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Women are faced with various challenges which affect their health and quality of life directly and indirectly. Incarceration is one such challenge, which is growing in the United States due to a host of social problems which include substance abuse, mental illness, unemployment and poverty (Rich, Cortina, Uvin & Dumont, 2013). Lack of support and scarce resources contribute to the growing rate of this marginalized group. Healthcare in correctional facilities is suboptimal, placing incarcerated women at a further disadvantage to achieving optimal health. The state of Texas now incarcerates more women than any other state and has one of the top 10 highest female incarceration rate in the country (Texas Criminal Justice Coalition, 2018).
Clearly, this is a significant issue that needs to be addressed to ensure ideal health for this marginalized group so they can be reformed members of society. In this paper, the background and significance of incarcerated women will be discussed. Socio-economic issues this group face will be examined in addition to social injustice experienced. Healthcare gaps and needs will be explored along with ethical issues. A plan of action that can be implemented will be presented followed by a conclusion.
Background and Significance
In the United States, approximately 870 of every 100,000 adults are in prison or jail which is the highest incarcerated in the world (Davis, Bello & Rottnek, 2018). The number of incarcerated women has grown by over 700% since 1980 which is significantly higher than the growth rate of the general prison population which has increased by around 500% (Texas Criminal Justice Coalition, 2018). There was an escalation on the war on drugs in the 1980s and since then the judicial system in the United States has seen an exponential rise in the number of incarcerated women.
African Americans and Hispanics females are more likely to be incarcerated at 2.5 and 1.4 times respectively than white females (Center for Prisoner Health and Human, 2016). More than fifty percent (50%) of the females who are incarcerated have been imprisoned for nonviolent wrongdoings which include property offenses and drug-related crimes (Kajstura, 2017; Nargiso, Kuo, Zlotnick &Johnson,2014). Majority of the women behind bars are between 18 and 44 years old (Carson, 2014) and in Texas over 10,000 are mothers (Texas Criminal Justice Coalition, 2018).
The health status of an incarcerated woman impacts the society in relation to healthcare costs, communicable disease transmission and criminal activity (Bryant, 2013). Incarcerated women are generally from poor socio-economic background, have minimal education, history of abuse and violence (Kelsey, Medel, Mullins, Dallaire & Forestell, 2017). Poverty is of significant concern for women in the criminal justice system with most of these individuals previously employed in low paying jobs or at entry-level position jobs. Their socioeconomic status hinders access to healthcare services before incarceration and they experience difficulties while imprisoned or detained which led to poor nutrition, psychological issues and other health challenges due to inability to access healthcare.
Women of low socioeconomic status may resort to prostitution, stealing or selling drugs to meet their needs and that of their family. To break this cycle reformation should include steps to prevent recidivism of these women (Kelsey et al., 2017). Incarceration affects the family unit as the imprisoned woman is separated from her children. Due to the limitation on visitation, significant distance and expensive prison phone charges, incarcerated women are isolated from their children and eventually social services permanently place these children with strangers.
This action can affect the woman negatively worsening her socioeconomic status and desire to become a productive law-abiding member of society.
Social justice and Relationship to Health Disparities and Healthcare
Imprisoned women are at a disadvantage due to health disparities resulting in them receiving suboptimal or no healthcare. An inmate’s healthcare need is not considered during incarceration as the focus is containment. Incarcerated women have the highest prevalence of chronic diseases, but it is challenging to ensure continuity of care while imprisoned (Davis et al., 2018). The care required to manage a condition may not be allowed in a prison environment. For instance, daily moderate exercise for thirty minutes to prevent weight gain or maintain blood glucose control. Inmates may not get adequate exposure to sunlight and get insufficient nutrients leading to other illness including bone loss.
Incarcerated women are at a higher risk of contracting lift-threating diseases such as HIV/AIDS, human papillomavirus (HPV) infection hepatitis C and experiencing high-risk pregnancies (Kelsey et al., 2017). Correctional facilities are common sites for the transmission of infectious diseases (Davis et al., 2018; Bryant, 2013). More than 80% of incarcerated women have an unintended pregnancy (Davis et al., 2018). Other health concerns women face while incarcerated include stress, physical violence, substance abuse, mental health challenges, inadequate nutrition, sexually transmitted infections and limited access to reproductive care. These health concerns may have been present prior to incarceration, however, due to inadequate healthcare availability, the women will experience a decline in health and or develop complications.
Ethical issues incarcerated women face range from custodial privatization, prison labor, misconduct from guards and or other intimates, harsh punishment and lack of rehabilitation. Private prisons have more security incidents than public prisons (Laird, 2017). These incidents include complaints about staff, assaults by inmates, the presence of contrabands and frequent lockdown (Laird, 2017). Imprisoned women are sexually assaulted by prison staff during their routine medical examination. Correctional officers will touch inmates inappropriately or through coercion for the exchange of privileges or goods (Kelsey et al., 2017).
Plan of Action
Incarcerated women are usually childbearing age with gynecological and or mental health issues. To decrease the impact of inadequate mental and gynecological healthcare, policymakers at each level will be lobbied and introduced to telemedicine, benefits of comprehensive health assessment, annually wellness check and scheduled routine screening. Female inmates screening includes communicable disease, sexually transmitted disease and reproductive health screening (Davis et al.,2018).
Telemedicine is an evidenced-based healthcare delivery method that provides healthcare access without compromising the correctional facility environment. Through this medium, a family nurse practitioner (FNP) can deliver healthcare services to an inmate remotely without compromising the safety of the provider or the inmate. Centers for Medicare and Medicaid Services can be approached for funding of this service so the patient can access cost-effective service and continuity of care, preventing treatment interruption for certain illness such as hepatitis C and HIV (Venters, 2016).
Lobby for a well-organized and coordinated system of healthcare that follows the incarcerated women from the start of the imprisoned period to the end of incarceration and successful return to the community. This system would include a mandatory comprehensive health assessment of all inmates upon entry and exit of the correctional facility. Electronic health record will be used to decrease the current disconnect between imprison care and that rendered outside, in addition to smooth release planning and transition to civilian life. Policymakers will be encouraged to offer broader correctional facility services to include screening instead of focusing primarily on acute complaints (Venters, 2016).
The FNP can assist with the development and dissemination of health literature through collaboration with special interest groups and correctional facility employees. Intimates will be educated about preventable conditions and common chronic disease management. Additionally, special interest groups can educate employees at these facilities on the challenges incarcerated women experience and how these employees can assist to promote healthy habits and prevent deterioration of this marginalized group health. Most important would be to petition legislators at a national level for prison system reform and stop punishing poverty. Also, steps need to be taken to address the increased availability of illegal substances.
The FNP must examine the current correctional health care and seek opportunities to gain a clear understanding of the areas that need their expertise and service (Bryant, 2013). This is achieved through continuing education, reading peer-reviewed articles and engaging the effect groups. As a primary care provider FNP need to be prepared for when this group of women re-enter society and seek healthcare. Outcomes would be measured with a decreased in the incidence of preventable and worsening chronic conditions (Nargiso et al., 2014). The reduction in the number of incarcerated women and a decline in recidivism in addition to a stable family unit can be measured at the state level through online surveys and reviewing incarcerated records.
The United States has the world’s highest incarceration rate with imprisoned individuals disconnected from healthcare. Individuals with mental health issues, people of colour and the poor are frequently incarcerated which places them at more disadvantage. The scope and quality of healthcare care available to inmates are inconsistent and focused on security instead of health care delivery and health professional. To provide quality healthcare and adequately meet the needs of women in correctional facilities a multifaceted approach is necessary. This is difficult since incarcerated women are in an environment which controls and limit their movement.
The FNP must be creative and strategic when approaching healthcare concerns of these marginalized groups. Policy makers and correctional administrators need to be reminded of the healthcare needs of women. The importance of making budget allocations despite escalating cost should be emphasized as an attempt to reduce recidivism, trauma and improve psychological and physical health. A healthier woman creates the opportunity for a healthier family system and by extension a healthier society. Incorporating technology such as telemedicine can help close the gap in healthcare and combat the challenges incarcerated women face.
- Bryant, K. (2013). Brief Report: Advanced Practice Nurses in Correctional Health Care. The Journal for Nurse Practitioners, 9(3), 177–179. https://doi-org.chamberlainuniversity.idm.oclc.org/10.1016/j.nurpra.2012.12.016
- Carson, E.A.(2014). Prisoners in 2014. Bureau if Justice Statistics, Retrieved from https://www.bjs.gov/content/pub/pdf/p14.pdf
- Center for Prisoner Health and Human Rights. (2016). Incarceration and women. Retrieved from https://www.prisonerhealth.org/educational-resources/factsheets-2/incarceration-and-women/
- Davis, D. M., Bello, J. K., & Rottnek, F. (2018). Care of Incarcerated Patients. American Family Physician, 98(10), 577–583. Retrieved from https://chamberlainuniversity.idm.oclc.org/ login?url=https://search.ebscohost.com/login.aspx?direct=true&db=mdc&AN=30365288&site=eds-live&scope=site
- Kajstura, A. (2017). Women’s mass incarceration: The whole pie 2017.Retrieved from https://www.aclu.org/sites/default/files/field_document/womenprisonreport_final.pdf
- Kelsey, C., Medel, N., Mullins, C., Dallaire, D., & Forestell, C. (2017). An Examination of Care Practices of Pregnant Women Incarcerated in Jail Facilities in the United States. Maternal & Child Health Journal, 21(6), 1260–1266. Doi:10.1007/s10995-016-2224-5
- Laird, L. (2017). Trump administration reverses federal plans to phase out use of private facilities. ABA Journal, 22. Retrieved from https://chamberlainuniversity.idm.oclc.org/login?url=https://search. ebscohost.com/login.aspx?direct=true&db=bah&AN=124885384&site=eds-live&scope=site
- Nargiso, J. E., Kuo, C. C., Zlotnick, C., & Johnson, J. E. (2014). Social support network characteristics of incarcerated women with co-occurring major depressive and substance use disorders. Journal Of Psychoactive Drugs, 46(2), 93–105. https://doi-org.chamberlainuniversity.idm.oclc.org/1 0.1080/02791072.2014.890766
- Rich, J. D., Cortina, S. C., Uvin, Z. X., & Dumont, D. M. (2013). Women, incarceration, and health. Women’s health issues, 23(6), 333-4. doi: 10.1016/j.whi.2013.08.002
- Texas Criminal Justice Coalition. (2018). A growing population: The surge of women into Texas criminal justice system. Retrieved from https://www.texascjc.org/sites/default/files/ publications/TCJC%20Womens%20Report%20Part%201%20Executive%20Summary.pdf
- Venters, H.(2016). A Three-Dimensional action plan to raise the quality of care of US correctional health and promote alternatives to incarceration. American journal of public health, 106(4), 613-4. Doi: 10.2105/AJPH.2016.303076
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