Incarcerated Women are Failed by the Prison Healthcare System

(USCF School of Medicine / Kacey Berry)


The prison system primarily accommodates for the needs of men, resulting in many correctional facilities unable to satisfy the unique biological and psychological needs of women. Incarcerated women are more likely to suffer from substance abuse, have a history of sexual or physical abuse, and have chronic STIs, with rates of these conditions higher than that of incarcerated men. This, coupled with the fact that female prison populations are rising at almost twice the rate of male prisons, indicates the need for gender-specificity in prison healthcare systems. 

It has been estimated that 43% to 57% of state and federal women prisoners and 67% to 79% of women in jail have been physically or sexually abused. This type of abuse can lead to psychological issues such as stress, anxiety, and depressive disorders. It is well known that inmates face higher rates of mental health issues than the general population, with female inmates outpacing their male counterparts (61% vs 44% in federal prisons). The few inmates whose mental health problems are recognized and addressed receive subpar care, with one study finding that more than 50% of those who were taking medication for their mental health conditions did not receive treatment once imprisoned. 

Moreover, women entering prisons have higher rates of STIs due to limited access to preventative health services prior to their imprisonment, sexual assault, or substance abuse; one study found that 33% of women tested positive for an STD upon admission. Incarcerated women are also at a greater risk of testing positive for an STD because of their substance abuse history. A U.S. Department of Justice study found that 69% of incarcerated women met the criteria for substance dependence. Often, those who suffer from substance dependence are more likely to come into contact with tainted or infected needles. Thus, HIV and AIDS are prevalent among incarcerated women largely because of this abuse. History has shown that the drug counseling incarcerated women receive does not work–inmates with an addiction will almost always relapse

Inadequate access to family planning services and reproductive health care, including pre- and post-natal care for pregnant women, continue to plague women’s prisons. Incarcerated women are prone to having more complicated, high-risk pregnancies, resulting chiefly from high rates of substance-abuse. Either before or after incarceration, pregnant inmates often lack prenatal care–some women don’t even know they’re pregnant until after they enter a correctional facility. Access to this type of care significantly improves the outcome of the pregnancy, but, often, prisons fall short of meeting these needs. In fact, only 54% of incarcerated women were reported to have received pregnancy care according to a report by the Bureau of Justice Statistics. To this, the use of restraints or shackles during delivery is not only an acceptable practice but has legal ramifications in only 18 states. As birth-related health outcomes are the greatest indicator of population health, this reflects a fundamental flaw in the correctional treatment of women and a greater issue in the health of the incarcerated female population. 

The health of female prisoners is further threatened when they are not cisgender. They face a wide array of risks to their health, physical and mental, while incarcerated. Often times, transgender women who have been convicted are placed in male correctional facilities, increasing their vulnerability to abuse. They face abuse from officers and fellow inmates alike, with a study by the Bureau of Justice Statistics revealing that transgender people are almost ten times more likely to be sexually assaulted than the general prison population. Many face constant degradation and humiliation, and if they report their abuse, they are either dismissed or, in many cases, thrown in indefinite solitary confinement, which is detrimental to their mental health. Additionally, some facilities place medical decisions in the hands of the administration rather than the health care provider, inhibiting trans people from receiving hormone therapy and other necessary care. What’s more, while these facilities cannot create blanket policies that outrightly deny transition-related care, they are not obligated to provide specific types of treatments or the best treatment. This care is medically necessary both physically and mentally. When treatment is denied or withheld, it can intensify feelings of anxiety and stress caused by gender dysphoria and increase the prevalence of depression and substance abuse as well as other health complications. 

If the purpose of incarceration is rehabilitation, then the system that currently governs prisoners’ health must be reformed as well. Several factors that contribute to incarceration are found in instances of trauma prior to imprisonment. Thus, the policies governing prisons must re-center treatment to acknowledge these traumas that impact the victim’s rehabilitation. Without commitment to gender-specific approaches to the frequent issues that lead to prosecution, female prison populations will continue to grow at incredibly high rates. 

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