NPS-MatHealth instrument

Attachment A
NPS-MatHealth instrument

NPS-MatHealth

OMB No. xxxx-xxxx: Approval Expires xx/xx/202x

RETURN
Abt Associates
TO

FORM

NPS-MatHealth
(xx-xx-202x)

National Prisoners Statistics Survey
55 Wheeler Street
Cambridge, MA 02138

2023 Maternal
Health Special Data
Collection

US DEPARTMENT OF JUSTICE

BUREAU OF JUSTICE STATISTICS
AND ACTING COLLECTION AGENT
ABT ASSOCIATES INC.

DATA SUPPLIED BY
NAME

TITLE

ADDRESS
TELEPHONE

Area Code

Number

FAX NUMBER

Area Code

Number

E-MAIL ADDRESS

GENERAL INFORMATION
• If you have any questions about completing this form, please contact the Abt Associates Project Director, Jennifer Bronson
(301-347-5647 or [email protected]) or BJS Statistician, Laura Maruschak (202-598-0802 or
[email protected]).
• Please complete the questionnaire before June 28, 2024 by emailing a scanned copy of the form to
[email protected], by mailing the completed form to Abt Associates at the address above, or by FAXing all
pages to 617-218-4500.
• Please retain a copy of the completed form for your records.

WHAT TO ✓ INCLUDE AND ✗ EXCLUDE IN THIS DATA COLLECTION
Facilities
✓ INCLUDE state-and BOP-operated correctional facilities (e.g., prisons, penitentiaries, and correctional institutions; release centers,
halfway houses, boot camps; prison farms; reception, diagnostic, and classification centers; and road camps; forestry and
conservation camps; vocational training facilities; prison hospitals; and drug and alcohol treatment facilities for prisoners).

✗ EXCLUDE private or contracted facilities housing persons under your authority

Admissions
✓ INCLUDE all types of admissions to your prison system, for sentences of any length or any total time served.
✗ EXCLUDE females under your jurisdiction held in local jails or in out-of-state prison facilities

Custody population
Persons physically held in your state- or BOP-operated correctional facilities
✓ INCLUDE
• Persons who are unsentenced or who are sentenced to any length of time.
• Persons who are temporarily absent (less than 30 days), out to court, or on work release.
• Persons held in your facilities who are serving a sentence for your jurisdiction and another
jurisdiction at the same time.
• Persons held in your facilities for another jurisdiction.
✓ EXCLUDE
• Persons held in local jails, private facilities, and in facilities in other jurisdictions.

BURDEN STATEMENT
Under the Paperwork Reduction Act, we cannot ask you to respond to a collection of information unless it displays a currently valid OMB
control number. Public reporting burden for this collection of information is estimated to average 2.5 hours per response, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the
collection of information. Send comments regarding this burden estimate or any other aspects of this collection of information, including
suggestions for reducing this burden, to the Director, Bureau of Justice Statistics, Washington, DC 20531; and to the Office of Management
and Budget, OMB No. xxxx-xxxx, Washington, DC 20503.
Page 1

1. Does your prison system —
Yes

No

Yes

No

Yes

No

b. H
 ave a pre-existing arrangement for
where they would transport a pregnant
women in the event of a pregnancy
emergency or labor...............................

a. Train staff on best practices for housing
and caring for pregnant women............

2. Do any of your correctional facilities —
✓ INCLUDE testing and appointments that are conducted either on or off facility grounds.

Yes
a. Conduct pregnancy tests during intake..
b. Have an on-site medical infirmary or unit
that can care for pregnant women.........

No

f. P
 rovide support services to assist pregnant women
throughout their pregnancy
i. Social workers...........................
ii. Psychologists............................

c. Have 24/7 nursing care or on-call medical
providers for pregnant women...............
d. Conduct a medical appointment with a qualified
pregnancy care provider (e.g. obstetriciangynecologist, a family physician, certified nurse
midwife, women’s health nurse practitioner)
i. Within 2 weeks of a positive
pregnancy test or from admission
if already pregnant.........................
ii. Routinely throughout the pregnancy..
iii. Within 3 weeks after delivery..........
e. Provide pregnant women with
i. Lower bunk assignment.................

iii. Doulas......................................
g. Screen for depression during pregnancy.
h. S
 creen for postpartum* depression........
* Postpartum refers to the period following the birth of a child.

i. Provide the opportunity to pump
breastmilk to maintain milk supply or to
provide to baby or baby’s caregiver......
j. Provide a specialized diet for those
breastfeeding or pumping breastmilk....
k. Have a nursery or residential program
where mothers and infants co-reside....

ii. Extra pillows...................................
iii. Special diet.....................................

If YES to 2k, GO  Q3
If NO to 2k, GO  Q4

iv. Prenatal vitamins............................

3. On December 31, 2023 —
How many women in your custody were participating in a nursery or residential program where
mothers and infants co-reside?

4. Between January 1, 2023 and December 31, 2023 —
a.How many women were admitted to your prison system? .......................................
Count individuals multiple times if they were admitted more than once during this time period.

b. Of the admissions reported in item 4a, how many were tested for pregnancy? .........................
Count individuals multiple times if they were admitted and tested for pregnancy multiple times during this period.

1.How many tested positive for pregnancy? ...............................................................................
Count individuals multiple times if they were admitted and tested positive multiple times during this period.
Page 2

5. On December 31, 2023 —
a. How many women in your custody were pregnant?
IF zero (0) SKIP  Q6

b. Of the pregnant women reported in item 5a, how many were –
White, not of Hispanic origin ....................................................................................................................
Black, not of Hispanic origin ...................................................................................................................
Hispanic or Latino ..................................................................................................................................
American Indian or Alaska Native, not of Hispanic origin ........................................................................
Asian, not of Hispanic origin ...................................................................................................................
Native Hawaiian or Other Pacific Islander, not of Hispanic origin ............................................................
Two or more races, not of Hispanic origin ..............................................................................................
Other racial category, not of Hispanic origin ............................................................................................
Unknown racial category, not of Hispanic origin ......................................................................................
TOTAL (Sum should equal item 5a TOTAL)

6. Between January 1, 2023 and December 31, 2023, how many women while in your custody —
a. Gave birth to a live baby(ies) ..............................................................................................................
b. Experienced a miscarriage .................................................................................................................
c. Experienced a stillbirth .......................................................................................................................
d. Experienced an ectopic pregnancy ....................................................................................................
e. Experienced an abortion (exclude terminations from ectopic pregnancy) ...........................................

END OF SURVEY