Incarceration and Women's Health: The Utility of Effective Health Education Programming--A Commentary.

The health and well-being of incarcerated women is a significant public health concern. (1-4) In 2009, women accounted for 18% of the total corrections population. (5) Men comprised a smaller portion of the corrections population in 2009 compared with 1990 (82% in 2009 vs. 86% in 1990), while the percentage of women has increased (18% in 2009 vs. 14% in 1990). (5) Compared with non-incarcerated women, incarcerated women in the United States are more often from minority populations, (3,6) younger (between the ages of 18 and 34 years), of low socioeconomic status, unemployed and mothers to children under 18 years of age. (7,8) More than 80% of women are incarcerated for nonviolent offenses, including drug-related crimes. (9) The increased incarceration rates of women have resulted in large part from changes in drug policies due to the "War on Drugs." (7,8,10) Both poverty and addiction represent precursors to involvement in criminal behaviors. In a study by Freudenberg et al., (11) more than 90% of incarcerated women reported drug use and more than 60% reported a history of physical or sexual abuse. The incarceration of women poses an additional burden as women prisoners are more likely than male prisoners to have had sole responsibility for their children prior to incarceration. (8,10) Whereas parental incarceration is difficult for children regardless of which parent is incarcerated, separation from an incarcerated mother is especially traumatic. (12,13) Two-thirds of incarcerated women have children under the age of 18, (8,10,14) and children of women offenders are more likely to be placed in foster care. (14) This commentary explores the health of incarcerated women as well as the need for and challenges of effective health education and promotion programming for these women. The diverse needs of incarcerated women have often been ignored because the overwhelming percentages of incarcerated persons are men. However, incarcerated women often have physical and mental health needs that may be worse than those of incarcerated men or women in the general population. (8,10,15-17) Prior to incarceration, women offenders, like male offenders, often are uninsured or underinsured, have not received routine primary care and have poor health. (6,10,18,19) Women inmates report medical problems more often than male inmates in both state and federal prisons. (20) Women offenders are also more likely to report a mental health issue. (20) Women prisoners report chronic health problems such as arthritis, asthma, diabetes, hypertension, heart and kidney problems at greater rates than men. (20) Women prisoners' health problems may also include gynecologic problems, obesity, dental problems and HIV infection. (1,21-26) Both men and women offenders report higher rates of childhood sexual abuse compared with non-offenders, and several studies have supported the association between childhood sexual abuse and later drug use. (27) Incarcerated women report histories of physical or sexual abuse or both at a rate of 60% to 70%. (6,8,10,11,18,19,26) Incarcerated women also report drug use more often than incarcerated men, and drug use is associated with mental health issues in this group. (28) Furthermore, women offenders not only report histories of childhood sexual assault but also report adult sexual and physical abuse more often than non-offenders and incarcerated men. (28) Trauma from abusive experiences often contributes to physical and mental health problems and increases the risk of substance abuse, high-risk pregnancies, and sexually transmitted diseases. Substance-abusing women offenders are more likely to report depression, anxiety, eating, stress and personality disorders. (14,17,29) Conversely, studies show a range of reported history of sexual abuse among male offenders from 5% to 60%. (27,28) More research is needed to assess the prevalence of male sexual abuse among incarcerated men. Thus, the high rates of abuse experienced by both male and female offenders must be addressed for inmates' eventual successful reintegration into communities. …