Understanding the Complex Reproductive Health Needs of Formerly Incarcerated Young Men

PROJECT SUMMARY (30 lines max) Incarceration, which disproportionately impacts minoritized and socioeconomically disadvantaged groups, is a salient form of structural inequality that impedes individuals’ sexual and reproductive health (SRH) and autonomy. Most research in this area, which focuses almost entirely on females, finds that women involved in the criminal justice system have minimal access to SRH services, experience high rates of unplanned and undesired pregnancies, and are more likely to underutilize contraception to help meet their reproductive goals. However, we know almost nothing about the SRH needs and care of young men (aged 15-29) involved in the criminal justice system, despite this group being identified as a “high-priority target population” among SRH experts for at least the past two decades. Instead, the few studies related to justice-impacted men’s SRH have taken a harm reduction approach (e.g., an exclusive focus on sexual risk reduction) that overlooks other facets of men’s reproductive lives. This proposed R21 breaks new ground by focusing on young males’ reproductive attitudes, behaviors, and SRH needs prior to the birth of children, in order to identify upstream social determinants for intervention that contribute to the cycle of disadvantage faced by justice-impacted individuals, their partners, and their families. Informed by the socio-ecological framework of young men’s SRH care, the proposed study will examine formerly incarcerated young men’s SRH attitudes and behaviors, as well as their experiences with, and barriers and facilitators to, accessing SRH education and care. In Aim 1, we will employ secondary, population-based data from the National Survey of Family Growth (NSFG) for the years 2011-2019 to compare SRH outcomes between eligible participants with and without incarceration histories. We will focus on outcomes including risk for unintended pregnancy, need for family planning, and SRH education exposure and care use. In Aim 2, we will conduct semi-structured interviews with recently incarcerated young men (ages 15-29, incarcerated in the past 12 months) who have yet to father children. We will recruit a diverse sample across three regions: the Mid-Atlantic [Maryland], the Midwest [Minnesota], and the Southwest [Texas]. In Aim 3, we will conduct key informant interviews with national and regional justice, medical, and public health experts to elicit their perspectives and experiences pertaining to formerly incarcerated young men’s SRH education and care. We will identify potential intervention approaches using a consensus building methodology. Critically, we will organize a Justice-Impacted Youth Advisory Board for this study to integrate the input of youths with lived experience into all stages of the research. Study findings will inform the development of regionally focused interventions to support the SRH goals, education, and care of formerly incarcerated young men, and will provide critical preliminary data to develop a national agenda for further research centering this neglected and understudied group.