Physicians of the Institute of Paediatric Clinic of the Catholic University of Rome – Policlinico Agostino Gemelli entered the Casa di reclusione di Roma Rebibbia, the main prison of Rome, where the majority of these children live, to assess their health conditions. The paper has been published on the last issue of the Scandinavian Journal of Public Health.
"When we first began this study", explains Pietro Ferrara, researcher of the Institute of Paediatric Clinic of the Catholic University of Rome, and one of the authors of the article, "thanks to the collaboration of the managers of the prison, we had access to all the clinical diaries of the children who had lived in the prison within one and a half year, beginning from January 2003 to mid-2005".
The total number of children numbered 150. For comparison, researchers also used the data of around 150 children of the same age who had visited the paediatric surgeries of the Gemelli Hospital and those of around a hundred children of immigrant parents living in Italy.
The first data measured was the gestational age, which is the length of the pregnancy. A good 20% of the children who had lived in a jail had had a gestational age lower than 37 weeks (the average length of a pregnancy). As a comparison, 9% of the children of immigrants were born before time, whereas only 5% of the Italian children are premature. Why do we see this difference?
"Of course", answers Ferrara, "environmental risk factors play an important role. Often women who end up in prison are subjected to infections, have wrong habits, like smoking or the intaking of narcotics, and frequently pregnancy is not properly taken care of."
Another important factor was breast feeding. Around 70% of the mothers of all three groups decided to nurse their babies but the time of weaning in jail was earlier. Both Italian mothers and foreign mothers by and large ceased breast feeding after 5 months but in jail, the weaning was earlier. "An early weaning can predispose to the risk of hypertension and obesity. Early interruption of the contact with mother's milk can also lead to sensitization towards food antigens, predisposing to allergies, and increasing the risk of intoxication of substances like preservatives or food colouring agents. In newborns, as a matter of fact, the detoxification processes are still not well developed," says Ferrara.
What mostly differentiated the health of children in or outside prison was immunization status.
"When we realized this, we were really shocked", tells Ferrara. "In Italian children the rate of vaccinal coverage is about 100%, which means that nearly all of them are correctly vaccinated. Immigrants' children, who live through greater logistical and cultural hitches, still reach more than 80%. On the other hand, not more than 14% of the children in jail have been correctly vaccinated. Of course, we are talking about few children over all, but let's not forget that these small ones are taking a very dangerous risk."
Ferrara and his colleagues were optimistic about conditions overall. "First of all, because we have verified that today even inside a prison there is a good level of health assistance", comments Ferrara. "Also, doctors make a very good work of prevention. Mothers explained how to wean, children are correctly vaccinated and the percentage of vaccinated babies has doubled. Of course, there's room for improvement, but let's not forget that children remain in a prison for a variable amount of time, and it's hard to keep track of them once they are out. The idea is to extend to mothers in prison the health care education programs we routinely perform to evaluate with a paediatrician the health of the child, to talk about prevention and to give suggestions to the parents.
"We found a situation which of course still could be enhanced. For example, it would be useful to computerize the clinical diaries, so that we could save us from sifting through the pages, or to transform the meetings with the mothers into regular ones. Yet we can state that preventive and therapeutic assistance in jail is of a good level: a level that many of these children would never have had access to. If I did not fear to be misunderstood, I could nearly say that it was good for these children to have spent some time in prison."
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