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Increasing access to sexual and reproductive health care for youth in custody

Pediatric Research (2024)Cite this article

Youth in custody—defined as youth in carceral facilities including juvenile detention and residential facilities, immigration detention centers, or prisons—are at greater risk for sexually transmitted infections (STIs), unplanned pregnancy, and sexual victimization compared to their peers. Yet, the pediatric community has largely disregarded the sexual and reproductive health needs of youth in custody. To answer the call of “Increasing Access to Quality Healthcare for Youth in Custody,” the 2023–2024 American Pediatric Society president’s issue of the year, we highlight opportunities to address sexual and reproductive health care disparities of youth in custody, including STI screening and testing, contraception, gynecologic care, and pregnancy care. Beyond the 8th amendment, which protects youth from negligent care (“cruel and unusual punishment”), no federal regulations govern sexual and reproductive health care in youth custodial facilities. Sexual and reproductive health care for youth in custody is provided on an ad hoc basis for limited portions of the detained population.1 To address existing gaps, we recommend that pediatric leaders work to ensure that youth in custody: (1) have access to comprehensive, patient-centered sexual and reproductive health care informed by guidelines specific to youth in custody; (2) receive youth carceral-specific pregnancy care, including abortion access and postpartum care; (3) remain safe and free of sexual violence; and (4) are provided a seamless transition of sexual and reproductive health care during re-entry.

Of the 24,894 youth held in United States juvenile detention facilities in 2021, many had limited access to sexual and reproductive health care in their community, contributing to a higher prevalence of STIs compared to their peers. For example, chlamydia infection rates among youth in custody are five to seven times higher than among their non-incarcerated peers.2 National data on HIV prevalence among youth in custody are not available; however, the same behaviors that place youth in custody at higher risk for STIs place them at higher risk for HIV infection. Universal STI screening and treatment for youth in custody can lower STI incidence, prevent the spread of STIs following release, and improve long-term health outcomes.

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Fig. 1: This figure illustrates key statistics concerning sexual and reproductive health care among youth in custody, as detailed in the manuscript.

References

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Acknowledgements

We thank the Medical Writing Center at Children’s Mercy Kansas City for editing this manuscript. April D. McNeill-Johnson is supported by the Frontiers CTSI Career Development Award. (KL2 equivalent supported by Children’s Mercy Hospital via in-kind support through UL1TR002366 – Frontiers University of Kansas Clinical and Translational Science Institute). 7/1/2023 – 6/30/2025.

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Authors and Affiliations

  1. Division of Emergency Medicine, Children’s Mercy Hospitals, Kansas City, MO, Assistant Professor, Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA

    April D. McNeill-Johnson

  2. Associate Professor, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Carolyn Beth Sufrin

  3. Professor of Pediatrics and Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA

    Michael R. DeBaun

  4. Associate Professor, Department of Pediatrics, UCLA David Geffen School of Medicine, Los Angeles, CA, USA

    Elizabeth Barnert

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  1. April D. McNeill-Johnson
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  2. Carolyn Beth Sufrin
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  3. Michael R. DeBaun
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  4. Elizabeth Barnert
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Contributions

April D. McNeill-Johnson developed the initial concepts and draft of the manuscript and led revisions. Carolyn Beth Sufrin made significant revisions to the format and content of the manuscript. Michael DeBaun and Elizabeth Barnert contributed to developing the concepts for the manuscript and critically reviewed the manuscript.

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Correspondence to April D. McNeill-Johnson.

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Competing interests

M.D. and his institution sponsor two externally funded research investigator-initiated projects. Global Blood Therapeutics (GBT) will provide funding for the cost of the clinical studies. GBT was not a co-sponsor of either study. M.D. did not receive any compensation for the conduct of these two investigator-initiated observational studies. M.D. is a member of the Global Blood Therapeutics advisory board for a proposed randomized controlled trial for which he receives compensation. M.D. is on the steering committee for a Novartis-sponsored phase II trial to prevent priapism in men. M.D. was a medical advisor in developing the CTX001 Early Economic Model. M.D. provided medical input on the economic model as part of an expert reference group for the Vertex/CRISPR CTX001 Early Economic Model in 2020. M.D. consulted for the Forma Pharmaceutical company about sickle cell disease in 2021 and 2022. E.B. volunteers as Chair of the Juvenile Health Committee of the National Commission on Correctional Health Care and serves on its Board of Directors. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

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McNeill-Johnson, A.D., Sufrin, C.B., DeBaun, M.R. et al. Increasing access to sexual and reproductive health care for youth in custody. Pediatr Res (2024). https://doi.org/10.1038/s41390-024-03266-5

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