The lack of adequate health care is a serious problem for the growing population of incarcerated women in the United States. Between 1980 and 2019, the number of incarcerated women increased by 700% to more than 220,000 women, according to the Sentencing Project (http://www.sentencingproject.org). And, although this increase is twice that in the male population, experts assert that correctional health services-originally designed for men-haven't responded adequately to women's needs.

Among these needs are programs and services that recognize the high rates of trauma and victimization suffered by women who end up in prison. According to 2016 data compiled by the National Resource Center on Justice Involved Women, at least 50% of women in the correctional system have experienced physical or sexual abuse-and some studies put it as high as 98%. Incarcerated women are also more likely than their male counterparts to have both mental health problems and substance abuse disorders. A 2017 BMC Public Health study using Iowa Corrections Offender Network data found that 41% of women had serious mental illness versus 27% of men, and a Bureau of Justice Assistance study found that among incarcerated women, 53% had a history of posttraumatic stress disorder and 82% had a history of substance abuse disorder.

Health care in prisons is often delivered as part of a "sick call" system, whereby inmates receive episodic care for illnesses but little primary or preventive care. Even if an institution has primary care services, they are often inadequate to meet the needs of the prison population and women-specific services are limited or nonexistent. Lack of access to obstetric and gynecologic care is a particular concern, since approximately 85% of incarcerated women are of childbearing age. Access to menstrual care products, such as tampons, is another problem for female inmates. Only 12 states have laws requiring prisons to provide these products, and there are reports of guards withholding them from inmates as a means of coercion or to extract payment. Other historic forms of ill-treatment of incarcerated women include shackling them during childbirth, a practice that was outlawed only in 2018. Separating mothers and their infants after birth, however, continues to this day, according to a report from the Wilson Center.

Another pressing health issue for incarcerated women is the abuse they are subjected to by staff and inmates, causing both mental and physical harm. The New York Times recently reported on widespread physical and sexual abuse of inmates at Edna Mahan Correctional Facility, a large women's prison in New Jersey, noting that it had been going on for years, despite multiple complaints and inquiries. In 2020, a U.S. Department of Justice (DOJ) investigation of sexual misconduct at Lowell Correctional Institution, Florida's largest women's prison, found a long-standing pattern of sexual abuse by staff. According to the DOJ report, the Florida Department of Corrections had "been aware of a pattern or practice of staff sexual abuse of Lowell prisoners since at least 2006" yet took no action to remedy systemic problems enabling the abuse. Incarcerated women may also face harsher discipline than men for relatively minor infractions. An investigation by National Public Radio (NPR) and the Medill School of Journalism found that women are punished more frequently and receive twice the number of disciplinary tickets, the greatest disproportion being for tickets related to insolence, such as making a derogatory remark or disrespecting an officer.

To address these abusive practices as well as chronic deficiencies in health care, experts have advocated for a variety of reforms to ensure that incarcerated women receive appropriate services, including trauma-informed care, protection against sexual violence, and opportunities for rehabilitation.-Karen Roush, PhD, RN, FNP-BC, news director