Improving Health Equity for Women Involved in the Criminal Legal System.

Abstract

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.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, 2019Bronson J. Carson E.A. Prisoners in 2017. Bureau of Justice Statistics, Washington, DC2019www.bjs.gov/index.cfm? ty=pbdetail&iid=6546Date accessed: April 25, 2019Google Scholar). Similarly, the male jail population decreased by 9% from 2008 to 2018, whereas the female jail population experienced a 15% increase (Zeng, 2020Zeng Z. Jail inmates in 2018. Bureau of Justice Statistics, Washington, DC2020www.bjs.gov/content/pub/pdf/ji18.pdfDate accessed: June 1, 2020Google Scholar). Women involved in the CLS (WICLS) have high rates of mental and physical health conditions, socioeconomic challenges, and trauma and violence histories (Meyer et al., 2014Meyer J.P. Zelenev A. Wickersham J.A. Williams C.T. Teixeira P.A. Altice F.L. Gender disparities in HIV treatment outcomes following release from jail: Results from a multicenter study.American Journal of Public Health. 2014; 104: 434-441Crossref PubMed Scopus (60) Google Scholar; McDaniels-Wilson and Belknap, 2008McDaniels-Wilson C. Belknap J. The extensive sexual violation and sexual abuse histories of incarcerated women.Violence Against Women. 2008; 14: 1090-1127Crossref PubMed Scopus (134) Google Scholar; Fedock and Covington, 2017Fedock G. Covington S.S. Correctional programming and gender. Oxford Research Encyclopedia of Criminology and Criminal Justice. Oxford University Press, Oxford2017Google Scholar; Sufrin, 2017Sufrin C. Jailcare: Finding the safety net for women behind bars. Substance Abuse and Mental Health Services Administration (SAMHSA). TIP 51: Addressing the Specific Needs of Women. SAMHSA, Rockville, MD2017Google Scholar). 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 (Broyles et al., 2014Broyles L. Binswanger I. Jenkins J. Finnell D. Faseru B. Cavaiola A. Gordon A. Confronting inadvertent stigma and pejorative language in addiction scholarship: A recognition and response.Substance Abuse. 2014; 35: 217-221Crossref PubMed Scopus (102) Google Scholar; Tran et al., 2018Tran N.T. Baggio S. Dawson A. Williams B. Bedell P. Simon O. Scholten W. Wolff H. Words matter: A call for humanizing and respectful language to describe people who experience incarceration.BMC International Health and Human Rights. 2018; 18: 41Crossref PubMed Scopus (27) Google Scholar).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 (Broyles et al., 2014Broyles L. Binswanger I. Jenkins J. Finnell D. Faseru B. Cavaiola A. Gordon A. Confronting inadvertent stigma and pejorative language in addiction scholarship: A recognition and response.Substance Abuse. 2014; 35: 217-221Crossref PubMed Scopus (102) Google Scholar; Tran et al., 2018Tran N.T. Baggio S. Dawson A. Williams B. Bedell P. Simon O. Scholten W. Wolff H. Words matter: A call for humanizing and respectful language to describe people who experience incarceration.BMC International Health and Human Rights. 2018; 18: 41Crossref PubMed Scopus (27) Google Scholar). 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 (Binswanger et al., 2012Binswanger I.A. Redmond N. Steiner J.F. Hicks L.S. Health disparities and the criminal justice system: An agenda for further research and action.Journal of Urban Health. 2012; 89: 98-107Crossref PubMed Scopus (137) Google Scholar; Cloud et al., 2020Cloud D.H. Bassett M.T. Graves J. Fullilove R.E. Brinkley-Rubinstein L. Documenting and addressing the health impacts of carceral systems.American Journal of Public Health. 2020; 110: S5Crossref PubMed Scopus (7) Google Scholar; Venters, 2019Venters H. Life and death in Rikers Island. Johns Hopkins University Press, Baltimore2019Google Scholar). 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, 2014Aday R. Farney L. Malign neglect: Assessing older women's health care experiences in prison.Journal of Bioethical Inquiry. 2014; 11: 359-372Crossref PubMed Scopus (34) Google Scholar; Fedock and Covington, 2017Fedock G. Covington S.S. Correctional programming and gender. Oxford Research Encyclopedia of Criminology and Criminal Justice. Oxford University Press, Oxford2017Google Scholar; Sufrin, 2017Sufrin C. Jailcare: Finding the safety net for women behind bars. Substance Abuse and Mental Health Services Administration (SAMHSA). TIP 51: Addressing the Specific Needs of Women. SAMHSA, Rockville, MD2017Google Scholar). 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., 2020Hayes C.M. Sufrin C. Perritt J.B. Reproductive justice disrupted: Mass incarceration as a driver of reproductive oppression.American Journal of Public Health. 2020; 110: S21-S24Crossref PubMed Scopus (15) Google Scholar; Meyer, 2019aMeyer J.P. The sustained harmful health effects of incarceration for women living with HIV.Journal of Women's Health. 2019; 28: 1017-1018Crossref PubMed Scopus (1) Google Scholar). 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, 2013Brinkley-Rubinstein L. Incarceration as a catalyst for worsening health.Health & Justice. 2013; 1: 1-17Crossref Google Scholar; Hatzenbuehler et al., 2015Hatzenbuehler M.L. Keyes K. Hamilton A. Uddin M. Galea S. The collateral damage of mass incarceration: Risk of psychiatric morbidity among nonincarcerated residents of high-incarceration neighborhoods.American Journal of Public Health. 2015; 105: 138-143Crossref PubMed Scopus (53) Google Scholar; Kajeepeta et al., 2020Kajeepeta S. Rutherford C.G. Keyes K.M. El-Sayed A.M. Prins S.J. County jail incarceration rates and county mortality rates in the United States, 1987–2016.American Journal of Public Health. 2020; 110: S109-S115Crossref PubMed Scopus (11) Google Scholar; Venters, 2019Venters H. Life and death in Rikers Island. Johns Hopkins University Press, Baltimore2019Google Scholar). 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. 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.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, 2019bMeyer 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: 16https://www.usccr.gov/pubs/briefing-reports/2020-02-26-Women-in-Prison.phpDate accessed: June 1, 2020Google Scholar; Rich et al., 2013Rich J. Cortina S.C. Uvin Z.X. Dumont D.M. Women, incarceration, and health.Womens Health Issues. 2013; 23: e333-334Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar). 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, 2014Metzl J.M. Hansen H. Structural competency: Theorizing a new medical engagement with stigma and inequality.Social Science & Medicine. 2014; 103: 126-133Crossref PubMed Scopus (590) Google Scholar; Meyer, 2019bMeyer 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: 16https://www.usccr.gov/pubs/briefing-reports/2020-02-26-Women-in-Prison.phpDate accessed: June 1, 2020Google Scholar). 4Metzl and Hansen, 2014Metzl J.M. Hansen H. Structural competency: Theorizing a new medical engagement with stigma and inequality.Social Science & Medicine. 2014; 103: 126-133Crossref PubMed Scopus (590) Google Scholar 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.4Metzl and Hansen, 2014Metzl J.M. Hansen H. Structural competency: Theorizing a new medical engagement with stigma and inequality.Social Science & Medicine. 2014; 103: 126-133Crossref PubMed Scopus (590) Google Scholar 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. 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 (Sufrin, 2017Sufrin C. Jailcare: Finding the safety net for women behind bars. Substance Abuse and Mental Health Services Administration (SAMHSA). TIP 51: Addressing the Specific Needs of Women. SAMHSA, Rockville, MD2017Google Scholar). 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., 2009Binswanger I.A. Krueger P.M. Steiner J.F. Prevalence of chronic medical conditions among jail and prison inmates in the USA compared with the general population.Journal of Epidemiological Community Health. 2009; 63: 912-919Crossref PubMed Scopus (381) Google Scholar). 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, 2018Harzke A. Pruitt S. Chronic medical conditions in criminal justice involved populations.Journal of Health and Human Services Administration. 2018; 41: 306-347Google Scholar). 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., 2014Meyer J.P. Zelenev A. Wickersham J.A. Williams C.T. Teixeira P.A. Altice F.L. Gender disparities in HIV treatment outcomes following release from jail: Results from a multicenter study.American Journal of Public Health. 2014; 104: 434-441Crossref PubMed Scopus (60) Google Scholar, Meyer et al., 2017Meyer I. Flores A. Stemple L. Romero A. Wilson B. Herman J. Incarceration Rates and Traits of Sexual Minorities in the United States: National Inmate Survey, 2011–2012.American Journal of Public Health. 2017; 107: 267-273Crossref PubMed Scopus (68) Google Scholar, Meyer et al., 2017Meyer J.P. 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Drug use, dependence, and abuse among state prisoners and jail inmates, 2007–2009.www.bjs.gov/content/pub/pdf/dudaspji0709.pdfDate: 2017Date accessed: November 1, 2017Google Scholar). 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., 2010Binswanger I.A. Merrill J.O. Krueger P.M. White M.C. Booth R.E. Elmore J.G. Gender differences in chronic medical, psychiatric, and substance-dependence disorders among jail inmates.American Journal of Public Health. 2010; 100: 476-482Crossref PubMed Scopus (191) Google Scholar; Williams et al., 2013Williams C.T. Kim S. Meyer J. Spaulding A. Teixeira P. Avery A. Simon D. Gender differences in baseline health, needs at release, and predictors of care engagement among HIV-positive clients leaving jail.Aids & Behavior. 2013; 17: 195-202Crossref Scopus (27) Google Scholar; Meyer, 2019aMeyer J.P. 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Women with psychiatric conditions are overrepresented in segregation environments (LaChance, 2018LaChance J. Women in Segregation Fact Sheet. Vera Institute of Justice Center on Sentencing and Corrections.www.vera.org/publications/women-in-segregationDate: 2018Date accessed: June 1, 2020Google Scholar). 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., 2017Owen B. Wells J. Pollock J. In search of safety: Confronting inequality in women’s imprisonment. University of California Press, Oakland2017Crossref Google Scholar; Rantala, 2018Rantala R. Sexual victimization reported by adult correctional authorities, 2012–15. Department of Justice, Washington DC2018Google Scholar). Violence targeting transgender women is particularly perilous, given disproportionate incarceration and victimization risks (Baćak et al., 2018Baćak V. Thurman K. Eyer K. Qureshi R. Bird J. Rivera L. Kim S. Incarceration as a health determinant for sexual orientation and gender minority persons.American Journal of Public Health. 2018; 108: 994-999Crossref PubMed Scopus (10) Google Scholar). 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, 2009Dolovich S. Cruelty, prison conditions, and the Eighth Amendment.New York University law review New York University Law Review. 2009; 84: 881-979Google Scholar; Venters, 2019Venters H. Life and death in Rikers Island. Johns Hopkins University Press, Baltimore2019Google Scholar). Estelle v. Gamble established the constitutional mandate that institutions of incarceration address “serious medical needs” (Dolovich, 2009Dolovich S. Cruelty, prison conditions, and the Eighth Amendment.New York University law review New York University Law Review. 2009; 84: 881-979Google Scholar). 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, 2017Pew Charitable TrustsPrison health care: Costs and quality. Pew Charitable Trusts.www.pewtrusts.org/en/research-and-analysis/reports/2017/10/prison-health-care-costs-and-qualityDate: 2017Date accessed: June 1, 2020Google Scholar). 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, 2017Pew Charitable TrustsPrison health care: Costs and quality. Pew Charitable Trusts.www.pewtrusts.org/en/research-and-analysis/reports/2017/10/prison-health-care-costs-and-qualityDate: 2017Date accessed: June 1, 2020Google Scholar). 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, 2020Carson E.A. Prisoners in 2018. Bureau of Justice Statistics, Washington, DC2020www.bjs.gov/content/pub/pdf/p18.pdfDate accessed: June 1, 2020Google Scholar). 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 (Hoff et al., 2020Hoff E. Adams Z. Dasgupta A. Goddard D. Meyer J. Reproductive health justice and autonomy: A systematic review of pregnancy planning intentions, needs, and interventions among women involved in US criminal justice systems.Journal of Women’s Health. 2020; ([Epub ahead of print])Crossref Scopus (1) Google Scholar; Strickler and Simpson, 2017Strickler R. Simpson M. A brief herstory of SisterSong.in: Radical reproductive justice: Foundation, theory, practice, critique. Feminist Press, New York2017: 9Google Scholar). 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, 2017Ross L. Solinger R. Reproductive justice: An introduction (Vol. 1). University of California Press, 2017Crossref Google Scholar; Price, 2011Price K. It's not just about abortion: Incorporating intersectionality in research about women of color and reproduction.Women's Health Issues. 2011; 21: S55-S57Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar). 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., 2020Hayes C.M. Sufrin C. Perritt J.B. Reproductive justice disrupted: Mass incarceration as a driver of reproductive oppression.American Journal of Public Health. 2020; 110: S21-S24Crossref PubMed Scopus (15) Google Scholar). 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., 2007Allsworth J.E. Clarke J. Peipert J.F. Hebert M.R. Cooper A. Boardman L.A. The influence of stress on the menstrual cycle among newly incarcerate