BACKGROUND:
The number of incarcerated women globally is rising, many pregnant and imprisoned for non-violent offences. These women often face poverty, domestic violence, trauma, and poor health. Maternal separation in prison remains under-examined, despite its profound impact on maternal and infant wellbeing.

OBJECTIVES:
The Lost Mothers Project aimed to explore the experiences of maternal separation in prison, assess the role of midwives and other professionals in these contexts, and highlight global implications for reproductive justice and midwifery care.

METHODS:
A qualitative, co-produced study funded by the UK’s ESRC, in partnership with Birth Companions and women with lived experience. Data was gathered through 29 interviews with incarcerated mothers, 45 with professionals (midwives, prison staff, social workers), and observations of mother-and-baby unit decision-making. Ethical approval was granted by the University of Hertfordshire and the prison service.

RESULTS:
Separation from newborns caused acute trauma, loss of maternal identity, and disrupted bonding: I was so upset; it was worse than giving birth. That was the hardest pain of my life. I've never felt pain like it…It was just in here; in my chest; in my heart. Even in my belly… Oh, it was painful. It was the hardest day of my life. Midwives, often lacking training or systemic support, played vital roles in offering continuity, advocacy, and care. Bureaucratic and institutional barriers often overshadowed compassionate practice. Structural inequalities, including racial bias, were prevalent.

CONCLUSIONS:
Maternal separation in custody is a global reproductive justice issue. Midwives must be supported to lead rights-based, trauma-informed care, and advocate for alternatives to custodial sentences for pregnant women and mothers.

KEY MESSAGE:
Midwifery leadership is essential in ensuring humane, respectful care for incarcerated mothers and babies. This research calls for global policy change and recognition of midwives’ crucial role in prison settings. Marginalized - maternal separation (including three-minute presentation competition)