We know incarceration damages child and family health, so why aren’t we tracking its impact?

By Caroline Parker

The effects of incarceration extend far beyond the prison walls. With 11.5 million people behind bars globally, including 2 million in the United States, 1.6 million in China, and 0.8 million in Brazil, incarceration is a crisis that quietly affects millions of families and communities worldwide, especially children, yet it remains largely invisible in our data systems.

The United States (the mainland, not its colonies) remains the only country with robust evidence tracking incarceration’s health effects—even though El Salvador (1,086 per 100,000), Cuba (794), and Rwanda (637)  now have much higher incarceration rates (the US stands at 531/100,000). Findings from the US mainland are clear. Women with incarcerated partners experience higher rates of obesity, heart attacks, sexual risk behaviours, and sexually transmitted infections. Young adults with incarcerated parents are more likely to suffer from depression, PTSD, and anxiety. At the community level, rising incarceration rates have been linked to higher incidences of teenage pregnancies and multidrug-resistant tuberculosis.

...children with incarcerated parents are more likely to experience developmental delays, speech problems, asthma, cholesterol, and a range of mental health issues—including ADHD, depression, and anxiety.

Most concerning are the findings on child health, with the US mainland, once again, providing the clearest evidence. Large surveys like the US National Survey of Children’s Health (NSCH) and National Longitudinal Study of Adolescent to Adult Health (Add Health) reveal that children with incarcerated parents are more likely to experience developmental delays, speech problems, asthma, cholesterol, and a range of mental health issues—including ADHD, depression, and anxiety. This ripple effect is not evenly distributed. In the United States in 2018, 20% of Native American children, 13% of Black children, 6% of Latinx children, and 6% of White children had experienced parental incarceration at some point. These disparities have led researchers to recognise incarceration as a driver of racial health inequity.

This isn’t just a US problem. While equivalent racial breakdowns are unavailable in most countries, the broader impact on children is evident. In the United Kingdom, an estimated 193,000 children, or about 1.4% of all children under 18, have a parent in prison. In El Salvador, an estimated 100,000 children and adolescents—roughly 5.6% of all children (under age 18)—have one or both parents incarcerated. That’s roughly equivalent to the share of children in the United Kingdom living with asthma or those in Sub-Saharan Africa affected by acute malnutrition.

Meanwhile, estimates suggest that  between 1.5 and 1.9 million children in the Latin American region and 2.1 million children in Europe have a parent in prison on any given day. These staggering figures only scratch the surface of a much larger, unmeasured crisis unfolding worldwide—underscoring the urgent need for comprehensive tracking and a clearer understanding of incarceration’s devastating impact on children.

Despite growing evidence, global monitoring of incarceration’s health impacts remains severely lacking. With the exception of the US mainland, incarceration is rarely included in routine family health surveys by governments or international agencies. Without this crucial data, the true toll of incarceration on child health and wellbeing, not to mention its implications for racial health equity, remains invisible.

To bridge this critical data gap, national governments and public health organisations must incorporate an incarceration variable into routine health and social surveys.

What can be done?

To bridge this critical data gap, national governments and public health organisations must incorporate an incarceration variable into routine health and social surveys. National longitudinal studies, such as the Health and Demographic Surveillance Systems (HDSS), operational in several countries across Africa and Asia, offer vital opportunities to track the long-term health impacts of incarceration by adding relevant variables. School-based health surveys and child and adolescent mental health assessments are additional vital touchpoints for identifying children at risk. These should include questions about family incarceration to better target interventions. Additionally, countries can develop custom surveys focused specifically on incarceration’s social and health effects, working closely with local health departments, social services, and non-governmental organisations. Internationally, platforms like the Multiple Indicator Cluster Surveys (MICS) and the Demographic and Health Surveys (DHS)—both widely used across low- and middle-income countries—could be readily adapted to include questions about parental or family incarceration. This would depend, however, on the full return of DHS, which was curtailed under the Trump administration. On a broader scale, international data platforms like WHO’s Global Health Observatory and UNICEF’s data repositories should integrate incarceration data into their existing datasets. By taking these steps, we can create a comprehensive, real-time picture of how incarceration affects child health worldwide and drive policies that protect vulnerable children.

Why does this matter? Because without counting, we remain in the dark—and cannot craft effective policies or direct resources where they’re needed most.

We must make incarceration a standard part of public health monitoring. Only then can we truly understand its hidden, unequal toll on children’s lives and take meaningful steps toward building healthier, more equitable societies.