Our study described below addresses how two “tough on crime” laws–Three Strikes and Truth in Sentencing–may have impacted birth outcomes of Black women between 1984 and 2004.

While research exists on the role state incarceration policies play in increasing mass incarceration in the U.S., their role in shaping population health and health disparities have remained largely unknown. In 2023, we released a study that examines how the implementation of two signature state incarceration policies in the early 1980s — so-called “tough on crime” laws — likely had a negative influence on birth outcomes, especially among lower socioeconomic status Black populations, who were most likely to be affected by the polices. The two laws at the heart of the study were popularly referred to as “three strikes” and “truth in sentencing.” 

Tough On Crime Bills

When President Bill Clinton signed into law the 1994 Violent Crime Control and Law Enforcement Act, the “Crime Bill” was the largest bill of its kind ever passed. It provided huge increases in funding for police officers, prison building, and crime prevention programs. 

These national trends and policy changes combined with state-level factors, resulting in many differences in how the policies were put into practice.

Three Strikes laws generally mandated 25 years to life sentences for third violations or violent felonies. California was the first state to pass the law, and by 1997, 27 states had passed their own version of three strikes. 

Truth in Sentencing laws funded the expansion of prisons and jails if states passed laws that required individuals convicted of certain violent crimes to serve at least 85% of their sentence. Several states enacted truth in sentencing laws, with rapid policy adoption between 1994 and 1998.

While on their face these policies were race-neutral, this was not the case in reality. Political support for these policies has been linked to racist ideologies, racial cleavages, the politics of racial resentment, and histories of racial violence and control. 

The variability in policy implementation at the local level stemmed from district attorneys, prosecutors, and judges using their own discretion in administering the laws. And there is evidence that the law was disproportionately applied to racially minoritized groups and was not, on the other hand, always applied to eligible cases. In California, Black individuals were roughly 1.5 times as likely as White individuals to receive a third strike sentence during the time period studied. 

Policies and Birth Outcomes: Possible Pathways

Given that mass incarceration has disproportionately affected Black individuals and communities, our study considered whether these policies contributed to racialized disparities in birth outcomes. A large body of research provides convincing evidence of a link between incarceration and declines in health among those who experience incarceration firsthand.

We speculate that state incarceration policies can impact birth outcomes by increasing incarceration rates for birthing people, their partners and family members, and the broader community. Incarceration increases risks of physiological stress, poor mental health, sexually transmitted infections, and a range of chronic conditions. The health burdens associated with incarceration can further spread through families and networks by increasing stress, financial burden, and relationship strain in ways that result in poor health for family members and partners left behind.

These policies may have also affected birth outcomes through the stigmatizing, marginalizing, and criminalizing language in the public discourse. Even if these policies did little to affect incarceration rates, they may have increased fear of imprisonment in ways that affected health, especially among those at greatest risk of incarceration.

Researchers have described this process as racialized legal status, which operates by marking members of racial/ethnic groups who are disproportionately incarcerated (in this case, Black people) for “for material and symbolic exclusion” in ways that harm health.

Our Findings: State Sentencing Policies and Population Health

Birth outcomes are a key marker of population health. Our study examines the differential effects of these policies on Black and White birth outcomes as these two policies were being implemented. We merged data on state incarceration policies with vital statistics birth records from 1984-2004 and used a difference-in-differences event study research design to model the dynamic impacts of these policies over time.

We found that the two policies had opposing effects on birth outcomes.

In the year three strikes policies were adopted, birth weight outcomes for Black infants—including mean birth weight and the rate of low-birth-weight infants—worsened markedly. The study provides suggestive evidence that three strikes policies adversely impacted Black birth outcomes through affective mechanisms, likely “by inducing highly racialized, stigmatizing, and criminalizing public discourse around the time of policy adoption.”

By contrast, we found that after truth in sentencing policies were adopted, birth outcomes for Black and White infants gradually improved. Results suggest that truth in sentencing likely impacted birth outcomes via material mechanisms, by gradually reducing both community incarceration and crime rates. Truth in sentencing was never as well-known or as widely publicly discussed as three-strikes.

Based on the results of the study, we believe that the discordant findings point to distinct, countervailing mechanisms by which sentencing policies can affect population health. The findings point to the need to further interrogate state criminal legal system policies for their impacts on population health, considering whether, how, and for whom these policies result in health impacts.

Our study is among the first to link state incarceration policies to infant health and, in doing so, provides evidence that state-level tough on crime incarceration policies can affect birth outcomes. Our findings indicate that the varied intent and implementation of these policies produced heterogeneous impacts on population health outcomes by both policy type and race.

Implications for Public Policy Promoting Health Equity

Despite some limitations, our work provides new evidence to inform how the criminal legal system shapes population health and health disparities. This study also provides new clues as to how structural racism operates within and across systems (i.e., criminal legal system, media, etc.) to shape population health by elucidating how seemingly race-neutral sentencing policies become racialized and operate to differentially impact population health.

Our findings regarding three strikes suggest that state adoption of this policy was a source of institutional, racialized stress that generated adverse birth outcomes in the Black population. Given that birth outcomes have life-long consequences for a range of health and labor market outcomes, political efforts to undo the harms of this and other stigmatizing policies will be needed to promote health justice in the cohorts exposed to this and other health harming policies.

Political efforts aligned with transformative justice—where social problems like crime or recidivism are not responded to with forms of state violence like punishment and incapacitation but with social investments aimed at equity and collective solidarity—provide a more humane and justice-oriented approach towards improving population health.

 

All data used in this study are publicly available. All relevant code will be shared upon publication. This study was pre-registered at Open Science Forum and published at the National Institutes for Health National Library of Medicine.     

 

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