources about parenting and child development for families. Many excellent resources are available, such as the Building “Piece” of Mind program from the Ohio chapter of the AAP ( http://ohioaap.org/tag/parenting/ ), the Zero to Three program ( http://www.zerotothree.org/child-development/ ), the Triple P Positive Parenting Program ( http://www.triplep-parenting.net/glo-en/home ), and the Talk, Read, Sing tool kit available from the Clinton Foundation (Too Small to Fail [ www.toosmall.org ]).

The pediatrician can share with parents the knowledge that children, at an early age, can learn through playful serve-and-return interactions with adults and that playing with and daily reading, singing, and talking to children from birth onward are recommended, as is providing a language-rich environment and minimizing media exposure.

Office materials and Web sites can demonstrate provider awareness of key early childhood resources in the community, from home visiting, Early Head Start, child care resource and referral agencies, quality child care settings, local libraries, and parent support groups, as well as cardiopulmonary resuscitation courses. A discussion of the types of child care typically available (family care, in-home baby-sitting, family day care, child care centers) is helpful.

A discussion of the hospital routines around delivery and nursery care may include: who will be in the delivery room and how new infants behave in the first hours and days; qualifying who will provide newborn care in the hospital and what will happen if there is (1) an unanticipated urgent delivery away from the expected hospital, (2) a home birth, or (3) an admission to a special care nursery is also helpful. This discussion might include the newborn infant’s ability to seek and attach to the mother’s breast right after delivery, the related concept of skin-to-skin care, and the 12-hour postdelivery sleep phase after the adrenaline rush of labor. Mothers often choose to have the infant with them continuously during the entire hospital stay, which aids successful lactation.

This is an appropriate teaching moment for describing to both parents the many advantages of exclusive breastfeeding and how it improves outcomes for both the mother and infant. 27 , 28 Special breastfeeding training of expectant fathers or partners has been shown to increase their support of breastfeeding mothers as well as the duration of breastfeeding. 29 For parents living with food insecurity, breastfeeding offers economic advantages as well. Rooming in and avoiding unnecessary supplementation can be mentioned as ways to support nursing.

The benefits of breastfeeding can be reviewed if there are no contraindications, and lactation support services can be discussed. 30 , – 33 However, ultimately, decisions about feeding the infant are made by the parents. If formula feeding is the parents’ choice, they can be supported in their decision and given advice on formula type and preparation and proper bottle use. Ultimately, the goal is a growing, healthy infant and parents who enjoy feeding so that they can be supported in whatever decision they make. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) also is available to help with nutrition discussion and support prenatally, and mothers can be referred to determine whether they are eligible for a nutrition package during pregnancy, if not already participating in the program.

Parental expectations can be shaped so that parents do not become overly concerned if infants take a few days to learn to latch to the breast and lose some weight before the mother’s milk comes in. Infants commonly lose weight for a few days before the mother’s milk comes in but typically regain birth weight at or before 2 weeks of age. If mothers who plan to breastfeed are taking any medication, a helpful reference for the pediatrician to evaluate safety is the LactMed Drugs and Lactation Database ( http://toxnet.nlm.nih.gov/newtoxnet/lactmed.htm ). 34  

Screening for various infections and conditions that can affect the fetus is an important part of pregnancy, delivery, and birth. The prenatal visit is an excellent time to discuss the benefit of screening and the specific screening tests prospective mothers will experience. For example, the mother is regularly screened by her obstetrician to assess fetal growth and development and may have fetal testing for genetic diseases and chromosomal abnormalities. In addition, the mother may be screened for conditions that may affect the fetus, such as gestational diabetes, pregnancy-induced hypertension, and the presence of infectious agents, such as hepatitis B, cytomegalovirus, group B streptococci, and HIV.

For the infant, the main universal screening programs are used to detect metabolic diseases, sickle cell disease, cystic fibrosis, newborn jaundice, critical congenital cardiac disease, and hearing impairments. Parents may seek more information about risk factors for the management of newborn jaundice. Some discussion of these conditions can be helpful to many families so they understand what is being looked for, how the tests are performed, and what the response to test results will be. Family history may have led to detailed genetic testing and counseling and may warrant special discussion. 35 , – 38 Routine postpartum care can be discussed. The rationale for routine recommendations for vitamin K to prevent gastrointestinal or cerebral hemorrhage, eye ointment to prevent eye infection leading to blindness, and the birth hepatitis B vaccine can be explained.

Discussion of circumcision, including benefits, risks, the surgical process, and analgesia, can be presented at this visit, with particular attention to the family’s religious, personal, and cultural views. 39  

Most parents are interested in understanding what to expect for a routine pediatric visit as well as information about office and telephone hours, the appointment scheduling process, and coverage for night, weekend, and emergency care. The prenatal visit also is a good time to establish the pediatrician’s expectations of the family and explain the use of electronic communications during and after routine office hours, including billing for this service. The routine periodic schedule of well-child care visits from Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Fourth Edition 3 can be shared with the parents ( http://brightfutures.aap.org/clinical_practice.html ), along with information from Bright Futures about behavior, development, and the importance of social determinants of health.

The prenatal visit also is a good time to ask parents about their preferred approach to communication with the office, clarifying office policies on the availability of telephone and electronic communications. Preferred Web sites (HealthyChildren.org) for sharing information and other helpful resources and books can be recommended.

Safety is an important topic to discuss with the parents, particularly advice on “safe sleep” 40 and the importance of proper bedding, 40 , 41 proper holding of the infant, water temperature during bathing, the proper use of a pacifier, and hand washing. Encouraging a good family diet, regular checkups with the family physician or obstetrician 42 and dentist, 43 , 44 and appropriate rest and exercise also is important. Guidelines from the American College of Obstetricians and Gynecologists (ACOG) increasingly emphasize attention to oral health and smoking cessation during pregnancy, and pediatricians can reinforce these recommendations during the prenatal visit. 45 , 46 Specific safety issues to discuss include the use of car seats, gun safety in the home, smoke detectors and carbon monoxide monitors, and reducing exposures to toxins such as mold and lead.

For many families, including those with other children, the unique emotional life of a newborn infant is unfamiliar and can be challenging. It is key to manage expectations and raise parental awareness about the range of temperaments infants can have as well as the strengths and challenges of them. There can be some discussion on how crying can be a normal mode of communication, explaining that a common peak typically occurs during the evening hours at 6 weeks of age and giving advice on how best to respond to it. Parents can be given techniques for soothing fussy infants, such as holding, including cuddling and skin-to-skin contact 47 ; rocking; singing; talking quietly; and dimming lights and playing soft music.

The prenatal visit provides an opportunity to discuss how to recognize when crying is an indicator of actual pain or illness. It is important to establish strategies for parental coping with the stress of an infant crying and the demands of infancy, including setting clear plans for strategies to deal with stress.

The experience of enhanced, powerful emotions of a wide variety is likely universal to most parents during and after delivery. Even if no serious difficulties with emotions emerge, it is helpful for expectant parents to be aware of the special power of both positive and negative emotions that surround a new person being born and entering their life.

It is also important for all expectant parents to be aware that it is common for many mothers, as many as 10% to 20%, 48 and some fathers to experience depression before, during, and/or after delivery. Postpartum depression is largely unappreciated, because stigma prevents a majority of parents from being identified and accessing services. 48 Several states have recommended universal postpartum depression screening by pediatricians, and insurers are increasingly paying for these screens. The prenatal visit offers mothers a valuable opportunity to become aware of the facts about depression so they know to call for help from their primary care physician or their obstetrician if they experience significant persistent sadness, which can be compounded by fatigue from lack of sleep. 49 , – 51  

The pediatrician can instruct parents that infants usually awaken to feed every 3 hours during the night until approximately 3 months of age, when brain maturation enables one longer sleep stretch in every 24-hour cycle. To shape this longer stretch to the dark hours, parents can wake infants every 3 hours to feed during the day, keep the lights dim after dark to entrain circadian rhythms, and schedule a bedtime feeding at 11:00 pm right from birth so that the longer sleep stretch after 3 months of age begins then.

At the prenatal visit, pediatricians can listen for and make note of fathers’ or partners’ feelings about lack of parenting skills and decreased marital intimacy. This is an opportunity to lay the groundwork for pediatric providers to be available to fathers as well as mothers after the birth of the infant.

The prenatal visit is a good time to review family history of any illnesses or congenital diseases or any concerns the parents have had during the pregnancy. Adolescent parents often benefit from more guidance than more experienced parents, and older-than-usual parents also feel stressed and insecure. Single parents may not have family or other support systems and may benefit from postpartum referral to social service agencies, evidence-based home visiting programs, or parenting programs (Incredible Years, Triple P) in local communities, if available, for help. The absence of the father, parental conflict, a chronic parental physical condition or concern about mental health, and preterm birth or a birth defect in the infant may require additional medical visits and involvement of specialists 52 , – 55 and can present physical, emotional, and financial burdens for the parents. Many expectant parents wish to discuss the value of cord blood banking and the relative merits of private– versus public–cord blood donation. 56  

During the pregnancy, maternal obesity and maternal drug use 8 , 9 are risk factors for labor complications, birth defects, and/or developmental impairment. 57 , – 59 Maternal diet is important, and ACOG recommendations about the weight gain during pregnancy can be emphasized.

New data are increasingly available about the adverse health effects of environmental toxins during pregnancy (eg, mercury and fish), and pediatricians can work with obstetricians and the ACOG to knowledgably respond to parents’ questions on this topic. 60 , – 63 Pediatric providers may want to request direct contact with obstetric providers and request obstetric records to clarify prenatal complications, particularly regarding abnormalities detected on prenatal ultrasonography that may require postnatal follow-up. New understanding of the relationship between environmental toxins and epigenetic modifications have provided a stronger evidence-based recommendation highlighting the fetal programming of adult diseases. 64  

The prenatal visit also is a good time to give parents guidelines about the timing of taking their newborn infant out in crowded public places or inviting visitors/relatives to their home. With regard to preventing infections, this is a good moment to discuss and encourage parents and family members to be immunized against pertussis and, if during the right season, influenza. Tetanus-diphtheria-acellular pertussis (Tdap) immunization is recommended for every pregnant woman after 20 weeks’ gestation, for every pregnancy, and for fathers as well. 65 Underimmunized siblings at home also present a risk to a newborn infant, and expectant parents can be encouraged to ensure siblings are fully immunized before the delivery.

Many parents have questions about the recommended schedule of immunizations. The prenatal visit is a valuable opportunity to discuss the value of immunizations and the reason for the recommended schedule. It is an opportunity to listen to any parental concerns well before the infant is born, and the decision is on the family. It is also important for the pediatric provider to outline office immunization policy with regard to parents who wish to alter the standard immunization schedule.

Although the volume of information and advice may seem overwhelming to expectant parents, they can be given appropriate handouts to supplement and reinforce information provided at the prenatal visit. A follow-up visit or telephone call can be offered if they still have questions. A Web page can be a good source of information and can include parent questionnaires for subsequent visits.

The most comprehensive form of prenatal visit is a scheduled office visit with both expectant parents. Nurse practitioners can have a significant role in conducting prenatal visits. The objectives listed previously are accomplished through an in-person discussion with the provider. Discussion can include office and telephone hours; fees; office staff; hospital affiliations; coverage for night, weekend, and emergency care; arrangements for newborn care after delivery both at the hospital the pediatricians visit and at a hospital where the pediatrician is not on the staff; and the pediatrician’s expectations of the family. A handout containing this information can be helpful for the family, including information on how and when to schedule the first visit after newborn discharge and how to retrieve the discharge summary if care was provided by a hospitalist. This type of visit is most important for first-time parents, for adolescent and other young parents, when pregnancy complications or newborn problems are anticipated, or when parents are unusually anxious for any reason. The establishment of a mutual commitment to a sound and rewarding family-physician relationship usually results from the visit.

If women with high-risk pregnancies require bed rest, there may be a need for a prenatal visit with only 1 parent and/or telephone calls. These contacts can include the same content as the full prenatal visit. The outcome should be the same mutual commitment as from the full prenatal visit in the office. If an infant is born prematurely, before a prenatal visit could occur, it is often helpful to meet with the parents in a modified prenatal visit before the infant is discharged from the NICU. In the tragic circumstance of a pregnancy loss after a prenatal visit, a follow-up expression of sympathy by the pediatric provider can feel supportive.

Some pediatricians may offer a less formal prenatal visit than a full consultation, and some parents also may prefer this option. A meet-and-greet session, individually or in a group, can include meeting key staff members such as the practice manager, taking a short tour of the office, and receiving other administrative information and handouts. This type of visit may be appropriate for parents before deciding on scheduling a full prenatal visit. Other models include group visits at the maternity hospital as part of a prenatal class or at community events for expectant parents.

The initial prenatal contact often is an expectant parent’s call to the pediatrician’s office. The staff member can offer a brief description of the practice, basic information including a source of referral, expected delivery date, and type of insurance and can be invited to make an appointment for a full prenatal visit. An office information handout may be sent to the expectant parents, if requested.

If no prenatal contact has been made, the objectives and discussion of the prenatal visit can be presented to the parents in the newborn visit or first postnatal visit. Because of other priorities, the parents may not absorb some of this discussion; therefore, a handout containing pertinent information may be used at this type of visit. At the infant’s first office visit, parents should be encouraged to have an additional family member accompany them to care for the infant while the parents and pediatrician confer.

Pediatricians or office staff can discuss with parents whether the visit will be covered by the expectant parent’s insurance and whether a referral will be required. A discussion of insurance plans that the practice accepts may be included. Payment for a prenatal visit often requires advocacy with third-party payers, both individually and through pediatric councils. Both the recommendations of Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Fourth Edition 3 and this clinical report can provide further support for advocacy. Pediatric providers may seek advice from AAP coding resources and may review acceptable codes with their health plans.

A prenatal visit is an important first step to help expectant families (especially first-time parents) establish their child’s medical home. The visit is a unique opportunity to address the relationship between the family and practice and for the bidirectional sharing of information between the parents and pediatric provider.

Pediatric practices can effectively incorporate prenatal visits into their routine. Services can be flexible and designed to meet the needs of expectant parents. A full prenatal visit is preferred, if feasible.

Payment for full prenatal visits is supported by the evidence in Bright Futures and this report. State chapters of the AAP (as through pediatric councils) and pediatric practices can advocate to payers the short-term and long-term benefits of prenatal visits on the health outcomes of infants and their parents.

Pediatricians can share their established practices on prenatal visits with local obstetricians, internists, and family physicians, and with expectant parents.

Pediatric residents can effectively be taught during residency about the content and importance of the prenatal visit.

Increased partnerships with colleagues in obstetrics and gynecology, who are now routinely screening mothers for perinatal depression, are encouraged. Whenever risk factors are identified, obstetric and gynecologic colleagues can be encouraged to refer expectant parents for prenatal pediatric visits so that postpartum family care is optimized.

A comprehensive review of this topic with suggested questions and specific suggestions for expectant parents can be found in the Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Fourth Edition . 3  

Parents can find resources of value during the prenatal period at www.healthychildren.org . 4  

What kinds of previous experience with infants have you had?

Are you working? Are you planning to return to work after delivery?

How are the siblings adjusting to the pregnancy?

Have you attended prenatal classes, and have they been helpful?

What kind of relationship did you have with your parents when you were growing up?

Are you planning to rear your infant in a manner similar to or different from the way your parents reared you?

What expectations do you have about this infant?

What worries and concerns do you have?

What are your plans about feeding the infant (offer support, whether for breast or formula feeding)?

To specifically engage the father/partner, when appropriate, address at least one question to just the father/partner, for example, if the infant is a boy, do you plan to have him circumcised?

Was this a convenient time for you to be pregnant?

How do you cope when you are stressed?

American Academy of Pediatrics

American College of Obstetricians and Gynecologists

This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication.

Clinical reports from the American Academy of Pediatrics benefit from expertise and resources of liaisons and internal (AAP) and external reviewers. However, clinical reports from the American Academy of Pediatrics may not reflect the views of the liaisons or the organizations or government agencies that they represent.

The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

All clinical reports from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

FUNDING: No external funding.

Michael Yogman, MD, FAAP

Arthur Lavin, MD, FAAP

George Cohen, MD, FAAP

Michael Yogman, MD, FAAP, Chairperson

Keith M. Lemmon, MD, FAAP

Gerri Mattson, MD, FAAP

Jason Richard Rafferty, MD

Lawrence Sagin Wissow, MD, MPH, FAAP

George J. Cohen, MD, FAAP

Sharon Berry, PhD – Society of Pediatric Psychology

Terry Carmichael, MSW – National Association of Social Workers

Edward R. Christophersen, PhD, FAAP (hon) – Society of Pediatric Psychology

Norah Johnson, PhD, RN, CPNP – National Association of Pediatric Nurse Practitioners

L. Read Sulik, MD – American Academy of Child and Adolescent Psychiatry

Stephanie Domain, MS

Competing Interests

Re: the prenatal visit.

We commend Drs. Yogman, Lavin and Cohen and the AAP Committee on Psychosocial Aspects of Child and Family Health on their recent clinical report, The Prenatal Visit (1), for drawing attention to the value of the third trimester in establishing a child’s medical home.

As the authors note, most pediatricians offer a prenatal visit, recommended by Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Fourth Edition (2), but most parents do not attend one. Pediatricians and families may never make up for this opportunity to address the most fundamental factors affecting the child’s health: their psychosocial risk factors and the social determinants of their health.

Prenatal visits are even less likely to take place for the urban poor, rural and minority families who may most need early intervention and anticipatory guidance. Achieving health equity demands extra efforts to pull in at-risk families and close the gap in access to the prenatal visit, especially as the rate of return on interventions is highest in the prenatal and earliest years (3).

Moreover, given how frequently this visit is skipped, we must remain attentive to the health of both the caregiver and child at the ‘postnatal’ well-child visits, especially for at-risk families. While caregivers may not access their own health care provider often, they visit their pediatrician four times a year on average (4). Providers can use these visits to provide guidance on healthy changes that will benefit the whole family – and they can bill for it.

Bright Futures sets periodicity schedules for screenings for substance and tobacco use and exposure; parental depression; and poverty, housing and food insecurity. These screenings are reimbursed by Medicaid under the Early and Periodic Screening, Diagnostic and Treatment services (EPSDT) benefit and by most private payers. Some states and health care systems have started successfully billing a child’s health insurance for caregiver health risk assessments that benefits the child. Effective January 1, 2017, providers can report CPT code 96161 for caregiver-focused, standardized health-risk assessments that can benefit the child (5).

The post-natal well-child visit, like the prenatal visit, offers critical, longitudinal, reimbursable opportunities for pediatricians to screen children for health-related social needs and caregivers for health risks. These opportunities are too important and costly to overlook.

References: 1.Yogman M, Lavin A, Cohen G. The Prenatal Visit. Pediatrics. 2018;142(1):e20181218 2. Hagan JF, Shaw JS, Duncan P, eds. Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2017 3. Heckman Econ Inq. 2008:46(3): 289-324 4. Newacheck PW, Stoddard JJ, Hughes DC, Pearl M. Health Insurance and Access to Primary Care for Children. N Engl J Med 1998; 338:513-519 5. AAP News. AAP Division of Health Care Finance. May 24, 2017. Update on use of, payment for new health risk assessment codes. http://www.aappublications.org/news/2017/05/24/Coding052317

In their recent revision of the prenatal visit for pediatricians, Drs. Yogman, Lavin and Cohen and the Committee on Psychosocial Aspects of Child and Family Health (Yogman M, Lavin A, Cohen G. The Prenatal Visit. PEDIATRICS. 2018, 142(1):e20181218) state in the beginning,”As advocates for children and their families, pediatricians can support and guide expectant parents in the prenatal period. Prenatal visits allow general pediatricians to establish a supportive and trusting relationship with both parents, gather basic information from expectant parents, offer information and advice regarding the infant and may identify psychosocial risks early and high-risk conditions that may require special care”, yet it seems as if more could have been included to guide the general pediatrician in making the most of the prenatal visit to accomplish the above mentioned psychosocial objectives. The prenatal visit can be an excellent time for the pediatrician to discuss the innate capacities and capabilities of the infant, the concept of infant-parent (or infant) mental health, the role of the parent and pediatrician in helping to support the infant/parent dyad in promoting positive infant mental health, how early experiences/interactions with the parent play a major role in determining not only the psychosocial health of the infant (later child and adult) but in fact sculpt, shape, modify the developing infant’s physiologic regulatory and system functions. To accompany this, the general pediatrician could discuss when in the hospital seeing the newborn he could demonstrate these capacities and capabilities for the parents, and so in the process help establish or enhance a positive attachment relationship by utilizing the late T. Berry Brazelton’s Newborn Behavioral Observations. As recent literature has shown parenting neurobiology, circuitry and interactions are negatively affected by conditions that can have their origins in the parent’s early life experiences, and beyond screening for substance (drugs, alcohol, tobacco) or present domestic violence, screening using the ACEs questionnaire may provide for the pediatrician a more complete picture of a parent’s need for early supportive care to improve their reflective capabilities and capacities and so enable improved infant-parent interactions and outcomes. Perhaps the time has come for a new AAP committee that focuses on integrative and translational aspects of parenting and infant-parent mental health.

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Benefits and risks of conjugal visits in prison: A systematic literature review

Affiliations.

• 1 Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK.
• 2 School of Social Sciences, Cardiff University, Cardiff, UK.
• PMID: 34597428
• DOI: 10.1002/cbm.2215

Background: Imprisonment impacts on lives beyond the prisoner's. In particular, family and intimate relationships are affected. Only some countries permit private conjugal visits in prison between a prisoner and community living partner.

Aims: Our aim was to find evidence from published international literature on the safety, benefits or harms of such visits.

Methods: A systematic literature review was conducted using broad search terms, including words like 'private' and 'family', to maximise search sensitivity but strict criteria for inclusion - of visits unobserved by prison staff and away from other prisoners. All included papers were quality assessed. Two of us independently extracted data from included papers, according to a prepared checklist. Meta-analysis was considered.

Results: Seventeen papers were identified from 12 independent studies, all but three of them from North America. The only study of health benefits found a positive association with maintaining sexual relationships. The three before-and-after study of partnership qualities suggested benefit, but conjugal visiting was within a wider family-support programme. Studies with in-prison behaviour as a possible outcome suggest small, if any, association, although one US-wide study found significantly fewer in-prison sexual assaults in states allowing conjugal visiting than those not. Other studies were of prisoner, staff or partner attitudes. There is little evidence of adverse effects, although two qualitative studies raise concerns about the visiting partner's sense of institutionalisation or coercion.

Conclusions: The balance of evidence about conjugal visiting is positive, but there is little of it. As stable family relationships have, elsewhere, been associated with desistance from crime, the contribution of conjugal visiting to these should be better researched.

Keywords: conjugal visit; consensual sex in prisons; imprisonment; prisoners; private visiting.

© 2021 John Wiley & Sons Ltd.

Publication types

• Systematic Review
• Interpersonal Relations
• Risk Assessment
• Sexual Partners

So What are the Actual Rules with Conjugal Visits and How Did They Get Their Start?

To begin with, in Britain, conjugal visits aren’t a thing, though in some cases when prisoners who have been locked up for a long period are getting close to their release date, if they are considered particularly low risk for committing crimes or going off on their merry way, they may be allowed to have family leave time for brief periods. This is time meant to help re-acclimate them to the world outside of prison and get their affairs in order, including re-connecting with family and friends, looking for work, etc.- all as a way to try to help said person hit the ground running once fully released.

Moving across the pond to the United States, first, it’s important to note that prisoners in federal custody and maximum security prisons are not allowed conjugal visits. Further, in the handful of states that do allow conjugal visits, prisoners and their guests must meet a stringent set of guidelines including full background checks for any visitors. On the prisoner’s side, anyone who committed a violent crime, has a life sentence, is a sex offender, and other such serious crimes are also not eligible. Further, in Connecticut, if an inmate is a member of a gang or even thought to be so, they are also banned from conjugal visits. On top of that, pretty much everywhere, any inmate who does anything wrong whatsoever while in prison also finds themselves either temporarily or permanently banned from such visits.

This brings us to how the whole conjugal visit thing got its start in the United States; the earliest official-ish policy with regards to allowing, in this case male, prisoners to enjoy the company of the fairer sex started in the Mississippi State Penitentiary (Parchman Farm) in the early 20th century. This was instituted as a way to get its black prisoner populace, who were used pretty literally as slave labor, to work harder while working the 20,000 acres of land at this institution. In fact, the superintendent of the prison at the time was actually a farmer himself, which is why he was hired to oversee things. As historian David M. Oshinsky, author of Worse Than Slavery: Parchman Farm and the Ordeal of Jim Crow Justice , notes, “[The Administrator’s] annual report to the legislature is not of salvaged lives. It is a profit and loss statement, with the accent on the profit.”

Prisoners who didn’t work hard could be beaten and other such “stick”-type incentives leveraged. On the other hand, prisoners who worked hard, were willing to help keep their fellow prisoners in line, etc. etc. were given various rewards. In fact, in the extreme, a prisoner who managed to kill another prisoner attempting to escape could even be rewarded with a full pardon for that and whatever crime they’d previously committed to get locked up in the first place.

Most pertinent to the topic at hand, for those prisoners who were particularly well behaved and worked the hardest, one reward they could be given was the company of a prostitute on their Sunday off-day. To help facilitate this, every Sunday a literal truck load of women would be brought in to tend to the best behaved prisoners. Later, the policy was expanded to include girlfriends and wives for the men who preferred their company.

To illustrate the thinking of the prison officials in perhaps the most offensive way possible, we have this time-capsule of a quote from one contemporary prison guard from Mississippi- “You gotta understand that back in them days n***ers were pretty simple creatures. Give ‘em pork, some greens, some cornbread, and some poontang every now and then and they would work for you.”

Moving very swiftly on from there, the effectiveness of promised sex for a male prisoner, regardless of race, if they toed the line caught on and, as the century progressed, around 1/3 of the states in the U.S. eventually adopted the practice, as well as many other countries through the 20th century also instituting similar programs.

As for that effectiveness, former warden of Great Meadow Correctional Facility in New York State, Arthur Leonardo, explains, “We don’t have much to give to people in prison. If you don’t have anything to take away from someone, you don’t have anything to take away to urge them to do the right thing.”

Illustrating the effectiveness on the prisoner’s side, one Ray Coles, whose temper resulted in an assault that saw him given a nine year prison sentence, states of the incentive the conjugal visits give him to never step out of line, “Every action or choice I make is made with my wife in mind.”

As for what actually goes on during a conjugal visit, the Hollywood idea and reality, as ever, are somewhat different. While in film and TV shows, a conjugal visit is a time to get hot and sweaty with your partner, the reality is that, while sex may or may not be involved, much of the time is spent just doing normal things with not just a partner, but kids and other family members. In fact, in New York, it’s reported that around 40% of conjugal visits don’t include a spouse or the like, rather often just children and other loved ones. For this reason, these visits are usually officially called things like “Extended Family Visits” or, in New York, the “Family Reunion Program”.

As one California inmate summed up of his extended family visit with his partner, “I got to spend 2 1/2 days one-on-one with my partner, my best friend, my confidant, my life partner. It wasn’t about the sex.”

For further context here, in the United States for most prisoners, at best during normal visitation they might be allowed a brief 2 second hug with their partner and a peck on the cheek, if the latter is allowed at all. On top of that, everything you say or do is being watched, and the time together is relatively brief.

As you can imagine from this, for many prisoners, regardless of their crime, whatever prison sentence was doled out often comes with a generally unmentioned punishment of the finishing of a relationship with their partner. Combined with limited access to phones and the extreme expense of prison and jail phone calls, this also often sees a near complete disconnect from their kids, friends, etc. while in prison.

Thus, for prisoners, while sex may or may not be involved, the reality of the extended family visit is just that- depending on the exact rules for a given prison, 6-72 hours where you can spend time with your partner, kids, and sometimes other family members or friends in a somewhat normal setting, doing normal things.

As for frequency, while in movies it’s a regular thing, and little lead up time, in reality in the United States, this may be granted at best once per month all the way up to once per year, or not at all.

Towards the end of facilitating family bonding, many prisons that allow this provide a couple bedrooms to accommodate a couple and their kids, as well as things like board games, a TV, and potentially food, though costs of things like food are footed by the inmate or their loved ones. For reference, the wife of the aforementioned Ray Coles, Vanessa, states she pays around $100 per extended family visit for things like food, which is then provided by the prison.

As for regions outside the United States, places like Canada allow for extended family visits up to 72 hours in length once every couple months, including allowing anyone with a close familial bond to take part, even friends if the authorities deem the bond strong enough. As in the United States, food and other such items are paid for by the inmate or their family or friends.

Interestingly one of the most generous of the nations when it comes to family visits is Saudi Arabia, which allows a once a month visit; but if you have multiple wives, you get once per month per wife! On top of that, beyond allowing such frequent visits, the government actually pays for the travel of those coming to see you.

Back over in the United States, at its peak in the late 20th century, extended family visits were allowed in about 1/3 of states, but began dropping precipitously starting around the 1980s and 1990s to just four states today- California, Washington, New York, and Connecticut.

This was around the same time a number of such programs designed to keep people from being repeat jailbirds were given the axe across the nation, unsurprisingly directly corresponding to the prison population in the United States absolutely exploding, in the four decades since rising an astounding 500%! For reference, before the 1980s, the growth was relatively slow and steady, more or less tied to population growth. More on this in the Bonus Fact in a bit.

As for the impetus for cutting the extended family visit programs, this is generally tied to increased public sentiment starting around the 1980s and 1990s that prisoners are there to be punished, not to be coddled, and that the program costs too much. For example, in New Mexico, who relatively recently killed the extended family visit program, it was costing taxpayers about $120,000 per year.

Now, this might sound like a lot, and if you go read the news reports, this was certainly used as the driving political rhetoric to get the program nixed by the politicians involved. However, it’s noteworthy that New Mexico reports an average cost per inmate annually is a whopping $35,540, which is pretty close to the national average of about $31,000…. Meaning the entire extended family visit program was costing about what it costs to house just over 3 of their approximately 16,000 inmates per year.

Of course this is still costing taxpayers something… except when you consider, for example, a 1982 study done on New York’s prison populace which found that prisoners who were allowed extended family visits were almost 70% less likely than other prisoners to end up back in prison within three years. This makes it potentially the single most effective recidivism program known, even soundly stomping on the second king of recidivism programs- education, which we’ll talk a bit more about in the Bonus Facts.

As to why family visits seem so effective at reducing recidivism, as the aforementioned warden Arthur Leonardo, notes, those who are able to maintain family bonds while in prison, when they get out, have “someone who loves you and will help you, and in the case of children, people who depend on you…”

Going back to the reality of an extended family visit, it’s usually required that partners and the inmates be tested for STDs and come out clean before being allowed to have their little rendezvous. Further, the prisoners themselves are strip searched both before the extended family visit and after. Should they test positive for drug or alcohol use after, they are then banned from future visits indefinitely, and those who brought in the contraband may also be banned from taking part again.

On top of that, those that are visiting the prisoners must be cleared as well, though strip searches, at least in the United States, are not allowed on the visitors, so contraband may occasionally be smuggled in in certain orifices or the like. To try to get around this in, for instance California, inmates and their families are searched regularly during the extended family visits, usually at a rate of about once every four hours.

This brings us to what you can bring for an extended family visit. Well, not much- mostly just things like clean linens, certain toiletries, strictly regulated clothing, and the like. No cell phones, no electronic devices, and really not much of anything else. Even things like family pictures are pretty strictly regulated in number, type, and size. Going back to clothing, one Myesha Paul, wife of California inmate Marcello Paul who is in prison for robbery, states, “They don’t want you to have anything that’s form fitting… although we come with hips and all that, so it’s kinda hard to find what don’t fit around, you know? I just buy some men’s sweat pants and make it work.”

If you go look at the California regulations on this, they also have strict regulations when it comes to colors of clothing, for example no blue denim or forest green pants, no tan shirts, no camouflage, nothing strapless, no skirts or dresses or non-capri shorts- the list goes on and on.

Myesha also helpfully describes what a real extended family visit is like, stating, “We sat outside and played dominoes on Saturday. After that we went in and watched TV, watched movies.” And while she states her and her husband do have sex during the visit, as is almost universally noted by every other inmate and their partner we looked it, it’s more about the closeness and little things like getting to hold your partner’s hand or just hold them in general, as well as waking up next to them. She states, “It feels good… because I don’t get that at home. Ya know. At home I’m sleeping by myself, unless my grandbaby or one of my kids wanna sleep with me. But they’re grown. But they still do sleep with me sometimes. But other than that, you know, I’m waking myself up in the morning, or the alarm clock is waking me up, or my grandson comes and wakes me up. It’s good to have my husband waking me up. It’s the nicest thing about being married. Isn’t it? Waking up?”

She also states of her husband, “He watches me through the night… I know he does ’cause sometimes I wake up and he’s looking at me. And I do the same to him. Sometimes he’s sleeping and he wakes up and I’m watching him.”

Similarly summed up by the aforementioned Vanessa Coles, the value of extended family visits is about keeping her family together- “It keeps our bond going, keeps our marriage strong and keeps him on track.” As for the couple’s young kids, “The little one needs it because that’s all he knows. The older one needs it to remember what he knows.” And as for those arguing against allowing such visits, she states, “[The prisoners] are being punished. I get it. [But] destroying your marriage and family should not be a part of your sentence.”

If you liked this article, you might also enjoy our new popular podcast, The BrainFood Show ( iTunes , Spotify , Google Play Music , Feed ), as well as:

• What Happens to Your Stuff When You Get Sent to Prison for Life?
• When Did Having a Prisoner’s Last Meal Be Anything They Want Start?
• From a Life of Crime to One of the Most Prolific Actors of All Time- Danny Trejo’s Prison Break
• Are You Really Entitled to a Phone Call When Arrested?
• What Happens if You Commit a Crime in Space?

Bonus Facts:

Going back to what caused the massive spike in U.S. incarcerations starting in the 1980s that has more or less continued unabated since, one thing often pointed to is that this was around the time the war on drugs was ramped up, generally considering to account for about 25%-50% of the increase in inmate population. This still leaves the rest, which is the majority. And unless you just think U.S. citizens are far more likely to commit crimes than, for example, our European brethren, obviously there is something weird going on. As to what, a variety of factors are pointed to including the cutting of many programs designed to keep people from being repeat offenders, marked increase in sentence length, especially compared to the rest of the world for similar crimes, and perhaps the catch-all which has driven a lot of this to the extreme- the privatization of prisons that occurred at this time, making many prisons for-profit institutions.

In the decades since, these entities have heavily lobbied for things that seem pretty directly tied to doing everything possible to make prison sentences longer and keep people coming back for more- most pertinent to the topic at hand, cutting costs wherever possible for themselves, including any and all recidivism programs. After all, they get paid per inmate, so aren’t too concerned with what the total cost is to the state, other than the greater that cost, the more they make.

Naturally, the longer sentences and increased likelihood of repeat offenders, at a rate of about 45% within 3 years and 76% within five, has seen prison populations skyrocket in the United States since the 1980s. The net result of all of this being that, at present, the land of the free currently houses almost one quarter of all inmates imprisoned in the entire world! The cost of housing these inmates comes to about $50-$70 billion annually. This does not include the police and judicial costs that get the prisoners put there in the first place- all summing up to massive sums of money being spent and many more crimes being committed while proven recidivism programs that see massive reductions in repeat offenders going largely unused. And noteworthy here is that about 95% of prisoners do get out at some point.

And speaking of recidivism programs like extended family visits, a study done by the United States Department of Justice noted that prisoners given access to educational programs were, for vocational certificates 14.6% less likely to find their way back in prison within 3 years vs. the general prison populace. For those achieving a GED while in prison, they were 25% less likely to end up back in the slammer. And those who attained an Associates degree were the highest of all in their study at about 70% less likely, approximately the same benefit as those given access to extended family visits.

Averaging it all out, the net effect of the educational programs was about a 43% reduction in rate of returning to prison within 3 years. From this, crunching the numbers, the study showed that this meant for every $1 spent by the states towards educating prisoners, it saved $5 annually thanks to the reduction of prison population, let alone other cost savings in court and police expenditures and, of course, a reduction in crime rate. Given each year about 700,000 inmates are released in the United States, that amounts to a massive reduction in crime, while a rather large increase in a better educated and more skilled populace.

Finally, one more bonus fact- while violent criminals are almost always seen as the most dangerous and most likely to re-offend by the general public, the data does not back that up at all- not even close. According to the United States Department of Justice, the highest rate of re-offenders within 3 years after being released were those stealing motor vehicles at 78.8%! Next up are those in prison for selling stolen property at 77.4%. The list goes on and on, but essentially, those who steal are generally about 70%+ likely to re-offend within 3 years and are the highest at-risk re-offenders. In stark contrast, violent crime convicts are massively less likely to re-offend. For example, rapists and murderers are only 2.5% and 1.2% likely to re-offend respectively. Of course, the latter is much more news worthy and traumatic, leading to the skewed public perception.

• Conjugal Visit
• Prisoner Murders Girlfriend
• The Dark Origins of Conjugal Visits
• No Laughing Matter
• Mississippi Ending Conjugal Visits
• How Conjugal Visits Work
• States That Allow Conjugal Visits
• Conjugal Visits Correlate to Fewer Sexual Assaults
• Conjugal Visits Rules and History
• Extended Family Prison Visit
• One Conjugal Visit
• Conjugal Visits
• California Inmate Visitation
• San Quentin Visitation
• Prison Visits
• The Conjugal Visit
• Canada Visiting an Inmate
• Pennsylvania Visiting Rules
• National Crime and Justice
• Conjugal Visits Not Practical
• Australia Conjugal Visits
• South Dakota Corrections
• United States Incarceration Rate
• New Mexico Incarceration Statistics
• New Research on Prison Education
• State of Phone Justice
• Cost of Incarceration

I can’t comment on everything in the bonus facts, but I think the low (1.2%) re-offending rate for murder can be put down to two things: (1) they receive very long sentences (if not actually executed!), and so leave prison in their old age, and (2) they were more likely to have committed a crime of passion, rather than be career criminals. For that matter, I read that, at Devil’s Island, the murderers looked down on the thieves. Murder might be a worse crime, but it was usually the only one they committed, while the thieves were habitual criminals. (That might be a reason behind the high re-offending rate for stealing cars and receiving stolen goods.)

You might want to look that up because it is actually not correct. Depending on the severity of the crime murder can carry as little as a 5 year sentence, and remember it is not uncommon to serve as little as one quarter of the issues sentence. Also, execution is remarkably rare with many US states banning it or in moratorium. For a detailed state by state list of murder recommended sentences see this wiki:

https://en.wikipedia.org/wiki/List_of_punishments_for_murder_in_the_United_States

SARAH INÉS RAMÍREZ, MD, FAAFP

Am Fam Physician. 2023;108(2):139-150

Related AFP Community Blog:   Practice Ancestry-Based Medicine, not Racial Essentialism

Related editorial:   Perinatal Care of Transgender Patients, Adolescent Patients, and Patients With Opioid Use Disorder

Author disclosure: No relevant financial relationships.

Well-coordinated prenatal care that follows an evidence-based, informed process results in fewer hospital admissions, improved education, greater satisfaction, and lower pregnancy-associated morbidity and mortality. Care initiated at 10 weeks or earlier improves outcomes. Identification and treatment of periodontal disease decreases preterm delivery risk. A prepregnancy body mass index greater than 25 kg per m 2 is associated with gestational diabetes mellitus, hypertension, miscarriage, and stillbirth. Advanced maternal and paternal age (35 years or older) is associated with gestational diabetes, hypertension, miscarriage, intrauterine growth restriction, aneuploidy, birth defects, and stillbirth. Rh o (D) immune globulin decreases alloimmunization risk in a patient who is RhD-negative carrying a fetus who is RhD-positive. Treatment of iron deficiency anemia decreases the risk of preterm delivery, intrauterine growth restriction, and perinatal depression. Ancestry-based genetic risk stratification using family history can inform genetic screening. Folic acid supplementation (400 to 800 mcg daily) decreases the risk of neural tube defects. All pregnant patients should be screened for asymptomatic bacteriuria, sexually transmitted infections, and immunity against rubella and varicella and should receive tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap), influenza, and COVID-19 vaccines. Testing for group B Streptococcus should be performed between 36 and 37 weeks, and intrapartum antibiotic prophylaxis should be initiated to decrease the risk of neonatal infection. Because of the impact of social determinants of health on outcomes, universal screening for depression, anxiety, intimate partner violence, substance use, and food insecurity is recommended early in pregnancy. Screening for gestational diabetes between 24 and 28 weeks is recommended for all patients. People at risk of preeclampsia, including those diagnosed with COVID-19 in pregnancy, should be offered 81 mg of aspirin daily starting at 12 weeks. Chronic hypertension should be treated to a blood pressure of less than 140/90 mm Hg.

Family physicians provide family-centered care for individuals and families before, during, and after the birth of a child. Well-coordinated prenatal care that follows an evidence-based, informed process results in fewer hospital admissions, improved education, greater care satisfaction, improved perinatal outcomes, and mitigates pregnancy-associated morbidity and mortality. 1 Family physicians are uniquely positioned to address social determinants of health while ensuring quality of care.

Prenatal Care Visits

Initiation of care between six and 10 weeks allows for identification of preexisting conditions that negatively affect maternal-fetal outcomes (e.g., diabetes mellitus, hypertension, obesity) 2 ; however, 22% of pregnant patients do not receive care during this time. 2 The COVID-19 pandemic resulted in a reevaluation of the number of physician visits needed, with an emphasis on increased flexibility, allowing for a combination of virtual and in-person visits depending on risk. 3 Table 1 outlines the components of prenatal care. 1 , 4 – 22 Table 2 provides opportunities for educating pregnant patients during prenatal care visits. 6 , 8 , 14 – 19 , 23 – 29

PHYSICAL EXAMINATION

Weight, height, and blood pressure should be measured at the first prenatal visit. Early identification of periodontal disease and treatment decreases adverse pregnancy outcomes. 7 Treatment may be performed in the second trimester, and emergent treatment may be completed at any time during pregnancy. 7 A bimanual pelvic examination has poor predictive value for clinical pelvimetry and screening for disease (i.e., sexually transmitted infections and cancer) but may be used as a diagnostic aid in patients with a discrepancy between uterine size and gestational age, which warrants ultrasonography assessment. 30 A pelvic examination is also useful in a symptomatic patient for evaluating spontaneous labor (e.g., cervical dilation, rupture of amniotic membranes). The clinical breast examination is a diagnostic aid in the symptomatic patient and addresses breastfeeding concerns or barriers but does not demonstrate benefit in patients already receiving screening mammograms and does not decrease mortality. 31 – 33

MATERNAL WEIGHT GAIN AND NUTRITION

A prepregnancy body mass index (BMI) greater than 25 kg per m 2 is associated with preterm delivery, gestational diabetes, gestational hypertension, and preeclampsia. A BMI greater than 30 kg per m 2 is also associated with an increased risk of miscarriage, stillbirth, and obstructive sleep apnea. 6 Prepregnancy BMI informs the timing of fetal surveillance, nutritional counseling, and goals for gestational weight gain. Table 3 lists general dietary guidelines for pregnant people. 8 , 17 , 34 , 35 For Black and Hispanic people, a prepregnancy BMI greater than 25 kg per m 2 and the associated poor outcomes are worse compared with non-Hispanic White people. 36

PARENTAL AGE AT CONCEPTION

Advanced maternal and paternal age (35 years and older) is associated with poor outcomes (i.e., aneuploidy, birth defects, gestational diabetes, hypertension, intrauterine growth restriction [IUGR], miscarriage, and stillbirth). Activities focused on improving perinatal outcomes for this group, such as a detailed fetal anatomic screening on ultrasonography, may decrease morbidity and mortality. 37

PREGNANCY DATING AND ULTRASONOGRAPHY

Accurate gestational age estimation is critical to quality care because it enables more precise timing of interventions (e.g., aspirin for preeclampsia prevention, steroids for fetal lung maturity), screening tests, and delivery. Up to 40% of people estimate their last menstrual period incorrectly; therefore, ultrasonography is recommended if uncertainty exists and for patients with irregular menstrual cycles, irregular bleeding, and discrepancy between uterine size and gestational age. 1 , 38 Ultrasonography before 24 weeks decreases missed multiple gestations and post-term inductions. 39 Although routine third-trimester ultrasonography may increase detection of IUGR, it does not improve outcomes. 40 If malpresentation is suspected on physical examination, confirmation with ultrasonography is recommended. 4

ALLOIMMUNIZATION

For patients who are RhD-negative and carrying a fetus who is RhD-positive, the alloimmunization risk is 1.5% to 2% in the setting of spontaneous abortion and 4% to 5% with dilation and curettage. The risk is decreased by 80% to 90% with anti-D immune globulin. 41 Testing for the ABO blood group and RhD antibodies should be performed early in pregnancy. A 300-mcg dose of anti-D immune globulin is recommended for RhD-negative pregnant patients at 28 weeks and again within 72 hours of delivery if the infant is RhD-positive. 41

Iron deficiency anemia increases the risk of preterm delivery, IUGR, and perinatal depression. The U.S. Preventive Services Task Force found insufficient evidence to assess the benefits and harms of screening for anemia in pregnancy. 42 Screening is recommended by the American College of Obstetricians and Gynecologists early in pregnancy, with iron treatment if deficient. 43 Intravenous iron should be considered for patients who cannot tolerate oral iron or in whom oral iron has been ineffective at correcting the deficiency. 43 Patients with non–iron deficiency anemia, or if iron repletion is ineffective within six weeks, should be referred to a hematologist for further evaluation. Iron supplementation in the first trimester decreases the prevalence of iron deficiency. 43

INHERITED CONDITIONS

Pregnant patients should be counseled and offered aneuploidy (extra or missing chromosomes) screening in early pregnancy, regardless of age. 44 In the United States, 1 in 150 infants has a chromosomal condition, the most common being trisomy 21 (Down syndrome). 44 Table 4 compares screening tests for Down syndrome. 1 , 45 , 46 If a screening test is positive, amniocentesis at 15 weeks or more or chorionic villous sampling between 11 and 13 weeks is recommended. Both procedures have similar rates of fetal loss. 47 At 35 years of age, the risk of Down syndrome (1 in 294 births) is similar to that of fetal loss from amniocentesis. 47 Serum and nuchal translucency testing can screen for other trisomies, including 13 and 18, the protocols for which have lower sensitivities and higher specificities compared with screening protocols for trisomy 21 because they are rarer. 47

Additional genetic screening should be based on maternal and paternal personal and family histories. Race is a social construct, necessitating a shift in genetic risk stratification from race-based to ancestry-based. Sickle cell disease affects up to 100,000 people in the United States, but its inheritance pattern (1:10) is based on people with African ancestry, which includes much of the world. 48 Cystic fibrosis is inherited mainly by people of European ancestry (1:25), but ignoring the possibility of European ancestry in certain racial and ethnic groups results in an underestimation of its prevalence: African (1:61), Hispanic (1:40), and Mediterranean (1:29). 49

NEURAL TUBE DEFECTS

In the United States, neural tube defects affect approximately 2,600 infants per year, with the highest prevalence in Hispanic populations. 35 , 50 All pregnant patients should be counseled and offered screening with maternal serum alpha fetoprotein. 35 Folic acid, 400 to 800 mcg daily, started at least one month before conception and continued until the end of the first trimester, decreases the incidence of neural tube defects by nearly 78%. 35 Patients taking folic acid antagonists (e.g., carbamazepine, methotrexate, trimethoprim) or who have a history of carrying a fetus with a neural tube defect should take 4 mg of folic acid daily, starting at least three months before conception. 35

THYROID DISORDERS

There is no evidence that screening for thyroid disorders improves pregnancy outcomes. Thyroid-stimulating hormone levels should be measured if there is a history of thyroid disease or symptoms of disease. If the level is abnormal, a free thyroxine test helps determine the etiology. 51 Hypothyroidism complicates 1 to 3 per 1,000 pregnancies and increases the risk of fetal loss, preeclampsia, IUGR, and stillbirth. Hyperthyroidism occurs in 2 per 1,000 pregnancies and is associated with miscarriage, preeclampsia, IUGR, preterm delivery, thyroid storm, and congestive heart failure. 51 The effect of subclinical hypothyroidism on a child's neurocognitive development is not well understood, and the effectiveness of treatment with levothyroxine is unproven. 51

CERVICAL CANCER

Intervals for cervical cancer screening are based on patient age, cytology history, and history of the presence of high-risk human papillomavirus (HPV). Routine screening for people at average risk of cervical cancer should begin at 21 years of age. Screening can be performed with either cytology alone every three years, HPV screening alone every five years, or cytology plus HPV screening every five years starting at 25 years of age. Screening is not indicated for people 65 years and older with negative screening in the previous 10 years, and no history of cervical intraepithelial neoplasia grade 2 or higher in the past 25 years. 52 Colposcopy is indicated when the risk of cervical intraepithelial neoplasia grade 3 is greater than 4%. Surveillance of high-grade lesions should be performed every 12 to 24 weeks. 52 , 53 Although colposcopy and cervical biopsy can be safely performed during pregnancy, endocervical sampling should be deferred until postpartum. 53

Infectious Disease

Bacteriuria.

Asymptomatic bacteriuria complicates up to 15% of pregnancies in the United States, 30% of which progress to pyelonephritis if untreated. 54 All pregnant patients should be screened for bacteriuria at the first prenatal visit. 54 A culture from a midstream or clean-catch sample with greater than 100,000 colony-forming units per mL of a single pathogen is considered positive and treated to decrease the risk of pyelonephritis and subsequent preterm delivery. 54

SEXUALLY TRANSMITTED INFECTIONS

Sexually transmitted infections can affect prenatal outcomes. 55 – 57 Table 5 lists routine screening and treatment for sexually transmitted infections in pregnancy. 55 , 56

Rubella immunity screening during the first prenatal visit is recommended. Postpartum vaccination should also be offered if the patient is not immune to prevent congenital rubella syndrome in subsequent pregnancies. 1 , 58 The presence of rubella immunoglobulin G should be interpreted with caution in patients recently migrating from areas where rubella is endemic because this may indicate a recent infection. 58 Rubella is a live vaccine and should not be administered during pregnancy but is safe during lactation after delivery. 59 , 60

Maternal varicella can result in congenital varicella syndrome (i.e., IUGR and limb, ophthalmologic, and neurologic abnormalities) and neonatal varicella; infection can occur from approximately five days before to two days after birth. A negative history of varicella infection or vaccination warrants serologic testing, and if immunoglobulin G is negative, varicella exposure should be avoided. Postpartum vaccination should be offered. 61

Although tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination is recommended for anyone in close contact with the infant, only antenatal maternal vaccination ensures increased protection against neonatal pertussis. 62 Pregnant patients should receive a Tdap vaccine beginning at 27 weeks to maximize time for passive immunity to the fetus through the placental transfer of maternal antibodies; vaccination is recommended in each subsequent pregnancy. 62

INFLUENZA AND COVID-19

Influenza and COVID-19 infection in pregnancy increase the risk of intensive care unit admission, preterm delivery, stillbirth, and maternal death. 63 , 64 COVID-19 infection almost doubles the risk of developing preeclampsia 64 ; therefore, initiating low-dose aspirin (81 mg daily) starting at 12 weeks should be considered. 5 Pregnant patients and their household contacts should be vaccinated for influenza and COVID-19. 63 , 64

GROUP B STREPTOCOCCUS

In the United States, group B Streptococcus (GBS) is the leading cause of infection in the first three months of life; 25% of all pregnant patients are GBS carriers. 65 , 66 Screening with a vaginal-rectal swab for culture between 36 and 37 weeks is recommended. 67 Intrapartum antibiotic prophylaxis decreases neonatal mortality. Antibiotics are recommended when there is GBS bacteriuria with the current pregnancy, a history of a previous infant affected by GBS (e.g., septicemia, meningitis, pneumonia, death), or unknown GBS status and risk factors (e.g., preterm labor, rupture of membranes more than 18 hours before delivery, GBS in previous pregnancy). 67 Patients with GBS bacteriuria in the current pregnancy are assumed to be colonized and do not need subsequent screening. 67

Social Determinants of Health

Social determinants of health represent up to 80% of the factors that directly affect a person's health. 68 Physicians who provide prenatal care play a critical role in mitigating the burden that social determinants of health play on maternal-child health without compromising the quality of care delivered. 69 An increased burden from social determinants of health increases the risk of depression, anxiety, intimate partner violence, substance use, and food insecurity 70 , 71 ; therefore, universal screening is recommended early in pregnancy.

DEPRESSION AND ANXIETY-RELATED DISORDERS

After the COVID-19 pandemic, rates of perinatal depression and anxiety have increased. People who are non-White, 24 years or younger, or who have 12 years or less of education, lower socioeconomic status, or a history of intimate partner violence or sexual trauma are at higher risk. 11 , 72 , 73 If untreated, depression and anxiety-related disorders increase the risk of preeclampsia, preterm delivery, IUGR, substance use, maternal suicide, infanticide, psychosis, and homicide. 11

INTIMATE PARTNER VIOLENCE

Intimate partner–related homicide is the leading cause of death in the United States in pregnancy. Screening is recommended at the first prenatal visit and once per trimester. 13 Intimate partner violence increases the risk of miscarriage, placental abruption, premature rupture of membranes, IUGR, and preterm delivery. 13 Family physicians should be aware of the signs of intimate partner violence (e.g., frequent sexually transmitted infections, repeated requests for pregnancy tests when pregnancy is not desired, fear of asking a partner to use a condom), the effect of violence on health, and the increased risk of child abuse after delivery. 13

SUBSTANCE USE

Substance use during pregnancy increases the risk of IUGR, preterm delivery, stillbirth, fetal malformations, and maternal death. 74 The use of prescription opioids complicates 7% of pregnancies in the United States; of these, 20% of patients report misuse. 75 Opioid use in pregnancy increased by 131% from 2010 to 2017 in the United States, and the incidence of babies born with withdrawal symptoms in that time increased by 82%. 76 Fetal alcohol exposure is the leading cause of preventable neurodevelopmental disorders in the United States. 14 However, 14% of pregnant patients report current drinking, and 5% report binge drinking in the past 30 days. 77 Exposure to cigarette smoking in utero increases the risk of sudden intrauterine and infant death. 15

FOOD INSECURITY

Maternal food insecurity increases the risk of poor outcomes (e.g., IUGR, preterm delivery, gestational diabetes, hypertension, depression, anxiety). However, few patients disclose this due to concerns about social stigma; therefore, a universal approach to screening is encouraged. The Hunger Vital Sign tool may be used. 12

Complications of Pregnancy

Gestational diabetes.

Gestational diabetes complicates up to 14% of U.S. pregnancies, with up to 67% of patients developing type 2 diabetes later in life. 78 Racial and ethnic minorities are at the highest risk. 79 Gestational diabetes is associated with hypertension, macrosomia, shoulder dystocia, and cesarean deliveries. 80 Screening for undiagnosed type 2 diabetes at the initial prenatal visit is recommended for people at increased risk 80 ( Table 6 5 , 80 ) . Universal screening for gestational diabetes should occur between 24 and 28 weeks with a one-hour (50-g) glucose tolerance test and, if results are abnormal, should be followed by a confirmatory, fasting, three-hour (100-g) test. 80

HYPERTENSION

Blood pressure should be monitored at each prenatal visit, and education should be provided on preeclampsia warning signs. 5 Patients at increased risk of preeclampsia should be screened for thrombocytopenia, transaminitis, and renal insufficiency, including proteinuria, during the first or second trimester and started on prophylactic daily low-dose aspirin (81 mg) between 12 and 16 weeks 5 , 85 ( Table 6 5 , 80 ) . [Updated] Screening for proteinuria in isolation has little predictive value for detecting preeclampsia. 5 Chronic hypertension (hypertension before 20 weeks) is treated to less than 140/90 mm Hg. 81

PRETERM DELIVERY

Preterm delivery (between 20 and 37 weeks) is a significant cause of neonatal morbidity and mortality, complicating 10.5% of U.S. pregnancies. 2 Modifiable risk factors include prepregnancy BMI (less than 18.5 kg per m 2 and greater than 25 kg per m 2 ), substance use, and short interval between pregnancies (i.e., less than 18 months). 82 Several options are available for the prevention of preterm labor in a singleton pregnancy. 82 Patients with a previous preterm delivery before 34 weeks should have a cervical length assessment starting at 16 weeks through 24 weeks. 82 These patients should be treated with progesterone supplementation (vaginal or intramuscular). In the asymptomatic patient with a short cervix and without a history of spontaneous birth before 34 weeks, vaginal progesterone (200 mg) started between 16 and 20 weeks and continued through 36 weeks is recommended. 82

POST-TERM DELIVERY

Stillbirth complicates 3 per 1,000 post-term (42 weeks or greater) pregnancies. 20 Antenatal testing should be initiated at 41 weeks; if the results are not reassuring, induction of labor is recommended. 20 , 21

Cultural Considerations

Maternity care improves outcomes; however, vulnerable populations (i.e., racial, ethnic, and religious minorities) are less likely to engage in care if it is not culturally centered, which acknowledges the effect of culture on health conditions (e.g., depression) and enhances patient-physician trust. 83 Addressing cultural needs (e.g., doula, community health workers, interpreters) throughout pregnancy helps mitigate barriers and improves outcomes.

This article updates previous articles on this topic by Zolotor and Carlough 1 ; Kirkham, et al. 17 ; and Kirkham, et al. 84

Data Sources: A search was completed using the key terms prenatal care, COVID-19, oral health, pelvic examination, prepregnancy body mass index, pregnancy dating and ultrasound, maternal and paternal age and impact on pregnancy outcomes, aneuploidy screening, inheritance patterns of sickle cell disease and cystic fibrosis, anemia, cell-free DNA analysis, thyroid disease, cervical cancer screening, management of abnormal cervical cytology, screening guidelines for sexually transmitted infections in pregnancy, group B Streptococcus screening, social determinants of health and prenatal outcomes, intimate partner violence, polysubstance abuse, food insecurity, maternity care deserts, hypertension in pregnancy, progesterone for preterm birth prevention, post-term delivery, and preconception care. Also searched were PubMed, Essential Evidence Plus, the Cochrane database, U.S. Preventive Services Task Force, American College of Obstetricians and Gynecologists, American Cancer Society, American Family Physician , and reference lists of retrieved articles. Search dates: July 1, 2022; February 19, 2023; and June 16, 2023.

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Rubella vaccine. Drugs and Lactation Database (LactMed) . June 15, 2020. Accessed October 11, 2022. https://www.ncbi.nlm.nih.gov/books/NBK501097

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Jamieson DJ, Rasmussen SA. An update on COVID-19 and pregnancy. Am J Obstet Gynecol. 2022;226(2):177-186.

Nanduri SA, Petit S, Smelser C, et al. Epidemiology of invasive early-onset and late-onset group b streptococcal disease in the United States, 2006 to 2015: multistate laboratory and population-based surveillance [published corrections appear in JAMA Pediatr . 2019; 173(3): 296, and JAMA Pediatr . 2019; 173(5): 502]. JAMA Pediatr. 2019;173(3):224-233.

Centers for Disease Control and Prevention. Active bacterial core surveillance (ABCs) report. Emerging infections program network, group B Streptococcus , 2018. May 19, 2020. Accessed October 12, 2022. https://www.cdc.gov/abcs/reports-findings/survreports/gbs18.pdf?CDC_AA_refVal= https%3A%2F%2Fwww.cdc.gov%2Fabcs%2Freports-findings%2Fsurvreports%2Fgbs18.html

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Partin M, Sanchez A, Poulson J, et al. Social inequities between prenatal patients in family medicine and obstetrics and gynecology with similar outcomes. J Am Board Fam Med. 2021;34(1):181-188.

Compton MT, Shim RS. The social determinants of mental health. Focus. 2015;13(4):419-425.

Kuhrau C, Kelly E, DeFranco EA. Social determinants of health associated with intimate partner violence in an urban obstetric population. Am J Obstet Gynecol. 2023;228(1):S110-S111.

Bauman BL, Ko JY, Cox S, et al. Vital signs: postpartum depressive symptoms and provider discussions about perinatal depression - United States, 2018. MMWR Morb Mortal Wkly Rep. 2020;69(19):575-581.

Lombardi BN, Jensen TM, Parisi AB, et al. The relationship between a lifetime history of sexual victimization and perinatal depression: a systematic review and meta-analysis. Trauma Violence Abuse. 2023;24(1):139-155.

Yazdy MM, Desai RJ, Brogly SB. Prescription opioids in pregnancy and birth outcomes. J Pediatr Genet. 2015;4(2):56-70.

Ko JY, D'Angelo DV, Haight SC, et al. Vital signs: prescription opioid pain reliever use during pregnancy–34 U.S. jurisdictions, 2019. MMWR Morb Mortal Wkly Rep. 2020;69(28):897-903.

Hirai AH, Ko JY, Owens PL, et al. Neonatal abstinence syndrome and maternal opioid-related diagnoses in the US, 2010–2017 [published correction appears in JAMA . 2021; 325(22): 2316]. JAMA. 2021;325(2):146-155.

Gosdin LK, Deputy NP, Kim SY, et al. Alcohol consumption and binge drinking during pregnancy among adults aged 18–49 years–United States, 2018–2020 [published correction appears in MMWR Morb Mortal Wkly Rep . 2022; 71(4): 156]. MMWR Morb Mortal Wkly Rep. 2022;71(1):10-13.

Diaz-Santana MV, O'Brien KM, Park YM, et al. Persistence of risk for type 2 diabetes after gestational diabetes mellitus. Diabetes Care. 2022;45(4):864-870.

Bower JK, Butler BN, Bose-Brill S, et al. Racial/ethnic differences in diabetes screening and hyperglycemia among US women after gestational diabetes. Prev Chronic Dis. 2019;16:E145.

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Congenital Syphilis

The rate of reported congenital syphilis in the United States has increased dramatically since 2012. During 2019, a total of 1,870 cases of congenital syphilis were reported, including 94 stillbirths and 34 infant deaths ( 141 ). The 2019 national rate of 48.5 cases per 100,000 live births represents a 41% increase relative to 2018 (34.3 cases per 100,000 live births) and a 477% increase relative to 2012 (8.4 cases per 100,000 live births). During 2015–2019, the rate of congenital syphilis increased 291.1% (12.4 to 48.5 per 100,000 live births), which mirrors increases in the rate of primary and secondary syphilis among females aged 15–44 years (a 171.9% increase, from 3.2 to 8.7 per 100,000 females).

Effective prevention and detection of congenital syphilis depend on identifying syphilis among pregnant women and, therefore, on the routine serologic screening of pregnant women during the first prenatal visit and at 28 weeks’ gestation and at delivery for women who live in communities with high rates of syphilis, women with HIV infection, or those who are at increased risk for syphilis acquisition. Certain states have recommended screening three times during pregnancy for all women; clinicians should screen according to their state’s guidelines.

Maternal risk factors for syphilis during pregnancy include sex with multiple partners, sex in conjunction with drug use or transactional sex, late entry to prenatal care (i.e., first visit during the second trimester or later) or no prenatal care, methamphetamine or heroin use, incarceration of the woman or her partner, and unstable housing or homelessness ( 174 , 633 – 636 ). Moreover, as part of the management of pregnant women who have syphilis, providers should obtain information concerning ongoing risk behaviors and treatment of sex partners to assess the risk for reinfection.

Routine screening of neonatal sera or umbilical cord blood is not recommended because diagnosis at that time does not prevent congenital syphilis in certain newborns. No mother or newborn infant should leave the hospital without maternal serologic status having been documented at least once during pregnancy. Any woman who had no prenatal care before delivery or is considered at increased risk for syphilis acquisition during pregnancy should have the results of a syphilis serologic test documented before she or her neonate is discharged. A quantitative RPR is needed at the time of delivery to compare with the neonate’s nontreponemal test result. If a stat RPR is unavailable and a rapid treponemal test is performed at delivery, the results should be confirmed by using standard syphilis serologic laboratory tests (e.g., RPR and treponemal test) and algorithms.

Evaluation and Treatment of Neonates

Diagnosis of congenital syphilis can be difficult because maternal nontreponemal and treponemal immunoglobulin G (IgG) antibodies can be transferred through the placenta to the fetus, complicating the interpretation of reactive serologic tests for syphilis among neonates (infants aged <30 days). Therefore, treatment decisions frequently must be made on the basis of identification of syphilis in the mother; adequacy of maternal treatment; presence of clinical, laboratory, or radiographic evidence of syphilis in the neonate; and comparison of maternal (at delivery) and neonatal nontreponemal serologic titers (e.g., RPR or VDRL) by using the same test, preferably conducted by the same laboratory. Any neonate at risk for congenital syphilis should receive a full evaluation and testing for HIV.

All neonates born to mothers who have reactive nontreponemal and treponemal test results should be evaluated with a quantitative nontreponemal serologic test (RPR or VDRL) performed on the neonate’s serum because umbilical cord blood can become contaminated with maternal blood and yield a false-positive result, and Wharton’s jelly within the umbilical cord can yield a false-negative result. The nontreponemal test performed on the neonate should be the same type of nontreponemal test performed on the mother.

Conducting a treponemal test (e.g., TP-PA, immunoassay-EIA, CIA, or microbead immunoassay) on neonatal serum is not recommended because it is difficult to interpret, as passively transferred maternal antibodies can persist for >15 months. Commercially available IgM tests are not recommended.

All neonates born to women who have reactive nontreponemal serologic tests for syphilis at delivery should be examined thoroughly for evidence of congenital syphilis (e.g., nonimmune hydrops, conjugated or direct hyperbilirubinemia † or cholestatic jaundice or cholestasis, hepatosplenomegaly, rhinitis, skin rash, or pseudoparalysis of an extremity). Pathologic examination of the placenta or umbilical cord using specific staining (e.g., silver) or a T. pallidum PCR test using a CLIA-validated test should be considered; direct fluorescence antibody (DFA-TP) reagents are unavailable ( 565 ). Darkfield microscopic examination or PCR testing of suspicious lesions or body fluids (e.g., bullous rash or nasal discharge) also should be performed. In addition to these tests, for stillborn infants, skeletal survey demonstrating typical osseous lesions might aid in the diagnosis of congenital syphilis because these abnormalities are not detected on fetal ultrasound.

The following scenarios describe the recommended congenital syphilis evaluation and treatment of neonates born to women who had reactive nontreponemal and treponemal serologic tests for syphilis during pregnancy (e.g., RPR reactive, TP-PA reactive or EIA reactive, RPR reactive) and have a reactive nontreponemal test at delivery (e.g., RPR reactive). Maternal history of infection with T. pallidum and treatment for syphilis should be considered when evaluating and treating the neonate for congenital syphilis in most scenarios, except when congenital syphilis is proven or highly probable.

Scenario 1: Confirmed Proven or Highly Probable Congenital Syphilis

Any neonate with

• an abnormal physical examination that is consistent with congenital syphilis;
• a serum quantitative nontreponemal serologic titer that is fourfold § (or greater) higher than the mother’s titer at delivery (e.g., maternal titer = 1:2, neonatal titer ≥1:8 or maternal titer = 1:8, neonatal titer ≥1:32) ¶ ; or
• a positive darkfield test or PCR of placenta, cord, lesions, or body fluids or a positive silver stain of the placenta or cord.

Recommended Evaluation

• CSF analysis for VDRL, cell count, and protein**
• Complete blood count (CBC) and differential and platelet count
• Long-bone radiographs
• Other tests as clinically indicated (e.g., chest radiograph, liver function tests, neuroimaging, ophthalmologic examination, and auditory brain stem response)

Aqueous crystalline penicillin G 100,000–150,000 units/kg body weight/day, administered as 50,000 units/kg body weight/dose by IV every 12 hours during the first 7 days of life and every 8 hours thereafter for a total of 10 days

Procaine penicillin G 50,000 units/kg body weight/dose IM in a single daily dose for 10 days

If >1 day of therapy is missed, the entire course should be restarted. Data are insufficient regarding use of other antimicrobial agents (e.g., ampicillin). When possible, a full 10-day course of penicillin is preferred, even if ampicillin was initially provided for possible sepsis ( 648 – 650 ). Using agents other than penicillin requires close serologic follow-up for assessing therapy adequacy.

Scenario 2: Possible Congenital Syphilis

Any neonate who has a normal physical examination and a serum quantitative nontreponemal serologic titer equal to or less than fourfold of the maternal titer at delivery (e.g., maternal titer = 1:8, neonatal titer ≤1:16) and one of the following:

• The mother was not treated, was inadequately treated, or has no documentation of having received treatment.
• The mother was treated with erythromycin or a regimen other than those recommended in these guidelines (i.e., a nonpenicillin G regimen). ††
• The mother received the recommended regimen but treatment was initiated <30 days before delivery.
• CBC, differential, and platelet count

This evaluation is not necessary if a 10-day course of parenteral therapy is administered, although such evaluations might be useful. For instance, a lumbar puncture might document CSF abnormalities that would prompt close follow-up. Other tests (e.g., CBC, platelet count, and long-bone radiographs) can be performed to further support a diagnosis of congenital syphilis.

Aqueous crystalline penicillin G 100,000–150,000 units/kg body weight/day, administered as 50,000 units/kg body weight/dose by IV every 12 hours during the first 7 days of life and every 8 hours thereafter for a total of 10 days

Benzathine penicillin G 50,000 units/kg body weight/dose IM in a single dose

Before using the single-dose benzathine penicillin G regimen, the recommended evaluation (i.e., CSF examination, long-bone radiographs, and CBC with platelets) should be normal, and follow-up should be certain. If any part of the neonate’s evaluation is abnormal or not performed, if the CSF analysis is uninterpretable because of contamination with blood, or if follow-up is uncertain, a 10-day course of penicillin G is required.

If the neonate’s nontreponemal test is nonreactive and the provider determines that the mother’s risk for untreated syphilis is low, treatment of the neonate with a single IM dose of benzathine penicillin G 50,000 units/kg body weight for possible incubating syphilis can be considered without an evaluation. Neonates born to mothers with untreated early syphilis at the time of delivery are at increased risk for congenital syphilis, and the 10-day course of penicillin G should be considered even if the neonate’s nontreponemal test is nonreactive, the complete evaluation is normal, and follow-up is certain.

Scenario 3: Congenital Syphilis Less Likely

Any neonate who has a normal physical examination and a serum quantitative nontreponemal serologic titer equal or less than fourfold of the maternal titer at delivery (e.g., maternal titer = 1:8, neonatal titer ≤1:16) and both of the following are true:

• The mother was treated during pregnancy, treatment was appropriate for the infection stage, and the treatment regimen was initiated ≥30 days before delivery.
• The mother has no evidence of reinfection or relapse.

No evaluation is recommended.

Benzathine penicillin G 50,000 units/kg body weight/dose IM in a single dose*

* Another approach involves not treating the newborn if follow-up is certain but providing close serologic follow-up every 2–3 months for 6 months for infants whose mothers’ nontreponemal titers decreased at least fourfold after therapy for early syphilis or remained stable for low-titer, latent syphilis (e.g., VDRL <1:2 or RPR <1:4).

Scenario 4: Congenital Syphilis Unlikely

Any neonate who has a normal physical examination and a serum quantitative nontreponemal serologic titer equal to or less than fourfold of the maternal titer at delivery § and both of the following are true:

• The mother’s treatment was adequate before pregnancy.
• The mother’s nontreponemal serologic titer remained low and stable (i.e., serofast) before and during pregnancy and at delivery (e.g., VDRL ≤1:2 or RPR ≤1:4).

No treatment is required. However, any neonate with reactive nontreponemal tests should be followed serologically to ensure the nontreponemal test returns to negative (see Follow-Up). Benzathine penicillin G 50,000 units/kg body weight as a single IM injection might be considered, particularly if follow-up is uncertain and the neonate has a reactive nontreponemal test.

The following situations describe management of neonates born to women screened during pregnancy by using the reverse sequence algorithm with reactive treponemal serologic tests and a nonreactive nontreponemal serologic test.

Reactive maternal treponemal serologies with a nonreactive nontreponemal serology (e.g., EIA reactive, RPR nonreactive, or TP-PA reactive) during pregnancy. Syphilis is highly unlikely for neonates born to mothers with a nonreactive nontreponemal test after adequate treatment for syphilis during pregnancy or documentation of adequate treatment before pregnancy (with no evidence of reinfection of relapse). If testing is performed again at delivery and 1) the maternal nontreponemal test remains nonreactive and 2) the neonate has a normal physical examination and nonreactive nontreponemal test (e.g., RPR nonreactive), the provider should consider managing similarly to Scenario 4 without a laboratory evaluation and with no treatment required. Benzathine penicillin G 50,000 units/kg body weight as a single IM injection might be considered if syphilis exposure is possible within 1 month of delivery and follow-up of the mother and infant is uncertain.

Isolated reactive maternal treponemal serology (e.g., EIA reactive, RPR nonreactive, or TP-PA nonreactive) during pregnancy. Syphilis is unlikely for neonates born to mothers screened with the reverse sequence algorithm with isolated reactive maternal treponemal serology. Among low-prevalence populations, these are likely false-positive results and might become nonreactive with repeat testing ( 638 ). If these neonates have a normal physical examination and the risk for syphilis is low in the mother, no evaluation and treatment are recommended for the neonate. If syphilis exposure is possible or unknown in the mother or the mother desires further evaluation to definitively rule out syphilis, repeat serology within 4 weeks is recommended to evaluate for early infection (see Syphilis During Pregnancy).

Isolated reactive maternal treponemal serology (e.g., rapid treponemal test) at delivery. For mothers with late or no prenatal care with a reactive rapid treponemal test at delivery, confirmatory laboratory-based testing should be performed; however, results should not delay evaluation and treatment of the neonate. These neonates should be evaluated and treated with a 10-day course of penicillin as recommended in Scenario 1, and consultation with a specialist is recommended.

All neonates with reactive nontreponemal tests should receive thorough follow-up examinations and serologic testing (i.e., RPR or VDRL) every 2–3 months until the test becomes nonreactive.

For a neonate who was not treated because congenital syphilis was considered less likely or unlikely, nontreponemal antibody titers should decrease by age 3 months and be nonreactive by age 6 months, indicating that the reactive test result was caused by passive transfer of maternal IgG antibody. At age 6 months, if the nontreponemal test is nonreactive, no further evaluation or treatment is needed; if the nontreponemal test is still reactive, the infant is likely infected and should be treated.

Treated neonates who exhibit persistent nontreponemal test titers by age 6–12 months should be reevaluated through CSF examination and managed in consultation with an expert. Retreatment with a 10-day course of a penicillin G regimen might be indicated.

Neonates with a negative nontreponemal test at birth and whose mothers were seroreactive at delivery should be retested at age 3 months to rule out serologically negative incubating congenital syphilis at the time of birth. Treponemal tests should not be used to evaluate treatment response because the results are qualitative, and passive transfer of maternal IgG treponemal antibody might persist for >15 months.

Neonates whose initial CSF evaluations are abnormal do not need repeat lumbar puncture unless they exhibit persistent nontreponemal serologic test titers at age 6–12 months. Persistent nontreponemal titers and CSF abnormalities should be managed in consultation with an expert.

Special Considerations

Penicillin allergy.

Neonates who require treatment for congenital syphilis but who have a history of penicillin allergy or develop an allergic reaction presumed secondary to penicillin should be desensitized and then treated with penicillin G (see Management of Persons Who Have a History of Penicillin Allergy). Skin testing remains unavailable for neonates because the procedure has not been standardized for this age group. Data are insufficient regarding use of other antimicrobial agents (e.g., ceftriaxone) for congenital syphilis among neonates. If a nonpenicillin G agent is used, close clinical and serologic follow-up is required in consultation with an expert. Repeat CSF examination should be performed if the initial CSF examination was abnormal.

Penicillin Shortage

During periods when the availability of aqueous crystalline penicillin G is compromised, the following is recommended ( https://www.cdc.gov/std/treatment/drug-notices.htm ):

• For neonates with clinical evidence of congenital syphilis (see Scenario 1), check local sources for aqueous crystalline penicillin G (potassium or sodium) and notify CDC and FDA of limited supply. If IV penicillin G is limited, substitute some or all daily doses with procaine penicillin G (50,000 units/kg body weight/dose IM/day in a single daily dose for 10 days).
• If aqueous or procaine penicillin G is unavailable, ceftriaxone (50–75 mg/kg body weight/day IV every 24 hours) can be considered with thorough clinical and serologic follow-up and in consultation with an expert because evidence is insufficient to support using ceftriaxone for treating congenital syphilis. Ceftriaxone should be used with caution in neonates with jaundice.
• procaine penicillin G 50,000 units/kg body weight/dose/day IM in a single dose for 10 days, or
• benzathine penicillin G 50,000 units/kg body weight IM as a single dose.
• If any part of the evaluation for congenital syphilis is abnormal or was not performed, CSF examination is not interpretable, or follow-up is uncertain, procaine penicillin G is recommended. A single dose of ceftriaxone is inadequate therapy.
• For premature neonates who have no clinical evidence of congenital syphilis (see Scenario 2 and Scenario 3) and might not tolerate IM injections because of decreased muscle mass, IV ceftriaxone can be considered with thorough clinical and serologic follow-up and in consultation with an expert. Ceftriaxone dosing should be adjusted according to birthweight.

HIV Infection

Evidence is insufficient to determine whether neonates who have congenital syphilis and HIV infection or whose mothers have HIV require different therapy or clinical management than is recommended for all neonates. All neonates with congenital syphilis should be managed similarly, regardless of HIV status.

Evaluation and Treatment of Infants and Children with Congenital Syphilis

Infants and children aged ≥1 month who are identified as having reactive serologic tests for syphilis (e.g., RPR reactive, TP-PA reactive or EIA reactive, RPR reactive) should be examined thoroughly and have maternal serology and records reviewed to assess whether they have congenital or acquired syphilis (see Primary and Secondary Syphilis; Latent Syphilis; Sexual Assault or Abuse of Children). In the case of extremely early or incubating syphilis at the time of delivery, all maternal serologic tests might have been negative; thus, infection might be undetected until a diagnosis is made later in the infant or child. Any infant or child at risk for congenital syphilis should receive a full evaluation and testing for HIV infection.

International adoptee, immigrant, or refugee children from countries where treponemal infections (e.g., yaws or pinta) are endemic might have reactive nontreponemal and treponemal serologic tests, which cannot distinguish between syphilis and other subspecies of T. pallidum ( 651 ). These children might also have syphilis ( T. pallidum subspecies pallidum ) and should be evaluated for congenital syphilis.

The following evaluations should be performed:

• CSF analysis for VDRL, cell count, and protein
• Other tests as clinically indicated (e.g., long-bone radiographs, chest radiograph, liver function tests, abdominal ultrasound, ophthalmologic examination, neuroimaging, and auditory brain-stem response)

Aqueous crystalline penicillin G 200,000–300,000 units/kg body weight by IV, administered as 50,000 units/kg body weight every 4–6 hours for 10 days

If the infant or child has no clinical manifestations of congenital syphilis and the evaluation (including the CSF examination) is normal, treatment with up to 3 weekly doses of benzathine penicillin G 50,000 units/kg body weight IM can be considered. A single dose of benzathine penicillin G 50,000 units/kg body weight IM up to the adult dose of 2.4 million units in a single dose can be considered after the 10-day course of IV aqueous penicillin G to provide more comparable duration for treatment in those who have no clinical manifestations and normal CSF. All of these treatment regimens should also be adequate for children who might have other treponemal infections.

Thorough follow-up examinations and serologic testing (i.e., RPR or VDRL) of infants and children treated for congenital syphilis after the neonatal period (aged >30 days) should be performed every 3 months until the test becomes nonreactive or the titer has decreased fourfold. The serologic response after therapy might be slower for infants and children than neonates. If these titers increase at any point >2 weeks or do not decrease fourfold after 12–18 months, the infant or child should be evaluated (e.g., CSF examination), treated with a 10-day course of parenteral penicillin G, and managed in consultation with an expert. Treponemal tests (e.g., EIA, CIA, or TP-PA) should not be used to evaluate treatment response because the results are qualitative and persist after treatment, and passive transfer of maternal IgG treponemal antibody might persist for >15 months after delivery. Infants or children whose initial CSF evaluations are abnormal do not need repeat lumbar puncture unless their serologic titers do not decrease fourfold after 12–18 months. After 18 months of follow-up, abnormal CSF indices that persist and cannot be attributed to other ongoing illness indicate that retreatment is needed for possible neurosyphilis and should be managed in consultation with an expert.

Infants and children who require treatment for congenital syphilis but who have a history of penicillin allergy or develop an allergic reaction presumed secondary to penicillin should be desensitized and treated with penicillin G (see Management of Persons Who Have a History of Penicillin Allergy). Skin testing remains unavailable for infants and children because the procedure has not been standardized for this age group. Data are insufficient regarding use of other antimicrobial agents (e.g., ceftriaxone) for congenital syphilis among infants and children. If a nonpenicillin G agent is used, close clinical, serologic, and CSF follow-up is required in consultation with an expert.

During periods when availability of penicillin G is compromised, management options are similar to options for the neonate (see Evaluation and Treatment of Neonates).

• For infants and children with clinical evidence of congenital syphilis, if IV penicillin is limited after checking local sources and notifying CDC and FDA about limited supplies, procaine penicillin G (50,000 units/kg body weight/dose IM up to the adult dose of 2.4 million units a day in a single daily dose for 10 days) is recommended.
• If procaine penicillin G is not available, ceftriaxone (in doses for age and weight) can be considered with thorough clinical and serologic follow-up. Infants and children receiving ceftriaxone should be managed in consultation with an expert because evidence is insufficient to support use of ceftriaxone for treatment of congenital syphilis among infants or children. For infants aged ≥30 days, use ceftriaxone 75 mg/kg body weight/day IV or IM in a single daily dose for 10–14 days (dose adjustment might be necessary on the basis of current weight). For children, ceftriaxone 100 mg/kg body weight/day in a single daily dose is recommended.
• procaine penicillin G 50,000 units/kg body weight/dose IM up to the adult dose of 2.4 million units a day in a single dose for 10 days, or
• benzathine penicillin G 50,000 units/kg body weight IM up to the adult dose of 2.4 million units as a single dose.
• If any part of the evaluation for congenital syphilis is abnormal or not performed, CSF examination is not interpretable, or follow-up is uncertain, procaine penicillin G is recommended. In these scenarios, a single dose of ceftriaxone is inadequate therapy.

Evidence is insufficient to determine whether infants and children who have congenital syphilis and HIV infection or whose mothers have HIV require different therapy or clinical management than what is recommended for all infants and children. All infants and children with congenital syphilis should be managed similarly, regardless of HIV status.

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news Public Health

As congenital syphilis cases soar in U.S., doctors group urges more screening in pregnancy

The american college of obstetricians and gynecologists recommends screenings be done at the first prenatal visit, during the third trimester and at birth..

By The Associated Press

3:05 PM on Apr 18, 2024 CDT

With syphilis cases in U.S. newborns skyrocketing, a doctors group now recommends that all pregnant patients be screened three times for the sexually transmitted infection.

The American College of Obstetricians and Gynecologists issued new guidance on Thursday sayinghe tscreening should be done at the first prenatal visit, during the third trimester and at birth. Though the screening isn’t required, health professionals generally follow the group’s recommendations.

Related: Feds eye Texas as cases of syphilis surge in newborns

“The cases of congenital syphilis are definitely climbing, and they’ve been climbing over the last 10 years. And it’s completely preventable ... It’s unacceptable,” said Dr. Laura Riley, who chairs the Department of Obstetrics and Gynecology at Weill Cornell Medicine and helped with the guidance. “We need to be able to do better diagnostics and treatment.”

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Previously, the group recommended one test in the third trimester — but only for women considered at risk of getting syphilis during pregnancy or those living in communities with high rates of the disease. But this risk-based approach is “how we get into trouble because we’re missing cases,” Riley said.

Related: Study: Plano the 2nd happiest city in the country, while Dallas checks in near the bottom

Earlier this year, the Centers for Disease Control and Prevention said more than 3,700 babies were born with congenital syphilis in 2022, the most in more than 30 years. U.S. health officials called for stepping up prevention, including screening which is done with a blood test.

In its advisory, the OB-GYN group said CDC statistics show nearly 9 in 10 congenital syphilis cases that year “could have been prevented with timely screening and treatment.”

Related: ‘Worse than COVID’: 41% fewer Texas students completed FAFSA this year

Infections during pregnancy are generally treated with at least two doses of penicillin. Babies born to women with untreated syphilis may be stillborn or die shortly after birth. The disease can also cause other problems in newborns, such as deformed bones, severe anemia, blindness or deafness.

“I hope that everyone takes it seriously,” Riley said. Kids with congenital syphilis may have birth defects that can be devastating — “which is incredibly sad.”

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A new york homeowner was arrested for changing the locks after finding a group of squatters in $1 million home she inherited.

In Queens, New York, a homeowner's confrontation with unexpected occupants at her late father's house spiraled into a dramatic legal tangle that highlights the complex issue of squatter rights in the city.

Adele Andaloro, 47, inherited a property valued at $1 million after her parents died. She discovered strangers living there during a visit to prepare the house for sale. When she changed the locks to secure the property, one of the occupants called the police, leading to her brief arrest. Though she faces no charges, the ordeal showcases the difficulties homeowners and law enforcement face with squatters in New York.

According to the Daily Mail, Andaloro voiced her concerns about the effectiveness of local laws, stating, "I'm really fearful that these people are going to get away with stealing my home."

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Neighbors have reported suspicious activity since the occupants moved in.

"We all know what they are up to, so we're all kind of pissed about it," Kosta, a 24-year-old college student living next door, told the news outlet.

Squatter's rights in New York offer a legal framework that can make eviction challenging. After 30 days of occupancy in New York City, squatters can claim legal rights to a property, complicating efforts to remove them. This situation has left Andaloro and her neighbors frustrated as they navigate the legal and social implications of squatter claims.

The incident has sparked a broader discussion on the need for clearer regulations and more support for property owners facing similar predicaments.

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This article A New York Homeowner Was Arrested For Changing The Locks After Finding A Group Of Squatters In $1 Million Home She Inherited originally appeared on Benzinga.com

© 2024 Benzinga.com. Benzinga does not provide investment advice. All rights reserved.

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Readout of ADM Rachel Levine’s visit to Georgia to learn about the impacts of congenital syphilis and syphilis

On Monday and Tuesday, U.S. Department of Health and Human Services (HHS) Assistant Secretary for Health ADM Rachel Levine traveled to Atlanta to hear from community partners and public health leaders how to best address the surge of syphilis and its impact on pregnant people and babies.

ADM Levine met with Centers for Disease Control and Prevention (CDC) leadership, visited Neighborhood Union Health Center to meet with health care providers, and met with Mayor Andre Dickens and LGBTQI+ stakeholders for a roundtable discussion to highlight efforts to spearhead a national congenital syphilis and syphilis public health response.

ADM Levine is chair of the newly established National Syphilis and Congenital Syphilis Syndemic (NSCSS) Federal Task Force.  The group’s mission is to leverage broad federal resources to reduce rates, promote health equity, and share resources with impacted communities.  The HHS Task Force utilizes a syndemic approach because of the complex nature of this public health challenge, in which social and economic environments can exacerbate negative health outcomes.

Actions the NSCSS will focus on during the next 90 days, include:

Working directly with the jurisdictions to maximize syphilis testing, particularly with pregnant people, and promoting sexual health discussions ;  

Expanding equitable access to syphilis testing and treatment in communities with limited health care resources;

Promoting alternative testing locations for pregnant persons beyond traditional prenatal care settings, such as substance use facilities, harm reduction programs, and emergency departments;

Educating health care providers who see pregnant persons about emphasizing syphilis testing, promoting evidence-based sexual health discussions, and ensuring prompt testing and treatment in high-risk counties; and

Working with health departments to identify counties with high syphilis rates, as well as new ways to notify physicians about the need for increased testing, collaborate on reducing barriers to patient care, monitor pregnancy status for timely treatment to prevent newborn syphilis, and facilitate partner notification after diagnosis.

The goal of the HHS Task Force is to avert five percent of congenital syphilis cases by September 2024.

ADM Levine and CDC Director Dr. Mandy Cohen discussed recently released CDC data and the tragic consequences of testing people too late and not receiving appropriate treatment for syphilis, especially during pregnancy. Timely testing and treatment during pregnancy can help keep people healthy and could have prevented 9 out of 10 of the newborn syphilis cases in 2022.

Neighborhood Union Health Center offers free sexual health and drug user health services with a sex positive harm reduction framework, and includes immunizations, child health checks and other services. ADM Levine heard from a variety of health care providers about opportunities for more immediate treatments to help stop the spread of syphilis and save lives, especially those of newborn infants. Participants stressed the need to ensure no one is left behind in addressing the spread of syphilis and getting needed interventions to everyone.

The roundtable focused on the recent alarming increase in congenital syphilis, the increasing prevalence of syphilis, and its frequent overlap with other LGBTQI+ health concerns. One health center serving the Atlanta-area saw 500 deliveries last year, at least 10 positive cases of syphilis, two of which died. Most doctors would not expect to see a single case of congenital syphilis in a baby during their career.

ADM Levine’s trip focused on congenital syphilis because Georgia is one of the 14 priority jurisdictions recently identified by the HHS Task Force as having the highest burden of disease. The Task Force will focus its efforts on Arizona, Arkansas, California, the District of Columbia, Florida, Georgia, Louisiana, Mississippi, New Mexico, New York, Ohio, Oklahoma, South Dakota, and Texas. Together, these jurisdictions make up nearly 75 percent of congenital cases and 50 percent of our nation’s syphilis cases.

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Definition of congenital

innate , inborn , inbred , congenital , hereditary mean not acquired after birth.

innate applies to qualities or characteristics that are part of one's inner essential nature.

inborn suggests a quality or tendency either actually present at birth or so marked and deep-seated as to seem so.

inbred suggests something either acquired from parents by heredity or so deeply rooted and ingrained as to seem acquired in that way.

congenital and hereditary refer to what is acquired before or at birth, the former to things acquired during fetal development and the latter to things transmitted from one's ancestors.

Examples of congenital in a Sentence

These examples are programmatically compiled from various online sources to illustrate current usage of the word 'congenital.' Any opinions expressed in the examples do not represent those of Merriam-Webster or its editors. Send us feedback about these examples.

Word History

Latin congenitus , from com- + genitus , past participle of gignere to bring forth — more at kin

1796, in the meaning defined at sense 1a

Phrases Containing congenital

congenital adrenal hyperplasia

Dictionary Entries Near congenital

congenialness

Cite this Entry

“Congenital.” Merriam-Webster.com Dictionary , Merriam-Webster, https://www.merriam-webster.com/dictionary/congenital. Accessed 26 Apr. 2024.

Kids Definition

Kids definition of congenital, medical definition, medical definition of congenital, more from merriam-webster on congenital.

Nglish: Translation of congenital for Spanish Speakers

Britannica English: Translation of congenital for Arabic Speakers

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FDA approves Pfizer's first gene therapy for rare inherited bleeding disorder

The Food and Drug Administration  on Friday  approved  Pfizer ’s treatment for a rare genetic  bleeding disorder , making it the company’s  first-ever gene therapy  to win clearance in the U.S. 

The agency  greenlit  the drug, which will be marketed as Beqvez, for adults with moderate to severe  hemophilia B  who meet certain  requirements .

The treatment will be available by prescription to eligible patients this quarter, a Pfizer spokesperson told CNBC. It has a hefty $3.5 million price tag, before insurance and other rebates, the spokesperson added, making it by far one of the most expensive drugs in the U.S.

More than 7,000 people in the U.S. are living with the debilitating  condition , which predominantly affects men, according to an  advocacy group . The condition is caused by insufficient levels of a  certain protein  that helps blood form clots to stop bleeding and seal wounds. Without that protein, called factor IX, patients with hemophilia B bruise easily and bleed more frequently and for longer periods of time. 

Beqvez is a one-time treatment designed to enable patients to produce factor IX themselves and prevent and control bleeding. In a late-stage trial, the drug was superior to the often-cumbersome  standard treatment  for hemophilia B, which involves administering the protein multiple times a week or a month through the veins. 

“Many people with hemophilia B struggle with the commitment and lifestyle disruption of regular [factor IX] infusions, as well as spontaneous bleeding episodes, which can lead to painful joint damage and mobility issues,” said Dr. Adam Cuker, director of Penn’s Comprehensive and Hemophilia Thrombosis Program, in a Pfizer  release  on Friday.

Pfizer’s drug “has the potential to be transformative for appropriate patients by reducing both the medical and treatment burden over the long term,” Cuker added. 

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The approval is a big step for Pfizer, which is trying to regain its footing following the rapid decline of its Covid business last year. The company is  betting big on cancer drugs  and treatments for other disease areas to help turn its business around. 

Pfizer is one of several companies to invest in the rapidly growing field of gene and cell therapies. They are one-time, high-cost treatments that target a patient’s genetic source or cell to cure or significantly alter the course of a disease. Some health experts expect cell and gene therapies to replace traditional lifelong treatments that people take to manage chronic diseases. 

Pfizer  gained the rights  to produce and market Beqvez from Spark Therapeutics in 2014. 

The company is offering payers a warranty program to cover patients who receive Beqvez, a spokesperson told CNBC. Pfizer expects that program to offer “financial protections by insuring against the risk of efficacy failure,” they added.

The gene therapy will compete with Australia-based CSL Behring’s  Hemgenix , a similar treatment that  won FDA approval  for hemophilia B in 2022. That drug has a similar list price of $3.5 million in the U.S., before insurance and other rebates. 

Notably, some health experts have said that high costs and logistical issues, among other factors, have  limited the uptake  of Hemgenix and another approved gene therapy for the more common hemophilia A. 

Pfizer also seeks FDA approval for its experimental antibody, marstacimab, to treat hemophilia A and B. The company is also developing a gene therapy for Duchenne muscular dystrophy, a genetic disorder that causes muscles to weaken gradually. 

Annika Kim Constantino covers the biotech and pharmaceutical industry for CNBC Digital.