For years, healthcare for women has been grossly underrepresented in the United States criminal justice system. Although comprising only 9% of incarcerated people in the US, the female inmate population has increased more than six fold in the past twenty years. Unfortunately, this increase in population has not been accompanied with proper increased attention to the health needs of these women. A survey conducted in 2011 found that two-thirds of female inmates reported a mental illness diagnosis, nearly double that of their male counterparts. Additionally, the unique gynecological needs of female inmates are often dismissed and not given importance by prison officials, and “medical concerns that relate to reproductive health and to the psychosocial matters that surround imprisonment of single female heads of households” are consistently overlooked. This lack of care is especially detrimental to this population since many incarcerated women have lacked health care prior to imprisonment. Also, an overwhelming portion of women in prison are survivors of physical and sexual abuse, putting them at a higher risk than the general population for HIV/AIDS, hepatitis C, and HPV, which may lead to cervical cancer. Furthermore, despite hypothetically being safe from harm, such as traffickers or abusers, while imprisoned, many women in prisons are suffer sexual abuse from prison staff and often “such abuse occurs during routine medical examinations”1
Experts can not pinpoint exactly why this gross gender disparity in healthcare exists in prisons. Can this all simply be explained by widespread misogyny? Even if this is the answer, it is important to see the specific actions that lead to this lack of proper care in order to see how this trend can be reversed. One striking factor contributing to this problem is how women are sentenced differently in court. For example, when convicted for drug related crimes, women often receive longer prison sentences than men because they usually play smaller parts in drug rings and their limited knowledge of operations hinders them from negotiating deals and often they are afraid to testify against the violent male leaders of drug rings. Additionally, women prisoners are more likely to be sent to a maximum security facilities than their male counterparts. Men are generally assigned to prisons on the basis of different factors such as “criminal offense, prior criminal history, and psychological profile”2. Also, because of the greater number of male prisons in the US, men are more likely than women to be incarcerated near their place of residence, making it easier for their family and attorneys to visit. Furthermore, in comparison to prisons for men, “rules within women’s prisons tend to be greater in number and pettier in nature. Women prisoners are commonly cited for disciplinary offenses that are typically ignored within male institutions, and while they are less violent than their male counterparts, they appear to receive a greater number of disciplinary citations for less serious infractions”2.
The prevalence of minority women, specifically Hispanic and African-American women, in the US prison system also influences the lack of care they receive. A 2012 study showed that minority inmates with mental health conditions were more likely to be directed to solitary confinement where white inmates were more commonly directed to health services2. In turn, the unfair treatment of minority inmates’ health has even more damaging effects to their mental well being. In addition to poor health care when it comes to mental health, the adverse health care procedures in place for women's unique, gender-specific health needs is even more striking:
Gynecological: Gynecological exams are not performed upon admission to the facility and adequate screening questions about the women's gynecological history is rarely asked. Also, many prisons and jails do not have trained Ob/Gyn providers so the minimal gynecological services female inmates received often comes from unspecialized professionals and is thus inappropriate care. Consequently, abnormal Pap smears go undetected for far too long. This improper implementation of gynecological services for female inmates puts these women at risk for breast and ovarian cancer and numerous other diseases.3
Pregnancy: “At any given time, approximately 6% to 10% of incarcerated women are pregnant”. Many female inmates learn about their pregnancy upon admission to a correctional facility. These women often lack prenatal care and show great need for thorough services while incarcerated in order to have the best clinical outcome of their pregnancies. Due to high rates of substance use disorders in this populations, many incarcerated women have complex, high-risk pregnancies. In order to ensure the survival of the mother and baby, proper prenatal care is crucial in high-risk pregnancies. For example, pregnant women with opioid use disorders “must not be detoxified and must be offered opiate substitution therapy, yet this is not uniformly available in jails and prisons”. Despite the prevalence of potentially fatal high-risk pregnancies, reports show that only half of pregnant prisoners received prenatal care and the restraints are still commonly used during childbirth despite the immense medical risks.3
Postpartum: Nearly one-fifth of women in the US experience postpartum depression and the lack of attention to postpartum mental health has dire consequences, especially for incarcerated women. Female inmates are at a higher risk than the general population for postpartum depression and psychosis due to a high prevalence of underlying (and often undetected) mental health disorders and emotional/physical trauma. This trauma is often enhanced after being separated from their newborns. Mother-infant attachment is critical for the infant’s psychological development and the mother’s mental well-being, especially during the first three months after giving birth. Unfortunately, most female inmates are forced to separate from their newborns within 1-2 days after giving birth. Additionally, incarceration makes it difficult for women to breastfeed their newborns, which has shown to have several benefits for the child and for the mother, but there are not many services in place in order to facilitate this service. “Nonetheless, screenings for postpartum physical and psychiatric complications often are not routinely performed for women who deliver while in custody and for women who enter custody and have recently given birth”. 3
The lack of attention and care given to female inmates in the United States puts this population in a vulnerable position leading to harsher sanctions than their male counterparts which has direct health consequences. Racial/ethnic socioeconomic disparities contribute to the overrepresentation of minority women in prison making systemic racism another factor for this population’s lack of proper healthcare. For incarcerated women who are addicted to drugs or have experienced physical/sexual trauma, a lack of health services in prison makes it virtually impossible for them to adjust to society when released from prison. Unfortunately, there is a blatant lack of prioritization by senior prison staff when it comes to this issue. As Eric Balaban, a senior staff counsel with the American Civil Liberties Union National Prison Project has said, “Prisons and jails are not hospitals…”, showing that the health of these women is such a low priority for those with authority in correctional facilities. However, providing proper health care and helping these women adjust from the traumatic lives they had before incarceration is crucial in order to help them return to society. Should that not be the goal of such correctional facilities?