In this commentary we will outline the unique health needs of Utah’s imprisoned female population, including the need to address cervical and breast cancer, age-related illness, substance abuse, and heart disease.
We highlight that incarcerated women experience higher rates of substance abuse, physical and sexual assault, and trauma than their non-incarcerated counterparts, leading to a greater need for specialized medical attention.
We will outline how Utah’s above-average rates of imprisoned women require more specialized and preventative healthcare. We further argue for greater research and advocacy for this marginalized population, which is hidden from the public eye.
We use the seven domains of women’s health as a framework to argue for a whole-health approach to the overall wellness for this population.
Status of the Literature
The rates of incarcerated women across the United States are vast when compared to other developed nations. Currently the United States “lock[s] women up at rates that are at least 5 times the rates of our closest international allies.”1 The rate of women in prisons across the country is growing faster than that of imprisoned men.2 The current system was built for men and falls short in addressing women’s unique biological and psychosocial needs.
The population in U.S. women’s prison is overwhelmingly made up of nonviolent drug offenders. The complex nature of women’s experiences of trauma creates a unique and desperate need for tailored interventions that address the overall health of this population.3 Women who are or have been incarcerated are less likely to have medical insurance, preventative healthcare, financial resources, and have lower levels of education.4 Marginalized groups such as incarcerated women, of whom many also belong to a racial minority, experience higher rates of oppression that lead to worse health outcomes,5 including chronic illness and infectious diseases.6
Women who are incarcerated are four to five times more likely to have cervical cancer compared to women without criminal histories. Although more research must be done, some studies suggest that imprisoned women are also several times more vulnerable to mortality due to cervical cancer.7 Research has shown that one contributing factor to the increased cervical cancer risk is low health literacy. Ramaswamy implemented brief but effective education interventions that improved health literacy. Education is intended to supplement advocacy, prevention services including cancer screenings, and resources for health insurance as women re-enter their communities.4
“The limited studies evaluating the health of older female inmates indicate that, like older male inmates, older female inmates are generally sicker than their non-incarcerated counterparts.”8 Female inmates over 55 have higher rates of hypertension, arthritis, and respiratory disease compared to non-imprisoned women over 65. Older women inmates also have higher rates of chronic illness than their male counterparts.8
Call to Action
Little progress has been made in changing legislation to increase incarcerated women’s access to medical care. In 2019, Utah lawmakers passed a bill to ban shackling inmates during birth and allocated funds for reproductive health education for incarcerated women.9 We could find no Utah law or code that dictated regular preventative screening methods for cervical cancer or other conditions that affect women over the lifespan. The Utah Prisoner Advocate Network reported that “hormones and gynecological attention [are] reported to be offered for women’s concerns in Draper at the Wasatch Infirmary.10 There were no other mentions of required preventative procedures or screening except for when an inmate is first admitted to the facility.
The limited demographic data for Utah’s incarcerated women’s population presents a barrier to providing appropriate healthcare resources. Without detailed data, it is difficult to understand the full scope of health issues imprisoned women face. More research and information are required to implement evidence-based interventions. It is important to recognize how the seven domains of health—physical, social, financial, environmental, intellectual, spiritual, mental—are intertwined for this marginalized population.11 Better, more complete demographic data are needed to motivate legislation changes to meet the unique needs of female inmates in Utah.
1. Kajstura, A. (2018). States of women’s incarceration: The global context2018. Prison Policy Initiative. Retrieved 08 July, 2021, from https://www.prisonpolicy.org/global/women/2018.html
2. Minton T. D., Ginder S., Brumbaugh S. M., Smiley-McDonald, H., & Rohloff, H. (2015). Census of jails: Population changes, 1999–2013. US Department of Justice. Office of Justice Programs. Retrieved 08 July, 2021, from https://www.bjs.gov/content/pub/pdf/cjpc9913.pdf
3. National Commission on Correctional Health Care Position Statement. (2005). Journal of Correctional Health Care, 11(4), 381-389. doi: 10.1177/107834580401100407
4. Ramaswamy, M., Lee, J., Wickliffe, J., Allison, M., Emerson, A., & Kelly, P. J. (2017). Impact of a brief intervention on cervical health literacy: A waitlist control study with jailed women. Preventive Medicine Reports, 6, 314–321. doi:10.1016/j.pmedr.2017.04.003
5. Ledesma, E., & Ford, C. L. (2020). Health implications of housing assignments for incarcerated transgender Women. American Journal of Public Health, 110(5), 650–654. doi:10.2105/AJPH.2020.305565
6. Timko, C., Johnson, J. E., Kurth, M., Schonbrun, Y. C., Anderson, B. J., & Stein, M. D. (2019). Health services use among jailed women with alcohol use disorders. Journal of Behavioral Health Services & Research, 46(1), 116–128. doi:10.1007/s11414-018-9634-7
7. Kouyoumdjian F. G., McConnon A., Herrington E. R. S., Fung K., Lofters A., & Hwang S. W. (2018). Cervical cancer screening access for women who experience imprisonment in Ontario, Canada. JAMA Netw Open;1(8) doi:10.1001/jamanetworkopen.2018.5637
8. Barry, L. C., Adams, K. B., Zaugg, D., & Noujaim, D. (2019). Health-care needs of older women prisoners: Perspectives of the health-care workers who care for them. Journal of Women & Aging, 32(2), 183202. doi:10.1080/08952841.2019.1593771
9. Jacobs, B. (2019, July 26). Utah lawmakers paid more attention to incarcerated women this year. The Salt Lake Tribune. https://www.sltrib.com/news/2019/07/26/utah-lawmakers-paid-more/
10. Utah Prisoner Advocate Network. (2020). Medical care and infirmaries (Draper and Gunnison prison). Retrieved July 08, 2021, from https://utahprisoneradvocate.org/prisoner-family- 101/medical-info/
11. Frost, C. J. & Digre, K. B. (Eds). (2016). The 7 domains of health: Multidisciplinary considerations of women’s health in the 21st century. Kendall Hunt Publishers.
Fuhriman C, Hill K, and Martin A (2021). Hidden Women: Unmet Medical Needs of Utah’s Incarcerated Women. Utah Women’s Health Review. doi: https://doi.org/10.26054/0D-NQ3T-8WYK