s10826-025-03082-3 by motherhoodbeyondbars

JournalofChildandFamilyStudies

https://doi.org/10.1007/s10826-025-03082-3

BrokenBonds:CaregivingStabilityAmongInfantsExposed PrenatallytoMaternalIncarceration

Accepted:6May2025

©TheAuthor(s),underexclusivelicencetoSpringerScience+BusinessMedia,LLC,partofSpringerNature2025

Abstract

Maternalincarcerationamongolderchildrenhasbeenlinkedtoadverseoutcomesduringchildhood.Lessisknownabout exposuretomaternalincarcerationprenatallyorininfancy.Caregiving-relatedfactors,particularlyinstabilityincaregivers, mayincreasechildren’sriskforpooroutcomes,butfewstudieshaveassessedcaregivingrelationshipsinthisvulnerable population.Thepurposeofthisstudywastoutilizeauniquecohortofinfantsexposedprenatallytomaternalincarcerationto investigatechildren’scaregivingexperiencesininfancy.Weanalyzedclosedandopen-endedsurveyquestionsfrom caregiversof57infantscollectedatbirthandwheninfantswerethree,six,nine,andtwelvemonthsoldtoascertainthe incidenceofchangeincaregivers,whychangeoccurred,andanypredictorsofchange.Wemappedinfants’ care arrangementsusingalluvialplots,calculatedtheincidenceofchangeincaregivers,conductedatextualanalysisofopenendedquestionsandusedCoxproportionalhazardsmodelstoascertainpredictorsofchangeinprimarycaregivers.Results revealedthatinfantsprimarilyremaininthecareofagrandparentorotherkin.Instabilityinprimarycaregiversaffectedone quarterofthesample.One ﬁfthofinfantsexperiencedinstabilityinnon-maternalcaregivers.Theprimaryreasonschildren experiencedachangeinnon-maternalcaregiverswerechildwelfarerelated.Beingplacedwithakinshipcaregiveratbirth wasprotectivefordisruptioninnon-maternalcaregivingrelationships.Ourresultssuggesttheseinfantsareathighriskof instabilityinprimarycaregiving,potentiallypredisposingthemtoadversedevelopmentaloutcomes.Caregiversofinfantsof incarceratedmothersshouldbetargetedforenhancedsocialsupport.

KeyWords Incarceration Infanthealth Attachment Childwelfare

Highlights

● Childrenexposedprenatallytomaternalincarcerationareanunderstudiedpopulationatparticularriskforadverse developmentaloutcomesduetobothprenatalincarcerationrelatedexposuresandcaregivingrelatedpostnatalexposures.

● Thisstudyisthe ﬁrsttoprospectivelyassesscaregivingamongchildrenexposedprenatallytomaternalincarceration duringinfancy,acriticalperiodforchilddevelopment,withaparticularfocusoncaregivinginstability,including predictorsofinstability.Weusedavarietyofdescriptiveandanalyticalmethodstotriangulatechildren’sexperiencesof caregiving.

● Aquarterofchildreninoursampleexperiencedadisruptionincaregivingintheir firstyearoflife,anda fifth experiencedadisruptioninnon-maternalcaregiving.Caregivingdisruptionswereprimarilychildwelfare-related,but alsoincludedreunificationwithformerlyincarceratedmothers,andinformalmovesbetweennon-maternalcaregivers.

● Beingplacedwithakinshipcaregiveratbirth,includingaformerlyincarceratedmother,wasprotectiveagainst instabilityinprimarycaregivers.

* BethanyC.Kotlar bkotlar@hsph.harvard.edu

1 HarvardGraduateSchoolofArtsandSciences,Cambridge,MA, USA

2 BystroAI,Boston,MA,USA

3 EmoryUniversity,Atlanta,GA,USA

4 HarvardT.H.ChanSchoolofPublicHealth,Boston,MA,USA

5 JohnsHopkinsSchoolofMedicine,Baltimore,MD,USA

6 UniversityofMinnesotaMedicalSchool,Minneapolis,MN,USA

PrenatalandPostnatalIncarceration

TheUnitedStates(US)hasthehighestincarcerationratefor womenintheworld(Fair&Walmsley, 2022).In2022, approximately180,700womenandgirlswereincarcerated intheUS(Carson&Kluckow, 2023;Zeng, 2023).Ina 2016surveyofincarceratedwomeninstateprisons,58% wereparentswithminorchildren,andapproximately16% ofthesechildrenwereaged4yearsoryounger(Maruschak etal., 2021).Furthermore,anestimated4%ofwomenin stateprisons,and3%ofwomenincountyjailswere pregnantatadmission(Sufrinetal., 2019;Sufrinetal., 2020).Asubstantialbodyofresearchhasdocumentedthe targetingofmarginalizedracialandethnicgroupsandpoor peoplebythecriminallegalsystem(Alexander, 2012;Pettit &Western, 2004;Roberts, 1997).Indeed,Blackpregnant andparentingwomenhavebeenparticularlycriminalized (Sadler, 2021).Inaddition,incarceratedpregnantwomen aremorelikelytoreportmentalhealthissues,substanceuse, andexposuretotraumaticevents(Knight&Plugge, 2005). Bothstructuralmarginalizationandmaternalriskfactors predisposechildrenofincarceratedmotherstosubsequent developmentalissues(Dallaireetal., 2015).

Beyondthesepregnancyandpre-pregnancyriskfactors foradversechildhealthconsequences,maternalincarcerationduringpregnancyandinfancyishypothesizedtobe particularlydamagingtochilddevelopmentviaseveral pathways.Thecontextofincarcerationmaycompoundthe inﬂuenceofpre-incarcerationtrauma,substanceuse,and mentalhealthissuesonchildhealthoutcomesviaasuboptimaluterineenvironmentcharacterizedbysubstandard prenatalcare(FersztandClarke, 2012),poornutrition (Shlaferetal., 2017;Vitaglianoetal., 2024),andharmful practicessuchasshacklingorsolitaryconﬁnement(Jensen, 2021).Indeed,asmallbodyofliteraturehaslinkedpregnancyduringincarcerationwithadversebirthoutcomes, suchaslowbirthweightandpretermbirth(Howardetal., 2010;TestaandJackson, 2020).

Infantswhoareborntoincarceratedmothersmaybe exposedtofurtherriskfactorsforadversedevelopment. Whilesomefacilitiesallowwomenwhogivebirthduringincarcerationtoresidewiththeirinfantforayearor morepost-birth,theseprogra msarefewandrestrictedto asubsetofmotherswithshortersentences(Jensen, 2021 ; Kotlaretal., 2015 ).Mostinfantsbornduringtheir mothers ’ incarcerationareroutinelyseparatedfromtheir mothersshortlyafterbir thandplacedwithanonmaternalcaregiverlivingint hecommunity(Kotlaretal., 2025 ).Forinfantsbornduringtheirmothers ’ incarceration,additionalfactorsrelatedtomaternalincarceration mayleadtoadversedevelopmentaloutcomes,including risksassociatedwithchildren ’ scaregivingenvironments,likepovertyandcaregivermentalhealth,aswell

asdisorderedattachmentcausedbyunstablecaregiving relationships.

TheoreticalFrameworksforMaternal IncarcerationandChildWellbeing

ResearchershaveusedframeworksintegratingBronfenbrenner’sdevelopmentalecologicalmodel(Bronfenbrenner, 1979)andBowlby’sattachmenttheory(Bowlby, 1999)tounderstandhowpostnatalmaternalincarceration negativelyimpactschilddevelopment(Arditti, 2005;MurrayandMurray, 2010;Poehlmannetal., 2008).The developmentalecologicalmodelpositsthatchilddevelopmentisinﬂuencedbycomplexreciprocalrelationships betweenthechildandtheirsocialenvironment,which Bronfenbrennerproposedexistedatfourbroad,nested levels,themicrosystem,mesosystem,exosystem,and macrosystem,eachofwhichinteractwitheachotherto shapeachild’slivedcontextandthusdevelopment(Bronfenbrenner, 1979).Whileallfoursystemscomeintoplayto shapechilddevelopment,themicrosystem,orthesystems andgroupsthatdirectlyimpactthechild’sdevelopment, particularlythechild’sfamily,isespeciallyimportantin infancy.Attachmenttheoryarguesfortheimportanceofa warmandengagedprimarycaregivingrelationshipduring childhoodforhealthysocialandemotionaldevelopment overthelifecourse.Bowlbypositedthattheabsenceor disruptionofthisrelationshipcanleadtoadversedevelopmentaloutcomes,particularlyforsocialdevelopment (Bowlby, 1999).Withinthecontextofearlylifematernal incarceration,childrenborntoincarceratedmothersare deprivedtheabilitytodevelopastrongattachmenttotheir motherduetoearlylifeseparation(Jensen, 2021).Thus, stableattachmenttotheircaregiverduringtheirmothers’ incarcerationisanimportantpotentialpredictorofdevelopmentaloutcomes.

Maternalincarcerationduringtheprenatalandpostnatalperiodsthreatenstheinfant ’ sabilitytodevelopand maintainasecureattachmenttoaprimarycaregiverat everyleveloftheecologicalmodel.Atthemacrosystem, theUScultureofpunitiveresponsestocrimes,particularlysubstancedependence,hasshapedthecurrent criminallegalsystem.This systemisprimarilycharacterizedbythefrequentincarcerationofpregnantand postpartumwomenandforcedma ternal/infantseparation atbirth(Jensen, 2021 ;Kotlaretal., 2015 ).Inmoststates, incarceratedwomenarecon ﬁ nedinprisonsandjails regardlessoftheirpregnancystatus.Furthermore,ifa womangivesbirthduringherincarceration,sheistypicallyseparatedfromhernewborn,whoisplacedwitha non-maternalcaregiverfortheremainderofthewoman ’ s incarceration(Jensen, 2021 ).

WithintheU.S.criminallegalsystem,incarcerated womenareconfinedattwodistincttypesoffacilities:jails andprisons.Carceralfacilitiesandtheirpolicies,while structurallybelongingtotheexosystem,infl uencethelower systemsbyconstrainingwhetherandtowhatextentthe motherisinvolvedwithherchild’slife.Althoughpolicies differbystatesandcounties,womenheldinjailareeither awaitingtrialorsentencingorareservingatermoflessthan ayear.Incontrast,womenconfinedinprisonshavetypicallybeensentencedtoatermofayearormore.Whethera motherisincarceratedatthecountyjailorstateprisoncould influencechildwellbeingbydeterminingthelengthofthe child’sseparationfromtheirmother(Poehlmannetal., 2008).Becausemothersincarceratedinjailstypicallyhave shortersentences,separationfromherchildisonaverage muchshorterthanformothersincarceratedinprison.Inthe caseofpregnancyduringincarceration,mothersmayserve ashortsentenceinjail,butbereleasedbeforethebirthof thechild.

Carceralfacilitiesalsodeterminetheamountofcontact infantsandtheircaregivershavewiththeincarceratedmother. Jailsareoperatedatthecountylevel,andthusarevariedin theircapacitytosupportvisitationandcontactbetweenan incarceratedmotherandherinfant(microsystem)orthe incarceratedmotherandherchild’scaregiver(mesosystem). Jailstypicallyhavefewerresourcesandpoliciesthanprisons surroundingfamilyvisitation,oftenforegoinginpersonvisitationentirelyinfavorofvideovisitation(Poehlmann-Tynan andEddy, 2019).Videovisitationiswoefullyinadequateto thedevelopmentalneedsofinfants,whorelyonphysical proximity,cleareyecontact,andserveandreturninteractions toformrelationships(Poehlmannetal., 2008).Thus,the facilityinwhichanincarceratedmotherisheldisakey exosystemlevelfactorinﬂuencingthedevelopmentofinfants exposedprenatallytoincarceration.

Beyondthepoliciesuniquetocarceralfacilities,maternal involvementinthecriminallegalsystemthreatensthe infant’sdevelopmentbyimpactingacaregiver’scapacity (whethertheprimarycaregiveristheinfant’smotherora non-maternalcaregiver)toprovideappropriateandstable careforthechild.Childrenwithincarceratedmothersare mostfrequentlycaredforbyotherrelatives,typically grandparents(RodriguezCarey, 2019;Glaze&Maruschak, 2008;Pendletonetal., 2021;Kotlaretal., 2025),although studiesassessingcaregivinginthecontextofprenatal exposuretoincarcerationassessedcaregivingretrospectively.Grandparentalcareofolderchildrenofincarceratedmothershasbeenassociatedwithmoremotherand childcontactandhigherlikelihoodofherfuturereuni ﬁcationwithherchildrenthanothercarearrangements(Loper &Clarke, 2013),however,thiscomesataprice.Studies haveshownthatcaregiversofchildrenofincarcerated mothersstrugglewithpoverty(Pendletonetal., 2021),and

otheradversitiessuchasfoodinsecurity(Cox&Wallace, 2013),andhousinginstability(Shaw, 2023).Furthermore, thereisevidencethatfamiliesofincarceratedmothersare negativelyimpactedbyherincarcerationthroughlossofher income(Glaze&Maruschak, 2008),potentiallossofchild support(Ardittietal., 2003),andthesigniﬁcantcostoflegal ﬁnesandfeesandofmaintainingcontactwithanincarceratedmother(Sandiford, 2007).Inaddition,thestressof theincarcerationofafamilymembermayleadcaregiversto experiencepoormentalhealthorengageinharshparenting styles,whichhavebeenshowntoincreaseinternalizingand externalizingbehaviorsinschool-agedchildrenofincarceratedmothers(Dallaireetal., 2015).Inasampleof childrenbetweentheagesoftwoandsevenexperiencing maternalincarceration,Poehlmann(2005a)foundthat caregiversociodemographicriskfactorssuchaspoor health,lowereducationalattainmentandhighernumberof dependentspositivelypredictedlowercognitivescores,but thisrelationshipwasmediatedbyawarmandsupportive familyenvironment.However,thishasnotbeeninvestigatedinchildrenexposed prenatally tomaternalincarceration,whoexperiencecaregivingduringinfancy,a criticalperiodforchilddevelopment.

CaregiverStabilityintheContextof MaternalIncarceration

Onlyonestudyhasinvestigatedcaregivingrelationshipsof infants ofincarceratedmothers.Pendletonetal.,retrospectivelyinterviewed30caregiversofinfantsofincarcerated mothersinaMidwestprison(2021).Aquarterofcaregivers inthissamplereportedlivingbelowtheFederalPovertyLine (FPL)and37%reportedhavingtoworklessbecauseof assumingcareoftheinfant.Caregiversalsodescribedstress relatedtoenrollinginsocialservicesandworseninghealth duetocaregiverresponsibilities(2021).Whileexposureto household-leveladversitylikepovertyandcaregiverdistress candirectlyimpactchildren’sdevelopment,theseriskfactors mayalsoincreasethelikelihoodthatchildrenexperience instabilityinprimarycaregivers.

AsBowlbyasserted,disruptionsinprimarycaregiving relationshipscanpredisposechildrentoadversesocialand behavioraldevelopment(1999).Inthecontextofmaternal incarceration,changesinprimarycaregiverscouldoccurifa childismovedfromoneprimarycaregivertoanotherduring themother’sincarcerationeitherbychildwelfareorbythe child’scaregiver,ifthemotherresumesexclusivecareofthe childonherrelease,orifamotherwhowasreleasedbefore herchildwasbornorresumedcareofthechildafterher releaseisreincarceratedorrelapses,relinquishingcustodyof thechild.Thereisemergingevidencethatmaternalincarcerationduringthepostnatalperiodleadstoinstabilityin

primarycaregivingrelationships-abruptchangesinwho providescareforthechild-overandabovematernal separationatbirth.Asinglestudysuggeststhatcaregivingin thecontextofmaternalincarcerationfrombirthishighly unstable.Pendletonetal.,foundthatonly45%ofcaregivers interviewedhadretainedcustodyofthechildbeyondthe ﬁrst yearoflifeandoftheseonlyaquarterhadmovedintothe careoftheirmotherafterherreleasefromprison.However, Pendletonetal.,werenotabletoassesswhythesechangesin non-maternalcaregiversoccurredduetoaretrospective design.Oneunderstudiedpossibilityforinstabilityinprimary caregivingthatoccursduringamother’sincarcerationischild welfareremoval.Researchershavedocumentedthedisproportionatenumberofchildwelfarecasesandchild removaloccurringinfamiliesminoritizedduetoraceand poverty(Kimetal., 2017;Roberts, 2022;Wildeman& Emanuel, 2014),whoarethefamiliesthataremostoften targetedformassincarceration.

Reuni ﬁcationwiththeincarceratedmotheruponher releasemayalsobeasourceofinstabilityinprimarycaregivingrelationships.Evidencefromresearchwithincarceratedmothersofolderchildrensuggeststhatchildren rarelyvisitmothersduringtheirincarceration(Poehlmann etal., 2008).Forinfantsseparatedfromtheirmothersat birth,in-personvisitswiththeincarceratedmotherwouldbe theonlydevelopmentallyappropriatewaytobuildand maintaintheirrelationship.Thus,mostinfantswithincarceratedmotherswouldhavebeendeprivedoftheabilityto formasecureattachmentwiththeirmothers(Poehlmann, 2005b),andwouldinsteadhavebondedprimarilywiththeir non-maternalcaregiver.Ifformerlyincarceratedmothers assumeexclusivecareoftheirchildrenonuponrelease, childrenmaybeatincreasedriskofdisruptionsintheir attachmentrelationships.

Finally,infantsmaybeatriskofdisruptionsincaregiving inthecontextofreincarcerationorrelapseofamotherwho hasservedasaprimarycaregivereitherfrombirthorfora periodafterherreleasefromincarceration.Studiesonthe stabilityofmaternalcaregivingpost-incarcerationarerare.A singlestudyofmothersandtheirinfants,whohadresided togetherinaprisonnurseryduringthemother’sincarceration, foundthatonreleasefromprison,17%ofmotherswereno longertheprimarycaregiversoftheirinfantattheendofone yearduetorelapseorreincarceration(Byrneetal., 2012).

Abruptearlylifechangesinprimarycaregiversputs infantsatriskfordisorderedattachment,aknownriskfactor foradversecognitiveandsocialandemotionaldevelopment (Schuengeletal., 2009).Astudyofchildrenwhoparticipatedinaprisonnurseryprogramwiththeirincarcerated mothersfoundthatchildrenhadmoresecureattachmentas comparedtochildrenwhosemotherswereincarceratedafter theywereborn,duringinfancyortoddlerhood(Byrneetal., 2010),suggestingthatmaternalseparationplacesinfantsat

riskofdisorderedattachment.Evidencefromstudieswith olderchildrenhasalsoshownthatcaregiverchangesduring themother’sincarcerationputschildrenatfurtherriskof attachmentissues.Inastudyconductedinasampleof2–7year-oldchildrenwithincarceratedmothers,morenonmaternalcaregivinginstabilitywasassociatedwithahigher riskofinsecureattachment(Poehlmann, 2005b).

Thus,exposuretomaternalincarcerationintheprenatal andpostnatalperiodsrepresentsasigni ﬁcantthreattochild andfamilywellbeingthathasthepotentialtoseverely disruptprimarycaregiverstabilityduringarecognized sensitiveperiodforthedevelopmentofattachmentrelationships.Yet,therehasbeenamarkedlackofresearchinto theprevalenceofdisruptedcaregivingoritspotentialpredictorsinthispopulation.Itisimperativetofullyunderstandcaregivinginthecontextofmaternalincarceration, particularlypredictorsofdisruptedcaregiving,tobuild evidence-basedpoliciesandprogramsthatcanprotect vulnerablechildrenandtheirfamilies.

TheCurrentStudy

Thepurposeofthisexploratorystudyisto fillacriticalgap intheliteraturebycharacterizingcaregivingrelationships forinfantsexposedprenatallytotheirmother’sincarcerationinthe fi rstyearoflifeandidentifypredictorsofcaregiverstability.Toachievethisgoal,wedrewdatafromthe BirthBeyondBarsStudy(BBBStudy),amixedmethods birthcohortofchildrenexposedprenatallytomaternal incarceration.Thisstudyrepresentsauniquedatasetthat includesassessmentsofinfantsofincarceratedandformerly incarceratedmothersandanynon-maternalcaregiversfrom birthuntil12months.Utilizingresponsesfrombothclosed andopen-endedsurveyquestionsfromthisdataset,we conductedalongitudinalanalysisofprimarycaregiving relationshipsoftheseinfantstoanswerseveralresearch questions.First,whocaredforinfantsintheir firstyearof life?Howwerecaregiversrelatedtotheinfant,andwhat sociodemographicriskfactorsweretheyexperiencingwhen theyassumedcareoftheinfant?Second,howoftendid infantsexperienceachangeinprimarycaregivers?Third, whydidanychangesinprimarycaregivingoccur?Finally, werethereanysociodemographicfactorsthatpredicted instabilityinprimarycaregivingrelationships?

Method Participants

Atotalof57infantsandtheirprimarycaregiverswere includedinthisstudy.WhilerecruitmentintheBBBStudy

isoccurringinthreestates(Maine,Pennsylvania,and Georgia),Georgiawaschosenasasingledatasourceasit hadthemostrobustdatacollection.Infantswhosemothers wereincarceratedinprisonorjailinGeorgiaatsomepoint duringtheirgestationwereeligibleforinclusion.Data collectionintheBBBStudyinGeorgiaisongoing,and researcherscurrentlyfollowchildrenuntiltheirthirdbirthday.Thecurrentstudyutilizesassessmentsconductedinthe ﬁrstyearofthechild’slifefromchildrenenrolledbetween August2020andMay2023.DatawerecollecteduntilMay 2024.Assessmentswereconductedbetweenbirthandsix weeksofage,andwhenthechildwas3,6,9,and 12monthsold.

Procedures

Thestudyteamapproachedalleligibleinfants ’ primary caregivers,eithermothers,fathers,ordesignatednonmaternalcaregivers,forenrollmentinthestudyduring pregnancyoratthebirthofthechild.Samplingtookplace incollaborationwithMotherhoodBeyondBars(MBB),a nonpro fi torganizationservingincarceratedpregnantand postpartumwomenandtheirfamiliesinthestateof Georgia.MBBstaffapproachedallparticipantsreceiving nonpro fi tservicesforenrollmentinthecohort.Nonmaternalcaregiversofchildrenborntowomenincarceratedinprisonwereapproachedbynonpro fi tstaffatthe birthinghospital.Formerly incarceratedmotherswere approachedbynonpro fi tstaffoverphoneattheirrelease fromprisonorjail.Primarycaregiversof86infantswere approachedduringthestudyperiod.Ofthe29familiesnot retainedinthestudy,eightinfantswereplacedintochild welfarecustodyfrombirthandtheirfosterparents declinedtoparticipate.Theremaining21families declinedtoparticipateorcouldnotbereached.Fiftyseveninfantsandtheirprimarycaregiversenrolledinthe studyand88%ofthesewereretainedinthestudyforone year( fi veinfantswerelosttofollow-upbeforetheir fi rst birthday).

InterviewswereconductedbyBKorbynonpro ﬁtstaffat MBB.Allinterviewersweretrainedinthedatacollection instrumentbyBKandcompletedHumanSubjectsResearch training.Interviewerscollecteddataviaaguidedphoneor videointerviewcontainingapreliminarysemi-structured interviewfollowedbyaquantitativesurvey.Thechild’s currentprimarycaregiverparticipatedineachguided interview.Participantswerecompensated$25aftereach interview.Responsestoclose-endedsurveyquestionswere collecteddirectlyintoHarvardMedicalSchool’sResearch ElectronicDataCapture(RedCAP)system.Interviewswere alsoaudiorecordedandtranscribedverbatimtocapture open-endedquestionresponses.TheHarvardLongwood MedicalIRBapprovedtheBBBStudy(20-1215;21-1247).

Measures

CaregiverSociodemographicCharacteristics

Interviewersaskednon-maternalcaregiverstoidentifytheir relationshiptotheinfant.Fordescriptiveanalyses,we groupedrelationshipsbymothers,fathers,grandparents, othermaternalkin,otherpaternalkin,fosterparent,and non-kin.Wemergediterationsofsteporcommon-law relativeswiththeirrespectiverelativecategories.Two maternalgreatgrandparentswereincludedinthegrandparentcategory.Forlongitudinalanalyses,researchers groupedrelationshipsas “kin,” whichincludedallkinship categories,includingparents,and “non-kin”,whichincludedcaregiverswithnokinshiprelationshipwiththeinfant andfosterparentsnotbiologicallyrelatedtotheinfant. Therewerenoadoptiveparentsinoursample.

Inadditiontothecaregivers’ relationshiptotheinfant, interviewersassessedthefollowingsociodemographic characteristicsatbaseline:primarycaregiver’sage,sex, race/ethnicity,educationalattainment,householdincome, householdsize,andcaregiver’smentalhealth.Toassess educationalattainment,participantswereaskedtoreportthe highestlevelofschoolingtheycompleted.Weselected caregiverrace,poverty,andmentalhealthasimportant potentialpredictorsofinstabilityincaregiving.Allcaregiverseitheridentifi edasBlack/AfricanAmericanorWhite. Duetothedisproportionatechildwelfareinvolvementof Blackfamilies,weincludedidentifyingasBlackasa potentialpredictorofcaregiverinstability.Weclassi fied childrenaslivinginpovertyifthecombinedhousehold incomeandhouseholdsizefellbelowtheFederalPoverty Line(FPL).Specifi cthresholdswereuseddependingonthe yearinwhichtheinterviewoccurred.Interviewersassessed caregiverdistressthroughtheKessler6,a6-itemdistress instrumentwhichusesa5-pointLikertscaleandisscored between0and24(Kessleretal., 2003).TheKessler-6has highinternalvalidityasassessedthroughfactoranalysisand hasbeenvalidatedinavarietyofpopulations(Mewton etal., 2016).Weclassi fiedinfantsaslivingwithaprimary caregiverwithdistressiftherespondentscored5orabove ontheKessler6.Basedonavaliditystudy,scoresof5or aboveontheKessler6areclassifi edasmoderatedistress andscoresof13andaboveasseveredistress(Prochaska etal., 2012)

ChangeinCaregivers

Wedeﬁnedachangeincaregiverasthecessationofcareby apreviouscaregiverthatwasperceivedaspermanentor lastedmorethanonemonth.Wedidnotincludeshortterm ortemporarychangesinprimarycaregivers,suchasrelocationofthechildduetothecaregiver’stime-limitedillness

orcompletionofarehabprogram.Whenaprimarycaregiverchangewasidenti ﬁedthroughstudyorprogrammatic activities,thestudyteamworkedtoidentifyandenrollnew primarycaregivers.Insomecases,intakeinterviews occurredwhenthechildwas3monthsoldorolder.Inthese instances,interviewerswererequiredtoindicatewhether theparticipanthadcustodyofthechildfrombirth,butcould notbereached,orwhethertheparticipantwasanew caregiverofthechild.Ifthelatterwasindicated,interviewerswererequiredtocompleteanopen-endedresponse detailingthecircumstancesofthechangeincaregiversas describedbytheparticipant.

Toascertainthereasonforchangesincaregivers,participantswereaskedatthebeginningofeachfollowup: “Are youanewcaregiverof[infantname]?” Ifrespondents answeredyes,interviewersthenasked “Whyareyou assumingcareofthischild?” and “Howdidyoubecomethe caregiverof[childname]”?Theageofthechildinmonths whenthenewcaregiverassumedcarewasalsorecorded.If newcaregiversrefusedstudyparticipation,weaskedMBB stafftorecordtheageofthechildinmonthswhenthechild leftthecareoftheirpreviouscaregiverandtherelationship ofthenewcaregivertothechild.

Analyses

CaregiverSociodemographicCharacteristicsatBaseline

Wecalculatedmeans,frequencies,andstandarddeviations (whereappropriate)ofinfantsexandrace/ethnicity;caregiverage,sex,race/ethnicity,relationshiptotheinfant,level ofeducation,andwhethertheyexperiencedpovertyor distressatintake.

PatternsofCaregiving

Tounderstandprimarycaregivingrelationshipsovertime, weplottedthetrajectoriesofcaregivingrelationshipsusing alluvialplots.Alluvialplotsusevariablewidthribbonsto visualizechangeincategoricalvariablesinlongitudinaldata (Brunson, 2020).Eachlinerepresentsonechild.Barsat eachtimepointrepresentthenumberofinfantsinthat category. “Flows,” orlinesthatmovefromonecategoryto anotherbetweentimepoints,indicatedinfantsthatmoved caregiversbetweentheassessmentperiods.

First,wecreatedanalluvialplotmappingthenumberof caregivingrelationshipsexperiencedbyeachchild.Inthis alluvialplot,wemappedwhetherchildrenwerebeingcared forbytheirmotheror ﬁrst,second,orthirdnon-maternal caregiverateachtimepoint.Ifmotherswerereleasedand weresharingcarewiththeirchild’spreviouscaregiver,we denotedthisas “Sharedcare.” Tobetterunderstandthe relationshipsofcaregiverstotheinfantwethenmapped

kinshiprelationshipsofcaregiverstotheinfantovertime.In eachplottoaccountforattritioninfantslosttofollowup wereindicatedbythecategory “Lost.”

CaregiverStability

Toanswerourthirdresearchquestionrelatingtothestabilityofprimarycaregiversinthispopulation,wedescribed childexperiencesofchangeinprimarycaregiversoverthe ﬁrstyearoflifeintwoways.First,toquantifytheextentof primarycaregiverinstability,wecalculatedtheincidenceof changeinanyprimarycaregiverbetweenbirthandone year.Wealsocalculatedtheincidenceofchangeinnonmaternalprimarycaregivers.

ReasonsforChangesinCaregiving

Tocharacterizewhychangesinprimarycaregiversoccurred,weconductedatextualanalysisofresponsestothe open-endedquestionsposedtonewprimarycaregivers: “Whyareyouassumingcareofthischild?” And “Howdid youbecomethecaregiverof[childname]”?Wethen assessedrationalesforchangeinprimarycaregiverfortheir abilitytobegroupedintosimilarcategories.

PredictorsofCaregiverStability

Toanswerour fi nalresearchquestiononpredictorsof caregiverstability,weconductedaseriesofCoxproportionalhazardsmodels.Aswewereprimarilyinterestedin caregiverinstabilityduringmaternalincarceration,theevent wasdefinedasa firstchangeinnon-maternalprimary caregivers.Tounderstandpotentialpredictorsofthehazard rateofchangeinprimarycaregiversweran fi vemodels, fourassessingasinglepredictorofexperiencingatleastone disruptioninnon-maternalcaregiversandoneassessinga compositescoreofallfourpotentialpredictors.Totestfor proportionalityofhazards,akeyassumptionoftheCox model,weranaglobalSchoenfeldtestofscaledSchoenfeld residualsforeachmodel(Grambsch&Therneau, 1994).

Predictorswereselectedbasedonaliteraturereviewas wellassubject-matterknowledgeashavinghighlikelihood ofinﬂuencingwhetheracaregiverchoseorwascompelled torelinquishcareoftheinfant.Potentialpredictorsassessed werea)whetherthecaregiverhadakinshiprelationship withthechild,b)whetherthecaregiverlivedundertheFPL atthebirthofthechild,c)whetherthecaregiverexperiencedmoderateorseveredistressatthebirthofthechild, andd)whetherthecaregiveridenti ﬁedasBlackorAfrican American.Eachpotentialpredictorwasoperationalizedasa binaryvariable.

Thesemodelsarebasedon656totalperson-months.The medianlengthoffollow-upwas12months.Sixinfants

werecensoredbeforereaching12monthsoffollow-up. Fivecouldnotbereachedforfollow-upinterviews.The averageageinmonthsatwhichinfantswerecensoreddue toattritionwas6.6months.Onechilddiedat11months.

Results

CaregiverSociodemographicCharacteristics

Amongthe57infantsinthesample,themajoritywere female(n = 31,54.4%).Approximatelyhalfoftheinfants wereeitherBlack(n = 20)ormixedrace(BlackandWhite) (n = 8).Oneinfantwasidenti fiedasNativeAmericanor AlaskanNative,andoneinfantwasidenti fiedasBlackand Paci ficIslander.Atbirth,82.5%(n = 47)infantswerecared forbynon-maternalcaregivers.Teninfants(17.5%)were caredforbytheirformerlyincarceratedmothers,allof whomwerereleasedbeforethebirthoftheinfantfromjail. Primarycaregiversweremostlikelytobegrandparentsof theinfant(49.1%, n = 28),primarilymaternalgrandparents (75%).Ninewereotherrelatives(15.8%),again,primarily maternalkin(77.8%).Fourcaregivers(7%)werefathers. Sixcaregivers(10.5%)hadnokinshiprelationshipwiththe infant;oneofwhomwasafosterparent(16.7%),and five (83.3%)werefriendsoracquaintancesofthemother.These includedtwocaregiversthemothermetinjailandwere releasedpriortothebirthofthechildandonestrangerthe mothercontactedafterhearingshewaswillingtotake childrenofincarceratedwomen.

Mostprimarycaregiversidentifi edaswomen(89.5%, n = 51).Theaverageageofprimarycaregiverswas44 years(SD11.5),witharangeof24–71years.Overathird ofcaregiversidentifiedasBlack(38.6%, n = 22),withthe remainingidentifyingasWhite.Seventy fi vepercentof caregivershadahighschooldiplomaorless(n = 43)and overone-third(40.4%)livedundertheFPL(n = 23).Seven caregivers(12.3%)scoredinthemoderateorsevere depressionrangeontheKessler6.SeeTable 1.

CaregiverStability

Changesinprimarycaregiversoccurredwhenachildwas movedfromonenon-maternalcaregivertoanother,whena childwasmovedfromthecareofanon-maternalcaregiver tothesolecareoftheirreleasedmother,andwhenachild whohadbeencaredforbytheirmotherfrombirthwas movedtothecareofanon-maternalcaregiver.Duringthe ﬁrstyearofinfants’ lives,15(26.3%)infantsexperiencedat leastoneofthesedisruptionsinprimarycaregiving relationships.

Table1 Participantcharacteristics

Infants(n = 57)

Sex = Female31(54.4%)

Ethnicity = HispanicorLatinx5(8.8%)

Race

White26(45.6%)

BlackorAfricanAmerican21(36.8%)

MixedRace9(15.8%)

Unknown1(1.8%)

PrimaryCaregiversatIntake(n = 57)

RelationshiptotheChild

Mother10(17.5%)

Father4(7.0%)

Grandparent28(49.1%)

Maternal21(75%)

Paternal7(25%)

OtherKin9(15.8%)

Maternal7(77.8%)

Paternal2(22.2%)

Non-kin6(10.5%)

Fosterparent1(16.7%)

Averageage44(SD11.5)

Sex = Female51(89.5%)

Ethnicity

HispanicorLatinx2(3.5%)

Non-HispanicorLatinx53(93%)

Missing2(3.5%)

Race

BlackorAfricanAmerican22(38.6%) White35(61.4%)

EducationalAttainment

Somehighschool,nodegree6(10.5%)

GEDoralternativecredential7(12.3%)

Highschooldegree30(52.6%)

Associateorbachelor’sdegree7(12.3%)

Master’sorprofessionaldegree3(5.3%)

Missing4(7.0%)

LivingUndertheFederalPovertyLine

Yes23(40.4%)

Missing5(8.8%)

ModerateorSevereDistress

Yes7(12.3%)

Missing2(3.5%)

Duringthestudyperiod,sixteenmotherswerereleased fromprison.Themajorityofreleasedmothersreported livingwithandsharingcareoftheinfantwiththeirformer caregiver( n = 11,68.8%).However,fourmothers reportedresumingsolecustodyofthechildontheir release,contributingtothequarterofinfantswho experiencedatleastonechangeinprimarycaregivers.See Table 2

Eleven(19%)infantsexperiencedachangeinprimary caregiverotherthanreuni ﬁ cationwiththeirformerly incarceratedmother,threeofwhichoccurredwhenachild wasintheirmother ’ scarefrombirthandwasmovedtothe careofanon-maternalcaregiverduringthestudyperiod. Fivechildrenexperiencedmorethanonedisruptionin primarycaregiver(7%).

Figure 1 illustratesthenumberofchildrenlivingwiththeir mother,or ﬁrst,second,orthirdcaregiverduringthe ﬁrstyear oftheirlife.Several(n = 5)childrenwerelosttofollowup (indicatedinFig. 1 by “Lost”),andonechilddiedduringthe studyperiod.Thischild’scauseofdeathwasundetermined. Thenumberofchildrenonlyhavingexperiencedoneprimary caregiverdeclinedfrom79–47%betweenbirthandtwelve

Mothersreleasedinthe ﬁrstyear(n = 16)

AgeoftheChildatMother’sRelease

Lessthan3months2(12.5%)

4–6months6(37.5%)

7–12months8(50%)

CaregivingArrangementsPost-Release

Mothertooksolecustody4(25%)

Caregiverretainedsolecustody1(6.3%)

Motherandcaregiversharecaregiving11(68.8%)

months,whilethenumberofchildrencaredforbytheirmother (18%by12months)orinasharedcarearrangement(14%by 12months)increasedduringthestudyperiod.By12months, 9%ofchildrenwerelivingwithasecondcaregiverand2% withathirdcaregiver.Figure 2 depictscaregivers’ relationships tothechildinthe firstyear.Grandparentswerethepredominantkinshipcategoryateachtimepoint.Grandparents weremostlikelytolatershare carewiththeformerlyincarceratedmotheronherrelease(seered flowsfrom “Grandparent” to “SharedCare”).Inaddition, flowssuggestthata subsetofchildrenfrequentlymoveintoandoutoffostercare. Thepercentageofchildrenbeingcaredforbytheirmothers decreasedfrom21%atintaketo18%at12months.Carebyall otherkinmembersdecreasedby12months(fathersfrom 7–4%;grandparentsfrom46–35%;othermaternalkinfrom 12–9%;andotherpaternalkinfrom4–2%).Sharedcare betweenthemotherandthechild’snon-maternalcaregiver increasedfromnoneto14%by12months.Childrencaredfor bynon-kincaregiversdecreasedfrom9–7%whilechildren withfosterparentsincreasedfrom2–4%by12months.

ReasonsforChangesinCaregiving

Themostfrequentreasonforachildexperiencingachange fromonecaregivertoanotherwasreuni ﬁcationwitha formerlyincarceratedmother,followedbychildwelfare

Fig.1 Alluvialplotofwhetherchildrenexperiencedtheir ﬁrst,second, orthirdnon-maternalcaregiver;carefromtheirformerlyincarcerated mother;orsharedcarebetweenaformerlyincarceratedmotherandthe

child’scaregiverduringthemother’sincarcerationateachtimepoint. Childplacementfrombirthtooneyearofageinthebirthbeyondbars cohort, n = 57

Table2

Fig.2 Alluvialplotofthekinshiprelationshipofthechild’sprimary caregiver(mother,father,grandparent,othermaternalkin,other paternalkin,non-kin,orfosterparent)ateachtimepoint.Caregiver

removal.Twochildrenenteredfostercareduringthestudy period,andonewasmovedfromonefosterhometoanother fosterhome.Twoofthechildreninchildwelfarecustody experiencedasecondchangeincaregiverwhentheywere movedfromnon-relativefostercaretokinshipcare,andone childexperiencedremovaltochildwelfareaftertheywere informallymovedfromonecaregivertoanother.Theother changesinprimarycaregivingrelationshipsoccurredoutsideoffostercare.Inthreeinstances,non-maternalcaregiverstransitionedachildtoanotherperson’scareafterthey wereunabletocopewiththeircaregivingresponsibilities. Threechildrenwhowereintheirmother’scustodyfrom birthtransitionedtoanon-maternalcaregiveraftertheir motherhadrecurrenceofsubstanceuse,andoneafterthe motherwasreincarcerated.Onecaregiver,theinfant’s grandmother,diedduringthestudyperiod,andtheinfant wasplacedwithanothergrandmother.Anotherinfantwas movedfromacaregiverwithnokinshiprelationshipwith theinfanttotheinfant’sgrandmother’scare,amovethat wasmutuallyagreeduponbyboththe ﬁrstandsecond caregiver(seeTable 3).

PredictorsofCaregiverInstability

Theprobabilityofmaintainingasingleprimarycaregiverover thestudyperiod,excludingreuniﬁcationwiththemother,

relationshiptothechildfrombirthtooneyearofageinthebirth beyondbarscohort, n = 57.

droppedsigniﬁcantlyovertime,fallingto80%atthe12-month assessmentwave(seeFig. 3).ResultsfromtheCoxproportionalhazardsmodelssuggestthatplacementwithakinship caregiveratbirthisprotectiveagainstdisruptionsinprimary caregivingrelationships.Comparedtochildrenplacedwith non-kinshipcaregiversatbirth,thoseplacedwithkinhada lowerhazardratioofdisruption inprimarycaregivingof0.18 (95%CI0.05,0.60,p<0.05).Povertywasnotassociatedwith thehazardratioofdisruptioninprimarycaregivingrelationships.Comparedtochildrenwhoseprimarycaregiverswere notlivingundertheFPLatintake,childrenwhoseprimary caregiverswerelivingundertheFPLhadahazardratioof0.37 (95%CI0.08,1.72,p = 0.21).Distresswasalsonotpredictive ofchangeinnon-maternalcaregiving(HR0.44,95%CI0.06, 3.44,p = 0.4).Finally,acompositeriskscorecombiningall fourfactorswasalsonotpredictiveofchangeinnon-maternal caregiving(HR0.88,95%CI0.44,1.73,p = 0.71).Allmodels exceptthemodelincludingpoverty(p = 0.048)hadnonsigniﬁcantp-valuesontheSchoenfeldtest,suggestingthat hazardrateswereproportionalacrossfollow-up.SeeTable 4

Discussion

Toourknowledge,thisisthe ﬁrststudytoprospectively assesscaregivingstabilityforchildrenexposedprenatallyto

Table3 Reasonschildreninthe birthbeyondbarscohort changedprimarycaregiversin the ﬁrstyear

From1st–2ndCaregiver(n = 15)From2nd–3rdCaregiver(n = 4)

Formerlyincarceratedmotherresumedsolecare4Movedfromfostercaretokinshipcare2 Informallymovedtoanotherfamilymoreableto takeoncareresponsibilities

3Informallymovedtoanotherfamilymoreableto takeoncareresponsibilities

Removedtochildwelfarecustody2Removedtochildwelfarecustody1

Movedfromastranger’scaretograndparent’scare1

Movedtoanothergrandparentafterthe ﬁrstdied1

Movedtoanotherfosterparent1

Fig.3 KaplanMeierCurvedescribingtheprobabilityofmaintaininga primarycaregiverateachtimepoint.Conﬁdenceintervalsaredisplayedingray.Thenumberofchildrenatriskandthenumberof

Table4 Coxproportionalhazardsmodelsofdisruptioninnonmaternalcaregiving(n = 57)

Explanatory variable Hazard ratio 95%CIp-valueLikelihood RatioTest

Poverty0.370.08,1.720.211.92,p = 0.2

Kinship0.18**0.052,0.60.0056.3,p = 0.01

Distress0.440.06,3.440.430.77,p = 0.4

Race(Blackor white) 0.680.20,2.310.530.4,p = 0.5

CompositeRisk Score 0.880.44,1.730.710.14,p = 0.7

Eachrowofthistablerepresentsaseparatelyrunmodel.

maternalincarcerationinthe ﬁ rstyearoflifeoutsideofa prisonnurserysetting.Thisstudyfoundthatduringinfancy, acriticalperiodforthedevelopmentofattachmentrelationships,infantsfrequentlyexperiencedchangesincaregivingrelationships,primarilycausedbychildwelfare

eventsateachtimepointaredisplayedundertheplot.Kaplainmeier curveoftheprobabilityofmaintainingasingleprimarycaregiverin the ﬁrstyear

involvement.Whilecaregiversociodemographicriskfactorsdidnotpredictinstabilityinnon-maternalcaregiving, thecaregiver’skinshiprelationshiptotheinfantwasprotectiveofdisruptionsinprimarycaregivingrelationships.

Our ﬁndingscorroboratedPendletonetal.’sretrospective study,whichfoundthatcaregiversofchildrenbornto incarceratedmotherswerepredominatelygrandparentsor otherrelativesoftheinfant(2021).Inourstudy,fathersand fosterparentswereleastlikelytobetheprimarycaregivers ofinfantsinoursample.However,inthecaseoffoster parents,thisislikelyduetoselectionbias.Descriptive analysesrevealedthatgrandparentsfrequentlysharedcare withtheinfant’smotheronherrelease.Thismaybea particularlybeneﬁcialstrategyforthemotherandherchild, allowingthemotherdedicatedtimetopursuetreatmentfor substancedependence,applyforjobs,andadjusttoher childcareresponsibilities,whilegivingthechildatransition periodbetweentheirtemporarycaregiverandtheirmother.

Whilewewereunabletoassesschilddevelopmentaloutcomes,ourresultsindicatethatgrandparentalcaremaybe protectiveofthemother’sroleinthefamilyinthecontextof maternalincarceration.

Reasonsforchangesinprimarycaregivingunrelatedto thereleaseoftheinfant’smotherwerediverse.Indeed,we identi fiedsevenseparatecausesfora firstmovefromone primarycaregivertoanother,sixofwhichwereunrelatedto thereleaseofthemother.Childwelfarerelatedcauseswere themostcited,particularlyinthecaseofasecondchangein primarycaregiver.Childwelfareremovalisacomplex phenomenon.Itisdif ficulttodisentanglethedevelopmental effectsofabuseorneglectfromthosecausedbythechild’s removalfromfamily(Doyle, 2013).However,researchers havehypothesizedthatthefrequentmovesassociatedwith childwelfareinvolvementmayatleastpartiallyexplainthe pooroutcomesassociatedwithfostercare(Doyle, 2013; Jacobsenetal., 2020;Newtonetal., 2000).Whenchildren areremovedfromfamilies,thereisevidencethatkinship careismoreprotectivetochildoutcomes,includingbehaviorandconnectedness,thannon-kinshipfostercare (Hassalletal., 2021;Winokuretal., 2014).Severalchildren inourstudywhowereinitiallymovedduetochildwelfare experiencedasecondmoveintokinshipcare.Itisunclear howmultiplemovementandkinshipcareinteracttopredict childoutcomes.

Furthercomplicatingthepicture,someadvocateshave arguedthatchildwelfareremovalmaybepartiallymotivatedbythedesiretopoliceminoritizedfamiliesratherthan tosupportthemincaringforchildren(Sankaranetal., 2019;Roberts, 2022).Likemassincarceration,thereis evidencethatchildwelfareinvolvementisfrequentlya resultoffamilies’ poverty(Huntington, 2007;Raz, 2017; Roberts, 2022).Evidencealsoconsistentlypointstoracial targeting,particularlyofBlackandIndigenousfamilies (Edwardsetal., 2021;Kimetal., 2017;Roberts, 2008; Roberts, 2022;Wildeman&Emanuel, 2014),inthechild welfaresystems.However,inthisstudy,acaregiver’sselfreportedracialidentitywasnotpredictiveofdisruptionsin primarycaregiving.Whilethisstudywasunabletoascertainwhychildwelfareremovaloccurred,moreresearchis neededtofullyunderstandthecomplexinterplaybetween maternalincarceration,caregiving,andchildwelfare involvement.

Inadditiontoformalizedchildwelfareremoval,we foundthatinfantsfrequentlyexperiencedinformalchanges incare.Inmostcases,theseinformalmovementswere describedasoccurringbecauseofthe ﬁrstcaregiver’s strugglestocarefortheinfant.Bothstudiesincaregiversof olderchildrenofincarceratedmothersandourownqualitativeresearch(Kotlaretal., 2024)havefoundthatcaregiversreportstrugglingwithphysicalhealth,mentalhealth, and ﬁnancialwellbeingasadirectresultofcaregiving(Cox

&Wallace, 2013;Pendletonetal., 2021;Shaw, 2023). Despitethesedescriptive findingsandastrongtheoretical rationaleforselectingthesepredictors,povertyandcaregivermentalhealthatbaselinedidnotpredicttheriskofa firstchangeincaregivers.Theremaybeseveralreasons whywedidnotdetectaneffectinthecasethatoneexists. First,becauserationalesforchangesinprimarycaregiving weresodiverse,predictorsmayalsodependontheimpetus foreachmove.Especiallyifthiswerethecase,butalso generally,wemayhavebeenunderpoweredtodetect smallereffectsizes(only11 firstchangesinnon-maternal caregiversoccurredduringthestudyperiod).Second,there maybealagbetweenassumingcareofanewbornandany impactsofacaregivers ’ fi nancialormentalhealth,inwhich casemeasuringtheseriskfactorsatbaselineisnotproximal enoughtotheeventitselftobeausefulpredictor.Said differently,caregivers’ financialstatusand/ortheirmental healthmayhavedeclinedovertime – ultimatelycontributingtotheneedtomakeachangeincaregiving arrangements.Finally,othermeasuressuchasparenting stress,socialsupport,orneighborhoodcohesionmayhave beenmoreappropriatepredictorsof firstchangeincaregivers.Futurestudiesshouldcarefullyassesstheroleof sociodemographicriskfactorsoncaregiverinstability overtime.

Ouranalysesdiddetectastrongprotectiveeffectof beingplacedwithakinshipcaregiveratbirth,includinga formerlyincarceratedmother,ondisruptionsinprimary caregiving.These ﬁndingsaddtotheliteraturethatsuggests thatkinshipcareinthecontextofmaternalincarceration mayleadtomorefamilyconnectednessandcohesion, whichinturncanleadtomoreoptimalchildoutcomes (Bakeretal., 2010;Loper&Clarke, 2013).Theseresults alsopointtothetenuousnatureoftherelationshipbetween infantsandnon-kinshipcaregiversinoursample.Results fromourqualitativestudyofcaregiverrelationshipformationinthesamesamplefoundthatmotherstypicallychoose caregiversnotrelatedtotheinfantonlywhenallothernonfostercareoptionshavebeenexhausted(Kotlaretal., 2025).Indeed,threecaregiversinthiscategorydidnot knowthemotheratall,oronlyknewherforseveralmonths beforeassumingcareoftheinfant.Thissuggeststhata mother’srelationshiptoherinfant’scaregiverand/orthe caregiver’srelationshiptotheinfantmaybeapowerful motivatorinretainingcustody.

Theseresultshaveseveralimplicationsforchildwellbeing.First,theyprovidepreliminaryevidencethatinterruptedattachmentrelationshipsareaconsequenceof maternalincarcerationandthusmayindeedbeamediator betweenmaternalincarcerationandchilddevelopmental outcomes.Futureresearchshouldassesstherelationship betweenchangesinprimarycaregivingandattachment relationshipsasanoutcomeinthispopulation.Inaddition,

our ﬁndingssuggestthatchildrenborntoincarcerated mothersfrequentlyexperiencechildwelfareinvolvement. Whilethereisnotyetenoughevidenceonwhichtobase policyrecommendationsrelatedtochildwelfareforthis population,itisessentialthatresearchersandpolicymakers continuetoconsiderthewaysinwhichcyclesofcriminal legalandchildwelfaresysteminvolvementmaycontribute tonegativedevelopmentaloutcomesforchildren.Finally, whilestatisticalmodelsdidnotcorroboratearelationship betweencaregiversociodemographicfactorsatbaselineand changesincaregivers,descriptiveresultssuggestthat caregiversfrequentlyfeltoverwhelmedbytheresponsibility ofcaringforthenewbornofanincarceratedmother.We urgestatelawmakerstoconsiderprioritizingcaregiversof childrenwithincarceratedparentsforsocialsupportprogrammingtolessentheburdenplacedoncaregivers (Mihalec‐Adkins&Shlafer, 2022;Kotlaretal., 2024).

Limitations

Thisstudywaslimitedinseveralways.First,datacollection wasconstrainedtoasinglestate,limitingthegeneralizabilityofourresults.However,ourresultsprovidekey dataonprenatalexposuretomaternalincarcerationinthe SouthernU.S.,aregionwithhighwomen’sincarceration rates.Second,despiteahighbaselineresponse,therewas evidenceofselectionbiasduetotheunderenrollmentof childrenplacedfrombirthintochildwelfarecustody.The limitedenrollmentofchildrenplacedintothecustodyof childwelfareagenciesatbirthlikelymeansourresults underestimatetheincidenceofchangesinprimarycaregiversinthispopulation.

Conclusion

Thisstudyfoundthatchildrenborntoincarceratedmothers experiencedhighlevelsofinstabilityinprimarycaregivers. Instabilityinprimarycaregiverswasprimarilydrivenby childwelfareengagement,whilekinshipcare,particularly grandparentalcare,wasprotectiveagainstinstability.These ﬁndingsindicatethatstabilityinprimarycaregivingrelationshipsmayplayanimportantroleinthepathwayfrom maternalincarcerationduringinfancytochilddevelopmentaloutcomes.

AuthorContributions BethanyKotlarwasprimarilyresponsiblefor thestudyconceptionanddesignincollaborationwithallcoauthors. Materialpreparation,datacollection,andanalysiswereperformedby BethanyKotlar.The ﬁrstdraftofthearticlewaswrittenbyBethany Kotlar.AlexKotlarwastheleadonsoftwareandvisualization.All authorscommentedonpreviousdraftsandreviewedthe ﬁnaldraftof thearticle.

JournalofChildandFamilyStudies

Funding ThisprojectwaspartiallyfundedbytheHRSACenterof ExcellenceinMCHgrant,T03MC07648-12-06.BethanyKotlar’s workonthisprojectwasfundedbytheReproductivePerinataland PediatricEpidemiologyFellowship,T32HD104612.

CompliancewithEthicalStandards

ConflictofInterest Thereareno financialconflictsofinterestto declare.BethanyKotlarservedasanunpaidBoardmemberfor MotherhoodBeyondBarsfrom2019until2022.

EthicsApproval ThisstudywasapprovedbyHarvardLongwoodMedicalArea’sInstitutionalReviewBoardthroughIRB20-1215;21-1247.

InformedConsent Studyparticipantscompletedaninformedconsent processandconsentedtopublicationofunidenti ﬁabledata.

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