Salience and context of incarceration history disclosure in sexual and reproductive health service delivery

Incarceration is a stigmatized event with profound health consequences, yet little is known about how its disclosure is experienced and managed within clinical encounters. Sexual and reproductive health (SRH) settings, where stigma and trust are particularly salient, provide a critical context for examining disclosures. We explore the context in which providers come to know patients’ incarceration histories in SRH service delivery, and the salience of disclosures. Drawing upon qualitative interviews (n = 49) with SRH providers who had treated patients with a history of incarceration (n = 7) and formerly incarcerated individuals who had sought or received SRH care (n = 42) between 2022 and 2023, we used a general inductive approach where we developed codes from provider interviews and applied them to both provider and patient interviews, with the latter complementing and triangulating the provider-derived findings. Providers reported learning of incarceration histories through direct patient disclosure, patient charts, transfers from correctional facilities, or referrals from reentry programs. While many emphasized offering the same care to all patients, providers and formerly incarcerated individuals nonetheless described how incarceration history informed treatment considerations and provider perceptions. Providers also described variation in care across correctional system involvements but noted they lacked training on the health consequences of criminal legal involvement and the intricacies of the system. Participants emphasized the importance of trauma-informed care and reported that family incarceration was also disclosed and shaped SRH. Findings highlight the salience of incarceration history in SRH services and underscore the need for provider training.