Providing Better Health Care to Women Who Have Been Incarcerated

Female inmates—among the fastest-growing demographics in prisons—have unique health care needs while incarcerated and after their reentry to society. “Many women who have been incarcerated have a history of addiction, domestic abuse and sexual violence in addition to the trauma incurred from being in prison,” says Gloria Bachmann, associate dean of Women’s Health at Rutgers Robert Wood Johnson Medical School and director of the Women’s Health Institute. She was appointed as medical director and serves as chairperson of the Health Committee on the Commission on Reentry Services for Women. The commission, which was established by the New Jersey State legislature last year, examines reentry needs of women in the areas of healthcare, employment, domestic violence, family reunification and housing.

Bachmann discusses how health care providers can address the challenges faced by these women.

What does the commission want to accomplish?
The commission, which was launched by former governor James McGreevy, seeks to identify physical and psychological hardships endured by women while incarcerated that may impede their successful reentry into society, identify services that are necessary for successful reentry and propose solutions to any obstacles they might have in obtaining those services.

The Women’s Health Institute, under my leadership, was asked to lead the health committee to address the physical and mental health care needs for these women who either are incarcerated, about to reenter society or have reentered society. We want to bring dignity to individuals and promote ways that clinicians can enhance their health and their wellness. I have experience caring for previously incarcerated patients and know there is so much more we could do. 

What are the most pressing needs of incarcerated women?
Women who have been in prison have more health issues than women in the community. A recent survey of more than 1,000 recently released women found that nine in ten suffered from diagnosed health conditions requiring active treatment and management. Two-thirds of those women reported having been diagnosed with a physical health condition that can be classified as “chronic,” such as asthma, diabetes, cancer, hepatitis, sexually transmitted diseases, tuberculosis and HIV/AIDS. They also have a higher rate of stroke.

Since so many had trauma pre-incarceration and because incarceration itself is traumatic, many have  mental health issues such as anxiety, depression or post-traumatic stress disorder. The survey also found that approximately two-thirds had actively abused substances in the six months leading up to incarceration. In addition, many have dealt with poverty, intimate partner violence and structural racism. Those who are LGBTQ+ might have been disowned from their families. It is important that these women receive trauma-informed care that takes into account these stressors.

What issues are the health committee addressing?
Since prisons have been set up for men, prison systems might not take into account issues like pregnancy, painful menstruation, breast cancer or the quality and quantity of hygiene products given to female prisoners. In addition, more than 60 percent of women in state prisons have a child under 18, so we need to look at how childbirth occurs for female prisoners, the amount of time allowed for a mother to bond a child she had while incarcerated and how technology can be used for visitation/rooming in with a child.  

We also are investigating what additional testing is needed and what should be included in their wellness visits, both in terms of their physical and mental health.

What are changes that should be made in the health care system to help women who are reentering society?
Many clinicians incorrectly assume that they are not involved in the care of incarcerated people, but in actuality 95 percent return to society. Since people who were incarcerated have higher rates of infectious disease, chronic conditions and trauma, it’s important to know this history. If a patient has been incarcerated and medical records from the correctional facility are not available, clinicians should do a thorough evaluation for baseline health values and test for tuberculous, HIV/AIDS, diabetes, cancer, arthritis and pulmonary conditions.

One of the initiatives I want to start is to have health care providers include asking a woman if she has been incarcerated during wellness visits as part of the standard interview—but to do so in a way that normalizes the woman’s history and does not put her in a negative spotlight. I do this in my practice, but instead of asking “Have you been incarcerated?” I say, “Many of the patients I have cared for have been sexually abused, been incarcerated and have trauma. Have you had any of these problems?” If so, I validate their feelings by saying, “I understand this has been traumatic. How can I help your mental and medical health needs?”

These women face bias for being incarcerated and have a tough time bringing it up even to their clinician. A health care provider who brings this up will break down those barriers. We should approach all patients—especially those who have been incarcerated—with acceptance and the elimination of negative emotions.

What other outreach is the committee doing?
We are bringing attention to incarcerated women’s health care through research, and are engaging many undergraduate, graduate and medical students at Rutgers in this work. Recently, the Journal of Perinatal Medicine published a study I led on pregnancy in incarcerated women, which shows we need more legislation that sets the templates for standards of obstetrical care for women, including maternal health and mother-baby units. We also recommend that prisons should consider allowing mothers who are not a danger to themselves or their children to enter into halfway houses after birth so they are not separated from their children. We will be presenting on this topic at the National Conference on Correctional Health Care this fall.

In addition, we launched the Journal of Women and Criminal Justice, which gives incarcerated women a voice and lets them know their perspectives are important.