You're at the Mercy of... Pretty Much Anybody Else: A Qualitative Examination of Women's Healthcare Experiences in Prison

Background: Currently, the US has incarcerated more of its population than any other country. While men are more likely to experience incarceration, the female prison population has increased at a faster pace. Over the past two decades, there has been a disproportionate increase in the number of incarcerated women; 800%, which is 1.5 times the rate of men. Prisoners, in general, are a neglected part of the population and are seen as less deserving of programs and services. However, this is especially true of incarcerated women who experience a complex and interconnected set of individual, societal and environmental factors that contribute to their disparities in health and limited access to healthcare.  Incarcerated women are disproportionately Black or Hispanic.  They are poor, earning less than $10,000 in the year prior to incarceration.  Three quarters of the women are not high school graduates and one half were unemployed in the year prior to incarceration. Over 40% report substance abuse issues. Up to 80% of these women have reported victimization as a child or adolescent and one third of incarcerated women reported abuse by an intimate partner.

Additionally, women in prison have more challenging health issues than other women and more health needs than men in prison. Specific to women is gynecological care, which is vital to women’s health and often overlooked in prison. This massive increase in women in prison makes access to and use of gynecological care a salient problem. Furthermore, the specific health needs of women in prison has received little empirical attention. Therefore, the purpose of this study was to explore the experiences of healthcare utilization of women prior to incarceration and in prison with gynecological care.

Method:A qualitative, collective case study methodology was used. In person, in-depth, semi-structured interviews were conducted with 16 incarcerated women in a medium security women’s state prison in a Midwestern city. Transcribed interviews were coded based on pre-determined and emerging codes. Subsequently, within-case and cross-case thematic analysis was completed.

Results:Recurring themes identified include: predisposing (prior to incarceration) abuse/assault substance abuse, lack of self-value and value from others play into how these women view medical care.  Themes that emerged related to care in prison include a lack of access to things they need such as tampons or sanitary wipes, a lack of autonomy surrounding healthcare decision making, and other institutional barriers such as lack of access to specialty care, time it took to see a provider, and the cost associated with visits.

Implications:Prison healthcare presents an opportunity to address the needs of a population that is medically underserved. Most policies and practices in prisons do not reflect an understanding of the needs of incarcerated women.  Knowledge from this study can inform appropriate, gender specific and trauma informed policies, programs and services in prison facilities.