The July/August issue of the Journal of Obstetric, Gynecologic, & Neonatal Nursing includes a series of articles on the health care needs of women in prison, including the need to address inequalities, provide thorough care for complex health conditions, and to attend to the end-of-life needs of female prisoners.
In End-of-Life Care and Barriers for Female Inmates, the authors explore a little-discussed topic. For background, they explain that “end-of-life” in prisons does not typically occur they way we might think, and so health care, and especially end-of-life care, for incarcerated women is much more complex than we might be aware:
Stereotypical images in the popular media promote a perception that prison death is due to suicide or homicide by fellow inmates. In reality, execution, homicide, and suicide combined account for less than one fourth of all prison deaths. The vast majority of deaths in U.S. prisons are a result of natural causes, and the leading causes are chronic, debilitating diseases, with heart disease, cancer, and liver disease the top three for women, followed by AIDS, suicide, septicemia, respiratory diseases, cerebrovascular diseases, influenza/pneumonia, and digestive diseases.
The authors explore the current problems with end-of-life care, such as inmates being removed to infirmaries that create social isolation and lack visiting hours, adequate facilities, or comfort care. They put it bluntly: “Within the current, prevalent public climate of ‘let ’em rot,’ incarcerated women with EOL (end-of-life) needs are highly vulnerable.”
The authors then come to the following conclusion in response, one that we can certainly get behind: “The time has come to set aside the question ‘why provide humane care to dying female inmates?’ and to provide better EOL to all people.”
Another piece in the series advocates for prison health care providers to consider how past traumas might inform a female inmate’s health needs, encouraging providers to develop greater understanding of trauma in order to provide better care.
Finally, Barbara Guthrie writes a compelling piece, Toward a Gender-Responsive Restorative Correctional Health Care Model, which argues for institutions to completely rework their model of providing health care to female inmates. She calls for the explicit addressing of women’s specific health care needs and disparities, development of health action plans, free access to children and.or their caregivers, inclusion of educational and vocational training, and identification of health resources (such as community clinics) for women to access after release.
Guthrie writes about the need to address health and other inequities women experience prior to becoming incarcerated, and the ways in which confinement can make these inequalities worse. She writes:
At the time of confinement, female inmates are sicker than their male counterparts and are in dire need of health care….Specifically, female inmates, irrespective of their ethnicity or race, are more likely than their male counterparts to enter the correctional system with very serious and long-standing comorbidities as well as preexisting infectious diseases (HIV/AIDS, STIs, TB), chronic illness (diabetes, hypertension, cardiac disease, asthma), cancer (cervical and breast), substance use and abuse, and mental health issues/disorders (bipolar, depression, abuse, posttraumatic stress disorder…
Female inmates also report long-standing reproductive issues, such as intermittent bleeding and pelvic pain/discomfort that require screening and/or follow-up tests (Pap smears and or breast exams) or treatment during and after their confinement. Unfortunately, most correctional health care systems are unable to address the existing physical, mental, and social needs of female inmates, which exacerbates their already poor health.
Related to Guthrie’s work, this piece on gender-responsive strategies in jails may be of interest and covers some of the same principles.