Imagine this: you wake up one morning and notice that something is wrong with you. It could be an abnormal pain in your side or maybe an onset of flu symptoms. Naturally, you would go see a doctor or go to a clinic. We, as humans have a fundamental right to life and therefore the right to seek methods to help extend it. However, there is a growing population in our country of people who cannot say that statement with confidence – those who reside in jails and prisons.
Mass incarceration strongly affects the health of prisoners, specifically with regards to STIs, HIV/AIDS, and mental health. As a matter of fact, prisoners tend to be the unhealthiest individuals in today’s society. But many studies tend to focus on men, since the mass incarceration rates are far higher among the male population than they are for women (women only represent 9-10% of the correctional population). Nevertheless, the number of women in jails and prisons has increased by over 700% since 1980, and that growth rate has outpaced the male imprisonment rate by more than 50%.
Women have unique health needs that need to be addressed, especially the population of women that are imprisoned. With female imprisonment rates rising at such alarming rates, mechanisms should be in place to ensure that their unique health issues can be addressed in order to improve the overall health in correctional facilities. But how exactly does mass incarceration affect women’s health?
Many incarcerated women are under the age of 50. Because these women are of reproductive age, they have health issues (including pregnancy) that make the care they require unique from men in many ways. In a correctional facility, gynecological exams are not required upon entrance, nor is it required for women to receive one every year. In fact, most correctional facilities do not have an OBGYN on site and that leads to inadequate and inconsistent care. As a result, women in prison have a higher risk for breast cancer, ovarian cancer, and general undetected illnesses because pap smears are not regularly administered. Besides not having access to women’s healthcare, women prisoners don’t even have regular access to feminine hygiene products.
Despite the fact that many incarcerated women are under the age of 50, female prisoners over the age of 50 still exist, and they have special health care needs as well. Not only are these women more likely than not going through menopause, they are at a higher risk than men for things like osteoporosis and other chronic diseases that require constant care and treatment. Women in jails also have higher rates of STIs and HIV due to limited access to services, risky behaviors with substances, higher chances of partaking in unprotected sex, and high chances of being sexually assaulted. Jails need to provide not just screenings, but treatment options.
At any point in time, 6% to 10% of incarcerated women are pregnant. Unfortunately, many don’t even know they’re pregnant until they take a pregnancy test upon arrival to the correctional facility. There is a lack of prenatal care, which is necessary for positive birth outcome and maternal outcomes. Pregnant women in jail are more likely to have high risk and complicated pregnancies because of the higher usage of alcohol and drugs. Despite the high risk of having a complicated pregnancy, only 54% of pregnant prisoners received prenatal care in 2008. Pregnant women in prison also have higher levels of psychological stress but usually do not receive the appropriate counseling and support services. The biggest health implication for pregnant women is treatment after giving birth. Women in jail do not have anywhere near enough time to recover after giving birth. The average time they report to general population is a day or two after giving birth, while the recommended recovery period is about six weeks. These women are thrown back into prison to deal with the psychological and physical stress while also dealing with postpartum recovery without the proper education and services to be able to take care of themselves. Women who give birth and go back to prison have higher rates of postpartum depression and psychosis for a few reasons – underlying previous mental health disorders (that may or may not be diagnosed), emotional trauma, and the stress of being away from their child. Women have specific nutritional needs while pregnant and they need certain foods as well as iron supplements and folate. But as the prison protests in Michigan and Alabama have shown, prisons are not supplying foods that are nutritious for the average person, much less a pregnant woman.
Between 70 to 80% of incarcerated women have abused alcohol and/or drugs. Imprisoned women are more likely to have used hard drugs in their past than men and 70% of them are considered to have a substance abuse problem. More than 40% of incarcerated women were under the influence of drugs when they committed their crimes that put them in a correctional facility. In addition, because of their increased risky behaviors like having unprotected sex and using dirty needles while using drugs, they have a much higher risk for HIV. Unfortunately, many women who are released return to drug usage shortly after.
Incarcerated women report higher rates of alcohol/drug abuse, STI, sexual/physical abuse and mental illness than incarcerated men. Mental illness has affected 61-75% of incarcerated women, compared to 44-63% of incarcerated men. The problem is that many of these women should be in mental illness facilities – not prison or jail. They will not receive the proper care they need in order to truly get better and as a result, they will end up in and out of the prison system when they should have been sent to a mental health facility. Solitary confinement is a punishment used disproportionately on people with mental illness (who tend to be women) and it only exacerbates underlying mental health conditions. Punishments used in correctional facilities – such as solitary confinement – increases chances of depression, anxiety, hallucinations, paranoia, and suicide. These women are punished for behavior that is going untreated and is beyond their control. About half of women in prison and jail have been physically and/or sexually abused, which can lead to depressive disorders, stress disorders, anxiety disorders, substance abuse, and behavioral disorders.
Many of the women in prison come from disadvantaged environments and are therefore at higher risk of chronic illness, substance abuse and other undetected health problems. While prison is a punishment for breaking the law, it should not allow these health issues to simply fester and get worse. Prisons should invest in improving the health of the women in their care. It is recommended that the prison system increase the amount of cancer, STI and other gynecological screenings that they give inmates upon initial arrival. Prisons need to completely revamp how they administer prenatal and postnatal care to women in order to reduce the amount of adverse birth outcomes and to possibly lower rates of complicated pregnancies, psychological stress, postpartum depression and psychosis. Behavioral interventions need to be incorporated with the drug counseling – unfortunately, studies show that the drug counseling that prisons and jails are providing are simply not enough. Lastly, women have a much higher rate than men of coming into correctional facilities with mental health illnesses and developing mental illnesses while in jail. Many of these women need to be sent to a mental health facility and not jail. That environment just adds to the psychological stress and in turn, can make mental illness even worse. All in all, just because they are incarcerated does not mean that they are no longer human. Those whom are incarcerated are people too, and it’s time that the prison healthcare system start treating them as such.
The Sentencing Project. (2016) Incarcerated Women and Girls. Retrieved June 01, 2016, from http://www.sentencingproject.org/wp-content/uploads/2016/02/Incarcerated-Women-and-Girls.pdf
Women’s and Children’s Health Policy Center – Johns Hopkins School of Public Health. (2014) Issues Specific to Incarcerated Women. Retrieved June 01, 2016, from http://www.jhsph.edu/research/centers-and-institutes/womens-and-childrens-health-policy-center/publications/prison.pdf
Women's Health Care Physicians. (n.d.). Retrieved June 01, 2016, from http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Reproductive-Health-Care-for-Incarcerated-Women-and-Adolescent-Females
National Commission on Correctional Health Care. (2014) Women’s Health Care in Correctional Settings. (n.d.). Retrieved June 01, 2016, from http://www.ncchc.org/women’s-health- care