My first job in correctional health was a position at a female prison. I had always been interested in women’s health, and this seemed like a great fit. I soon realized that my colleagues at the male facilities dealt with different issues in their patient population, and often they could not be a resource for me, never having had to address some of the issues that I faced. Certainly there were similar situations, like the need for chronic care clinics for diabetes, hypertension, seizure disorder, thyroid problems and more, and those expected differences, like the need to conduct pelvic exams and Pap smears, mammographies and pregnancy tests, but incarcerated women also have unique attributes that must be considered when providing healthcare.
Are Incarcerated Women Unique?
There are over 1.2 million women under the jurisdiction of the justice system in the United States, with over 220,000 incarcerated in jails, state prisons and federal prisons (2019). In February 2020, the US Commission on Civil Rights published a brief entitled Women in Prison: Seeking Justice Behind Bars. In it, they discuss the unique attributes of incarcerated women as compared to incarcerated men, including that a greater percentage of women have chronic or severe mental illness; they are more likely to be survivors of trauma and/or sexual violence; and they have higher rates of substance use. In fact, for many, their involvement in drugs is the reason they are incarcerated. In addition, prenatal care and care for the transgender person were also found deficient in the Commission’s review of the data from its investigation. It is notable that 60% of the women incarcerated have a child (or children) under the age of 18 and most were the primary caregiver for that child prior to incarceration. There is much more information in the report, and I encourage you to review it. As Correctional Nurses and patient advocates, we must ensure that our patients’ health needs are met through the healthcare services we provide, whether they are men or women.
In my experience (and the experiences of my colleagues), incarcerated women access health services at a greater rate than incarcerated men. Significant substance use issues, poverty, and multiple psychosocial issues including mental illness, trauma and abuse often make it difficult for incarcerated women to trust the healthcare team. The Correctional Nurse in a female facility may require more sensitivity and intuition, and sometimes a great deal more patience.
What has your experience been in caring for incarcerated women? Do you agree that things are different? Tell us your story……