More than 1,000,000 women in the United States are currently under supervision of the criminal legal system (CLS), with the majority on probation or parole.
1Jails are typically short-term holding facilities under local jurisdiction for the newly arrested, those awaiting trial or sentencing, and those serving short sentences. State or federal prisons are institutional facilities where those who are convicted serve longer sentences.
Since 1980, the number of women in prison has increased by more than 800%, which is twice the rate of growth for men, whose rates are falling (Bronson and Carson, 2019
). Similarly, the male jail population decreased by 9% from 2008 to 2018, whereas the female jail population experienced a 15% increase (- Bronson J.
- Carson E.A.
Prisoners in 2017.
Bureau of Justice Statistics,
Washington, DC2019
www.bjs.gov/index.cfm? ty=pbdetail&iid=6546
Date accessed: April 25, 2019
Zeng, 2020
). Women involved in the CLS (WICLS) have high rates of mental and physical health conditions, socioeconomic challenges, and trauma and violence histories (- Zeng Z.
Jail inmates in 2018.
Bureau of Justice Statistics,
Washington, DC2020
www.bjs.gov/content/pub/pdf/ji18.pdf
Date accessed: June 1, 2020
Meyer et al., 2014
; McDaniels-Wilson and Belknap, 2008
; Fedock and Covington, 2017
; Sufrin, 2017
). 2
Women and men involved in the CLS include adults serving sentences in prisons and jails, awaiting trial or sentencing, and those under community supervision. We try to use person-first and nonstigmatizing or pejorative language (
Broyles et al., 2014
; Tran et al., 2018
).2Women and men involved in the CLS include adults serving sentences in prisons and jails, awaiting trial or sentencing, and those under community supervision. We try to use person-first and nonstigmatizing or pejorative language (
These high rates are consequences of pre-incarceration factors, including poverty, structural racism, and inadequate health care access; limited jail and prison health care; and the health impacts of carceral systems themselves (Broyles et al., 2014
; Tran et al., 2018
).Binswanger et al., 2012
; Cloud et al., 2020
; Venters, 2019
). Broader efforts to address women's health equity should include WICLS, who are often otherwise excluded from public health programs, policies, and initiatives.The health and well-being of WICLS may also be adversely shaped by intersecting forms of oppression, including racism, poverty, ageism, ableism, homophobia, and sexism. Social determinants of health and CLS involvement include aspects of the social environment, such as discrimination and income, the physical environment, and health services. Furthermore, parenting and reproduction, health care needs as they age, and reentry challenges of WICLS are underrepresented in current policy, research, and clinical contexts (
Aday and Farney, 2014
; Fedock and Covington, 2017
; Sufrin, 2017
). These intersectional forces bear on women and their families before, during, and after incarceration and may lead to poor health across the lifespan (Hayes et al., 2020
; Meyer, 2019a
). CLS involvement increases risk of physical and sexual violence, with direct or indirect health and health care effects, which impact families and communities (Brinkley-Rubinstein, 2013
; Hatzenbuehler et al., 2015
; Kajeepeta et al., 2020
; Venters, 2019
).We delineate reproductive health and motherhood, aging in prison, and reentry as critical areas exemplifying women's complex health-related needs, which may be best addressed via gender-responsive and trauma-informed care.
3
This article focuses primarily on people whose biological sex is female and who identify as women (also known as cis-gendered women); however, we recognize transgender individuals' disproportionate contact with the criminal legal system and that people who may not identify as “women” (i.e., trans men) might have pregnancy and other reproductive health care needs.
3This article focuses primarily on people whose biological sex is female and who identify as women (also known as cis-gendered women); however, we recognize transgender individuals' disproportionate contact with the criminal legal system and that people who may not identify as “women” (i.e., trans men) might have pregnancy and other reproductive health care needs.
WICLS have different experiences and needs in comparison with men involved in the CLS as well as other women living in the community without CLS involvement. These complex medical, psychiatric, and social conditions may require dedicated high-quality, comprehensive, and evidence-based health care in prisons and jails, which link women to care and support in the community on release (Meyer, 2019b
; - Meyer J.P.
United States Commission on Civil Rights Hearing on Women in Prison. Panel 2: An analysis of women’s health, personal dignity, and sexual abuse in the U.S. Prison System. 2019.
2019: 16
https://www.usccr.gov/pubs/briefing-reports/2020-02-26-Women-in-Prison.php
Date accessed: June 1, 2020
Rich et al., 2013
). Patient-centered care is well-suited to address the heterogeneity of experiences, identities, and health conditions and to support developing well-tailored, structurally competent interventions and programs for WICLS (Metzl and Hansen, 2014
; Meyer, 2019b
).- Meyer J.P.
United States Commission on Civil Rights Hearing on Women in Prison. Panel 2: An analysis of women’s health, personal dignity, and sexual abuse in the U.S. Prison System. 2019.
2019: 16
https://www.usccr.gov/pubs/briefing-reports/2020-02-26-Women-in-Prison.php
Date accessed: June 1, 2020
4
Metzl and Hansen, 2014
introduce “structural competency”: 1) recognizing the structures that shape clinical interactions, 2) developing an extra-clinical language of structure, 3) rearticulating “cultural” formulations in structural terms, 4) observing and imagining structural interventions, and 5) developing structural humility.4
Paradoxically, some jails and prisons have become spaces where women can find health care, which reflects the withering health and social safety net that fails to advance equity in many of our communities (Metzl and Hansen, 2014
introduce “structural competency”: 1) recognizing the structures that shape clinical interactions, 2) developing an extra-clinical language of structure, 3) rearticulating “cultural” formulations in structural terms, 4) observing and imagining structural interventions, and 5) developing structural humility.Sufrin, 2017
).CLS Involvement and Health Among Women
CLS involvement among women closely affects a broad range of health outcomes. Women have similar or lower prevalence of chronic conditions compared to men in the general population, yet rates of chronic illness and comorbid conditions of WICLS are higher than those of other women in the community and men involved in the CLS (
Binswanger et al., 2009
). An analysis of Bureau of Justice Statistics data and nationally representative cross-sectional data from the early 2000s finds nearly 65% of women in prison and jail reported having a chronic condition, in comparison to approximately 50% of men in prison and jail reporting a chronic condition (Harzke and Pruitt, 2018
). Women's pathways to being enmeshed in the CLS are often associated with their relationships, including substance use in dyads, conscription or coercion to engage in illicit activity, and intimate partner violence exposure (Meyer et al., 2014
, Meyer et al., 2017
, Meyer et al., 2017
; Jiwatram-Negrón and El-Bassel, 2015
).Substance use, psychiatric disorders, and prior exposure to violence are prevalent among WICLS. According to the Bureau of Justice Statistics, 69% of women in state prison and 72% of women sentenced in jail in 2012 met criteria for severe substance use disorders, which require specialized approaches to management (
Bronson et al., 2017
). Similarly, infectious diseases related to injection drug use and high-risk sex networks, such as HIV and hepatitis C, were more prevalent than in the general population (Binswanger et al., 2010
; Williams et al., 2013
; Meyer, 2019a
). Furthermore, sexually transmitted infection rates were recorded as 10 to 20 times greater relative to women in the community without CLS experience and, if left untreated, these infections can negatively impact women's health (Knittel and Lorvick, 2019
; Linder, 2018
; Meyer, 2019b
). Thus, the Centers for Disease Control and Prevention issued recommendations to expand sexually transmitted infection screening and treatment in prisons and jails in 2015 (- Meyer J.P.
United States Commission on Civil Rights Hearing on Women in Prison. Panel 2: An analysis of women’s health, personal dignity, and sexual abuse in the U.S. Prison System. 2019.
2019: 16
https://www.usccr.gov/pubs/briefing-reports/2020-02-26-Women-in-Prison.php
Date accessed: June 1, 2020
Centers for Disease Control and Prevention (CDC), 2015
).The prevalence of co-occurring psychiatric disorders and substance use disorders, often associated with trauma, frequently exceed 75% among WICLS (
Meyer et al., 2013
; Prins, 2014
; Staton-Tindall et al., 2007
; Winkelman et al., 2018
). People with severe psychiatric disorders have high rates of repeated contact with the CLS, where evidence-based treatment may be lacking, further contributing to negative psychiatric outcomes (Baillargeon et al., 2009
; Glied and Frank, 2009
).Girls and young women of color are disproportionately vulnerable to “the sexual abuse to prison pipeline” (
Marquardt, 2020
). Girls only constitute 20% to 25% of the juvenile CLS population, yet 50% to 66% of those dually involved in juvenile criminal legal and child welfare systems are girls (Saar et al., 2015
). WICLS contend with violence and trauma history as prevalent as 95%, including sexual assault and intimate partner violence (Meyer et al., 2014
; McDaniels-Wilson and Belknap, 2008
; Richie, 2012
). Nearly 40% of WICLS meet criteria for post-traumatic stress disorder, and research shows that untreated posttraumatic stress contributes to women's distinct incarceration and recidivism pathways (Baranyi et al., 2018
; Fuentes, 2014
; Harner et al., 2015
).Exposure to degradation, body searches, shackles, cell shakedowns, restraints, and seclusion during incarceration further compound trauma; in addition, trauma-related symptoms may be mistaken for acts of aggression or defiance (
Center for Substance Abuse Treatment (CSAT), 2014
; - Center for Substance Abuse Treatment (CSAT)
Trauma-informed care in behavioral health services.
Substance Abuse and Mental Health Services Administration,
Rockville, MD2014
www.ncbi.nlm.nih.gov/books/NBK207191
Date accessed: June 1, 2020
Kramer and Comfort, 2011
; Fedock and Covington, 2017
; Kraft-Stolar et al., 2011
). Prison discipline policies punish women more harshly than men, including disproportionate isolation for minor, nonviolent infractions (- Kraft-Stolar T.
- Brundige E.
- Kalantry S.
- Kestenbaum J.G.
Avon Global Center for Women and Justice at Cornell Law SchoolWomen in Prison Project (Correctional Association of New York)From Protection to Punishment: Post- Conviction Barriers to Justice for Domestic Violence Survivor-Defendants in New York State
Avon Global Center for Women and Justice and Dorothea S. Clarke Program in Feminist Jurisprudence. Paper 2.
Avon Global Center for Women and Justice and Dorothea S. Clarke Program in Feminist Jurisprudence. Paper 2.
LaChance, 2018
; United States Commission on Civil Rights Office of Civil Rights Evaluation (OCRE), 2020
). Disciplinary record, charges, and punishment can be associated with gendered charges. Women with psychiatric conditions are overrepresented in segregation environments (LaChance, 2018
). Staff sexual misconduct, lack of respect, and potential control of women's bodies may be conducive to a lack of safety, abuse, exploitation, and violence (Owen et al., 2017
; Rantala, 2018
). Violence targeting transgender women is particularly perilous, given disproportionate incarceration and victimization risks (Baćak et al., 2018
).People who are incarcerated are the only population in the United States with a constitutional guarantee to health care, including protection from serious physical and psychological harm, yet health care standards and practices widely vary (
Dolovich, 2009
; Venters, 2019
). Estelle v. Gamble established the constitutional mandate that institutions of incarceration address “serious medical needs” (Dolovich, 2009
). However, there are no mandatory standards as to what services have to be provided or what conditions count as serious medical needs. Health care spending, quality, and organizational structures vary across facilities where services and practices also vary, particularly for women's health within prison and jail contexts designed primarily for men (Pew Charitable Trusts, 2017
). Overall, health delivery systems within prisons and jails are associated with various levels of expertise in evaluation, quality improvement, evidence-based practice, and implementation science (Pew Charitable Trusts
Prison health care: Costs and quality. Pew Charitable Trusts.
Prison health care: Costs and quality. Pew Charitable Trusts.
www.pewtrusts.org/en/research-and-analysis/reports/2017/10/prison-health-care-costs-and-quality
Date: 2017
Date accessed: June 1, 2020
Pew Charitable Trusts, 2017
).Pew Charitable Trusts
Prison health care: Costs and quality. Pew Charitable Trusts.
Prison health care: Costs and quality. Pew Charitable Trusts.
www.pewtrusts.org/en/research-and-analysis/reports/2017/10/prison-health-care-costs-and-quality
Date: 2017
Date accessed: June 1, 2020
Reproductive Health and Parenting
Approximately 75% of women in state and federal prisons are younger than 45, so health care needs must address reproductive health, including family planning care; comprehensive pregnancy, birth, and postpartum care; and abortion access (
Carson, 2020
). Addressing incarcerated women's health care within a reproductive justice framework prioritizes health care inequities, alongside material resources—such as safe neighborhoods, good schools, clean water, and just court systems—needed to parent (- Carson E.A.
Prisoners in 2018.
Bureau of Justice Statistics,
Washington, DC2020
www.bjs.gov/content/pub/pdf/p18.pdf
Date accessed: June 1, 2020
Hoff et al., 2020
; Strickler and Simpson, 2017
). Reproductive justice is an intersectional theory and platform for action that emerged from and centers the experiences of women of color and draws on the knowledge of historical legacies in which their reproduction has been systematically devalued (Ross & Solinger, 2017
; Price, 2011
). Three rights are central to achieving reproductive justice: the right not to have children, the right to have children, and the right to parent children in dignity and safety. Incarceration disrupts core reproductive justice tenets, denying contraception and abortion access and implementing coercive contraceptive practices, and providing substandard maternity and postpartum care (Hayes et al., 2020
). Currently, there is over-investment in systems to confine people and under-investment in safety net systems.Menstrual dysfunction is three times higher among incarcerated women, of whom 50% lack access to basic menstrual supplies (
Allsworth et al., 2007
; Linder, 2018
). Only four states offer free access to menstrual products in prison (). WICLS, in custody and upon release, experience unmet family planning service needs, including contraceptive access and counseling (Allsworth et al., 2007
; Clarke et al., 2006
; Larochelle et al., 2012
). Unlawful sterilization in California prisons as recently as 2010 runs counter to necessary noncoercive, patient-centered, reversible contraceptive methods access (Hayes et al., 2020
; Sufrin et al., 2009a
). Although incarcerated women retain their legal right to abortion, many facilities disallow access (Bronson and Sufrin, 2019
; Hayes et al., 2020
; Sufrin et al., 2009b
).Nearly 4,000 admissions of pregnant people to prisons and 55,000 to jails occur annually (
Bronson and Sufrin, 2019
; Sufrin et al., 2020a
). Until 2019, there was limited systematic data reporting on incarcerated pregnant people and related outcomes, including births, miscarriages, and abortions. This lack of data collection and reporting reflects a potential disregard for incarcerated women's gender and reproductive specific needs and the slow pace at which the growing female jail and prison populations have been addressed. Shackling women in labor in federal prisons is banned, yet only 29 states have similar laws for state prisons, which are frequently violated (Goshin et al., 2020
; Sufrin, 2019a
, - Sufrin C.
Criminal Justice reform must include pregnant women. The Hill.
https://thehill.com/blogs/congress-blog/healthcare/435118-criminal-justice-reform-must-include-pregnant-women
Date: 2019
Date accessed: June 1, 2020
Sufrin et al., 2019b
; Kuhlik and Sufrin, nd
). Pregnant people with opioid use disorder may experience withdrawal, despite this being contrary to standards of care (Sufrin et al., 2020b
). Prenatal care availability and quality vary considerably, as do policies promoting breastfeeding and infant bonding for birth while in custody.Approximately 60% to 80% of incarcerated women have minor children and most are single parents (
Fedock and Covington, 2017
; De Claire and Dixon, 2017
). Compared with incarcerated men, women in prisons and jails are five times more likely to have children placed in foster care (Swavola et al., 2016
; De Claire and Dixon, 2017
). Many barriers prevent children's visits, including inconvenient visiting hours, related costs, lack of child-friendly visiting space, caregivers' desire to keep child from carceral environments, and distance from home (Boudin, 2011
; Fedock and Covington, 2017
; Swavola et al., 2016
; United States Commission on Civil Rights Office of Civil Rights Evaluation (OCRE), 2020
). Incarcerated parents' children, who may struggle with this separation, are more than six times more likely to experience incarceration themselves (Boudin, 2011
; Wakefield and Wildeman, 2013
). Notably, women's removal and return to communities associated with incarceration can have effects on families and communities (Boudin, 2011
; Fedock and Covington, 2017
).Policy reforms should standardize and expand reproductive health care scope and quality for incarcerated women, including comprehensive prenatal, birth, and postpartum care; abortion and noncoercive contraception access; menstruation management; cervical and breast cancer screening, diagnosis, and management; and pregnancy data collection. Further, training and oversight will bolster policies in supporting the right to parent in safety and dignity, alongside alternatives to incarceration, community health, and economic infrastructure (
Hayes et al., 2020
). Lastly, supporting parenting skills along with contact and reunification with loved ones is critical to rehabilitation and reducing recidivism (De Claire and Dixon, 2017
; Fedock and Covington, 2017
; Meyer, 2019b
).- Meyer J.P.
United States Commission on Civil Rights Hearing on Women in Prison. Panel 2: An analysis of women’s health, personal dignity, and sexual abuse in the U.S. Prison System. 2019.
2019: 16
https://www.usccr.gov/pubs/briefing-reports/2020-02-26-Women-in-Prison.php
Date accessed: June 1, 2020
Aging
Disproportionate incarceration rates and longer sentences than men for similar offenses often combine with histories of violence, trauma, and poverty to compromise the health of older WICLS. Incarcerated older women experience higher rates of chronic disease and disability, victimization, and mental illness in comparison with men involved in the CLS and nonincarcerated women (
Aday and Farney, 2014
; Barry et al., 2020
). The proportion of aging women in prison is growing faster in comparison with men, which is associated with greater health demands and costs largely owing to increased comorbidity burden and physical and cognitive disabilities (Skarupski et al., 2018
). In 2018, nearly 25% of women in state and federal prisons were over the age of 45 (Carson, 2020
). Between 1993 and 2013, the number of women in state prisons age 40 and older increased by more than 300% (- Carson E.A.
Prisoners in 2018.
Bureau of Justice Statistics,
Washington, DC2020
www.bjs.gov/content/pub/pdf/p18.pdf
Date accessed: June 1, 2020
Carson and Sabol, 2016
).- Carson E.A.
- Sabol W.J.
Aging of the state prison population, 1993-2013.
Bureau of Justice Statistics,
Washington, DC2016
www.bjs.gov/content/pub/pdf/aspp9313.pdf
Date accessed: June 1, 2020
Geriatric syndromes, including cognitive and functional impairment, dementia, falls, and incontinence, are present at higher rates and at younger ages in incarcerated populations than for nonincarcerated women (
Bedard et al., 2016
; Williams et al., 2006
). Jail and prisons' environmental conditions “designed to restrict the liberty of young people,” poor lighting and ventilation, inadequate climate control, overcrowding, and service barriers exacerbate older women's physical challenges (Bedard et al., 2016
; Aday and Farney, 2014
). Physically demanding work activities lacking modifications for functional impairments persist and vary across states (Williams et al., 2006
). Additionally, daily living activities while incarcerated are also more challenging for women than men (Skarupski et al., 2018
; Williams et al., 2006
). Consequently, many older women who would be independent in the community are not in prison (Williams et al., 2012
).Clinicians working with patients who are incarcerated oftentimes lack training in palliative care, which is the community standard of care for patients with life-limiting or serious illnesses (
Bedard et al., 2016
). Additionally, while medical or “compassionate” release policies exist to allow people of advanced age or with serious illness to leave prison before they die, in practice few are released through these mechanisms (Mitchell and Williams, 2017
; Prost and Williams, 2020
). As a result, ideal medical release candidates frequently lack appropriate assessments and remain unnecessarily confined (Prost and Williams, 2020
). Many older women also experience difficulties and unmet needs around grief and loss as part of traumas of incarceration, which also include personal, social, and environmental deprivations (Aday and Farney, 2014
; Aday and Krabill, 2016
).Gender-sensitive, trauma-informed, patient-centered, and evidence-based geriatric and palliative care standards appropriate to carceral environments should be designed to minimize victimization and injury. Relatedly, improving disability trajectories by mitigating environmental risk factors and reducing avoidable suffering for women with serious and life-limiting illness while in prison is key if older women must remain incarcerated (
Rich et al., 2015
). Older women, in comparison with older men in prison and women in the community, are prone to fewer disciplinary infractions and lower recidivism rates upon release (Bedard et al., 2016
). Reentry supports for aging women should facilitate securing health care continuity, housing, employment, and social services. WICLS returning to the community may experience bias and discrimination associated with their age, gender, class, race, and criminal records.States continue to grapple with how to handle the aging prison population growth. The Centers for Medicare and Medicaid Services funds a privately owned nursing home facility contracted by the state of Connecticut, which houses ailing people in custody. Experts urge repeal of mandatory minimum, “habitual offender,” and truth-in-sentencing laws and support interim reform efforts, such as conditional release for aging men and women in custody who pose little security risk, compassionate release, parole board transparency, and federal aging prisoner release reauthorization (
Mitchell and Williams, 2017
; Williams et al., 2012
, Williams et al., 2012
). Moreover, further research in this area is needed to improve survey methods, tools, and research to optimally assess the health of older WICLS (Barry et al., 2020
; Bedard et al., 2016
; Skarupski et al., 2018
; Williams et al., 2012
).Reentry
Nearly 95% of those incarcerated will return to communities (
Hughes and Wilson, 2002
). This reentry period is associated with numerous health challenges, including increased mortality, psychiatric symptoms, and victimization (Binswanger et al., 2007
, Binswanger et al., 2011
; Binswanger et al., 2013
, Binswanger et al., 2016
; Meyer et al., 2014
). During reentry, women's high rates of co-occurring conditions can be exacerbated by care discontinuities, medication disruption, and inadequate insurance (Binswanger et al., 2011
; Johnson et al., 2015
; - Johnson J.E.
- Schonbrun Y.C.
- Peabody M.E.
- Shefner R.T.
- Fernandes K.M.
- Rosen R.K.
- Zlotnick C.
Provider experiences with prison care and aftercare for women with co-occurring mental health and substance use disorders: Treatment, resource, and systems integration challenges.
Journal of Behavioral Health Services & Research. 2015; 42: 417-436
Woods et al., 2019
). Common health care barriers include experienced or anticipated stigma and discrimination, low health literacy, and difficulties navigating health care systems (Johnson et al., 2015
; - Johnson J.E.
- Schonbrun Y.C.
- Peabody M.E.
- Shefner R.T.
- Fernandes K.M.
- Rosen R.K.
- Zlotnick C.
Provider experiences with prison care and aftercare for women with co-occurring mental health and substance use disorders: Treatment, resource, and systems integration challenges.
Journal of Behavioral Health Services & Research. 2015; 42: 417-436
Kramer and Comfort, 2011
; Winkelman et al., 2016
). Many women return to under-resourced neighborhoods amidst prevalent poverty, violence, and substance use (Fedock and Covington, 2017
; Golembeski and Fullilove, 2008
). Women's reentry challenges include greater parental responsibilities, income disparities, housing insecurity, and dependency on partners for subsistence needs (Fedock and Covington, 2017
; Johnson et al., 2015
; - Johnson J.E.
- Schonbrun Y.C.
- Peabody M.E.
- Shefner R.T.
- Fernandes K.M.
- Rosen R.K.
- Zlotnick C.
Provider experiences with prison care and aftercare for women with co-occurring mental health and substance use disorders: Treatment, resource, and systems integration challenges.
Journal of Behavioral Health Services & Research. 2015; 42: 417-436
Western, 2018
).Custody revocation laws and child welfare oversight may compromise family reunification (
Sufrin, 2017
). Reentry-related stressors may lead women to deploy survival strategies, including transactional sex, associated with recidivism (Kramer and Comfort, 2011
; Richie, 2012
). Difficulties securing housing and employment, plus exposure to potential violence, drug use, and high-risk survival behavior, can compound trauma (Binswanger et al., 2014
; Jiwatram-Negrón and El-Bassel, 2015
; Meyer et al., 2014
). Women often shoulder greater financial burdens and family responsibilities than men (Hersch and Meyers, 2018
; Richie, 2012
). Plus, collateral consequences of incarceration for women involving health, employment, housing, debt, civic involvement, families, and communities can reduce opportunities to sustain healthy relationships and financial security (Fedock and Covington, 2017
; Hersch and Meyers, 2018
; Kirk and Wakefield, 2018
).Transitions to care outside of jails or prisons have improved through the establishment of community-based clinics providing transitional care, including primary care and case management, as well as peer patient navigators (
Binswanger et al., 2015
; Fox et al., 2014
; Wang et al., 2010
). For instance, New York's Women's Initiative Supporting Health-Transitions Clinic involves peer health workers in providing treatment and support to recently released women (Bedell et al., 2015
; Morse et al., 2017
). Cross-agency collaboration, which incorporates psychological and emotional components that women need to heal and recover, can facilitate and sustain integrative continuity of care models that address structural racism, poverty and trauma histories, and mental and physical health conditions.Conclusions
Adverse life events are prevalent among WICLS, who contend with structural barriers that compromise health and well-being and facilitate contact with the CLS. Disproportionate health burdens and barriers to care are associated with syndemic effects of substance use disorders, plus chronic medical and psychiatric conditions within the context of racism and gender inequities (
Meyer et al., 2013
; Williams et al., 2013
). Sexual and physical violence within the CLS is a serious concern (McDaniels-Wilson and Belknap, 2008
; Venters, 2019
). Relatedly, the forced migration, also known as coercive mobility, of incarceration disrupts social, family, and sexual networks with secondary effects on communities (Binswanger et al., 2012
; Hatzenbuehler et al., 2015
).Most national health surveys exclude WICLS, so much is unknown to researchers and providers about their gender and reproductive health specific needs. This problem can be remedied: experts have developed ethical data collection for public health surveillance in jails and prisons and for individuals under community supervision (
Ahalt et al., 2018
; Binswanger et al., 2019
; Sufrin et al., 2019b
; Wang et al., 2019
). 5
Additional research, clinical, and policy efforts to address intimate partner violence, trauma, and comorbid health conditions are needed to improve health equity for WICLS (Data collection purposes include surveillance, health promotion and disease prevention, healthcare performance and patient value, policy relevance, health equity, and human rights and legal considerations (
Binswanger et al., 2019
).Bowen and Murshid, 2016
).The transformative role of WICLS in peer support, research, service delivery, and policy addressing inequities associated with the CLS is widely acknowledged (
Bedell et al., 2015
; Binswanger et al., 2015
; Epperson and Pettus-Davis, 2017
; Kraft-Stolar et al., 2011
; - Kraft-Stolar T.
- Brundige E.
- Kalantry S.
- Kestenbaum J.G.
Avon Global Center for Women and Justice at Cornell Law SchoolWomen in Prison Project (Correctional Association of New York)From Protection to Punishment: Post- Conviction Barriers to Justice for Domestic Violence Survivor-Defendants in New York State
Avon Global Center for Women and Justice and Dorothea S. Clarke Program in Feminist Jurisprudence. Paper 2.
Avon Global Center for Women and Justice and Dorothea S. Clarke Program in Feminist Jurisprudence. Paper 2.
Sturm and Tae, 2017
). Moreover, the Share Project, a health justice initiative, trains patients with incarceration histories, community health workers, policymakers, and researchers in participatory research involving a data-sharing platform (Elumn Madera et al., 2019
). Health care providers are uniquely qualified to improve the health of WICLS via care that is patient-centered, structurally competent, and sensitive to the complex interplay of trauma, violence, and co-occurring mental and physical health conditions (Goshin et al., 2019
; Hayes et al., 2020
; Metzl and Hansen, 2014
; Morse et al., 2017
; Sufrin, 2017
).Decarceration, drug policy reform, and alternatives to incarceration are necessary criminal justice reform efforts, which may improve health outcomes further upstream and aid women in addressing underlying challenges while maintaining and strengthening positive ties to families and communities. From a systems perspective, it is less costly and disruptive to avoid incarceration altogether and deliver continuous care in the community for chronic health conditions including substance use and psychiatric disorders (
Meyer, 2019b
). Women have strengths, needs, risks, and pathways into the justice system that often differ from men's (- Meyer J.P.
United States Commission on Civil Rights Hearing on Women in Prison. Panel 2: An analysis of women’s health, personal dignity, and sexual abuse in the U.S. Prison System. 2019.
2019: 16
https://www.usccr.gov/pubs/briefing-reports/2020-02-26-Women-in-Prison.php
Date accessed: June 1, 2020
Binswanger et al., 2013
; Richie, 2012
; Machtinger et al., 2015
). Gender-responsive, trauma-informed, strength-based care supports women's reintegration and recovery. Relevant clinical training, capacity building, material resources, and structural support in communities are also necessary to sustain such efforts (Machtinger et al., 2015
; Meyer et al., 2017
; Binswanger et al., 2014
).Bipartisan criminal justice reform legislation, which includes improving the health of WICLS, is gaining support. The Second Chance Act, the Fair Sentencing Act, and the First Step Act of 2018 have been enacted. The Dignity for Incarcerated Women Act, which focuses on health, visitation, programming, oversight, and telecommunications, was reintroduced by Senators Elizabeth Warren and Cory Booker in April 2019. The First Step Act, which only applies to federal contexts, contains some of the Dignity Act's clauses: menstrual product provision, shackling bans, and incarceration closer to home. Moreover, the proposed 2018 Pregnant Women in Custody Act supports data collection and reporting on pregnant women, prohibiting restrictive housing and restraints, and addressing health care needs in federal prisons. Relatedly, Senators Ann McLane Kuster and Booker's proposed Humane Correctional Health Care Act seeks to improve health care delivery and treatment behind bars (
Kuster and Booker, 2019
). As a public health community committed to advancing equity, we must evaluate and support legal and legislative reform that seeks to improve health care quality and access for this often overlooked population.- Kuster A.M.
- Booker C.
Medicaid should be available in prisons. The Washington Post.
www.washingtonpost.com/opinions/2019/10/11/medicaid-should-be-available-prisons/
Date: 2019
Date accessed: June 1, 2020
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Biography
Cynthia A. Golembeski, MPH, is a Rutgers University JD/PhD student who teaches undergraduate courses in prison with NJ-STEP. She is a Robert Wood Johnson Foundation Health Policy Research Scholar. Research interests include criminal justice/health policy and management, equity, ethics, nonprofit management and philanthropy, and citizen-state relations.
Biography
Carolyn B. Sufrin, MD, PhD, is an obstetrician-gynecologist and medical anthropologist at Johns Hopkins University. Her work is situated at the intersection of reproductive justice, health care, and mass incarceration, which she examines in her book, Jailcare: Finding the Safety Net for Women Behind Bars.
Biography
Brie Williams, MD, MS, is a professor of medicine at the University of California San Francisco in the Division of Geriatrics, who integrates a healthcare perspective into criminal justice reform. She founded Amend at UCSF, which draws on public health to transform prison and jail culture. She also co-directs the Aging Research in Criminal Justice Health (ARCH) Network funded by the National Institute on Aging.
Biography
Precious S. Bedell, MA, CHW, is with the University of Rochester Department of Arts, Sciences and Engineering and Turning Points Resource Center. Her research interests are health issues for women in prison, formerly incarcerated individuals, their family members, and community-based participatory research.
Biography
Sherry A. Glied, PhD, New York University Robert F. Wagner Graduate School of Public Service, is an economist focusing on health care policy and mental health policy. She has served as Assistant Secretary for Planning and Evaluation in the Department of Health and Human Services.
Biography
Ingrid A. Binswanger, MD, MPH, MS, Senior Investigator, Kaiser Permanente Colorado Institute for Health Research and a physician with the Colorado Permanente Medical Group, conducts research designed to prevent overdose and improve the health of populations that interact with the criminal legal system.
Biography
Donna Hylton, MA, wrote A Little Piece of Light. She is founder and president of A Little Piece of Light, Inc., which works to end the criminalization of women and girls.
Biography
Tyler N.A. Winkelman MD, MSc, is Co-Director of the Hennepin Healthcare Research Institute's Health, Homelessness, and Criminal Justice Lab; Associate Director, Virtual Data Warehouse; a physician with Hennepin Healthcare; and Assistant Professor, Departments of Internal Medicine and Pediatrics at the University of Minnesota.
Biography
Jaimie Meyer, MD, MS, FACP, is Assistant Professor, Yale AIDS Program, and Clinical Assistant Professor of Nursing. She is a board-certified physician in Medicine, Infectious Diseases, and Addiction Medicine. Her lab studies HIV interventions for women in criminal legal systems.
Article info
Publication history
Published online: July 29, 2020
Accepted:
June 20,
2020
Received in revised form:
June 12,
2020
Received:
May 16,
2020
Footnotes
Dr. Sufrin’s efforts were supported by grants from the National Institute on Drug Abuse (5K23DA045934-02) and the Society for Family Planning Research Fund (SFPRF11-09). Dr. Williams’ efforts were supported by the National Institute on Aging of the National Institutes of Health under the Aging Research in Criminal Justice Health Network (grant R24AG065175) and the University of California, San Francisco Pepper Center (grant P30 AG044281). Dr. Meyer’s efforts were supported by the Doris Duke Charitable Foundation Clinical Scientist Development Award (DDCF CSDA).
Identification
Copyright
Published by Elsevier Inc. on behalf of Jacobs Institute of Women's Health.
