[1] Many of the same factors that increase women's likelihood of incarceration also put them at a higher risk for contracting HIV/AIDS and other sexually transmitted infections, and for having high-risk pregnancies.
[2][3][4] The majority of incarcerated women are economically disadvantaged and poorly educated,[5] and have not had adequate access to preventive healthcare prior to their imprisonment,[2] such as Pap tests, STI screening, and pregnancy counseling.
Due to the difficulty inherent in proving that a prison official knew about a medical condition, yet failed to respond to it, this standard makes it difficult to hold correctional facilities accountable for their mistakes.
[7] With this ruling, the court determined that the medical care provided to prisoners must only be "reasonable,"[7] not necessarily "perfect, the best obtainable, or even very good.
[3] A 1996 study conducted by the National Council on Crime and Delinquency (NCCD) on women in California, Connecticut, and Florida state prisons found a lack of adequate prenatal and postnatal medical care, prenatal nutrition, level of methadone maintenance for opiate-dependent pregnant inmates, education regarding childbirth and parenting, and preparation for the mother's separation from her child.
[14] Often, inmates report receiving no regular pelvic exams or sonograms, and little to no information about proper prenatal care and nutrition.
For example, Washington State has a program called the Birth Attendants Prison Doula project, which provides support to incarcerated pregnant and postpartum women.
[3] When asked about her prison's response to pregnancy, Boo, an inmate in an Arizona correctional facility, said: They're real good people to me...
In 2019, the state of Georgia unanimously voted to outlaw this practice through HB 345[16] after the bill's author, Pamela Winn, received national attention for sharing her experience being incarcerated and shackled.
[1] The 1996 NCCD study found that female African American and Hispanic/Latina inmates were significantly more likely than their White counterparts to report testing positive for HIV.
[14] Many of the same social factors that increase the likelihood of incarceration for women, such as poverty, race, gender, and a history of victimization, are also correlated to HIV infection.
[14] The treatment of HIV requires a specialist, and generally, prison doctors don't have adequate training to treat women effectively.
[10] However, state standards regarding abortion for incarcerated women are unclear - actions are often left up to the discretion of prison officials on a case-by-case basis.
[20] However, many respondents also stated that although their prison did allow access to abortion, women receive little to no help with arranging an appointment, paying for the procedure, and getting themselves to the clinic.
[21] According to a 2021 research study, approximately 50% of prisons and 83% of jails allow for residing incarcerated women to receive permanent contraception regardless of whether a written policy was enforced.
[22] Researchers find this to be concerning which leads them to emphasize that institutions should offer emergency contraception for newly incarcerated women.
[23] As of 2020, 13 states (AL, CA, CO, CT, FL, KY, LA, MD, NY, TN, TX, VA) and Washington, D.C. have enacted legislation requiring free access to such products.
[23] In a survey conducted at The Missouri Department of Corrections it was found that even though free sanitary napkins were provided, 80.3 per cent of respondents to the survey reported that they had created tampons themselves because of poor absorption and had reported problems related to increased reproductive and urinary tract infections.
The DOCCS policies stray from community standards in the areas of the starting age for yearly GYN check-ups, the frequency of breast exams and Pap smears, follow-up for abnormal Pap smears, frequency of prenatal visits and ultrasounds, and the time frame for postpartum check-ups for women who have a Caesarean section.
[27] The Federal Bureau of Prisons' policy is to provide each inmate with a complete medical exam (which includes gynecological and obstetrical history) within 30 days of admission.
[7] According to a 1997 survey, approximately 90 percent of the inmates in women's state prisons reported having received a gynecologic exam from their institution upon intake.
In one extreme case, Sara, a woman incarcerated in New York, had to wait seven months before she was finally diagnosed with an aggressive cancer.
[4] In the same study, women brought attention to the discomfort suffered by inmates with personal histories of sexual abuse and victimization when they were forced to be examined by a male physician.
[4] Researchers have found that most of the women interviewed in the 2005 California state prison study had negative perceptions of their gynecologic tests and treatment.
"[4] The California prison system employs corrections officers who are also trained to be licensed nurses (called medical technical assistants).
[14] The simultaneous positions that these officers hold as both security personnel and medical caretakers or advocates may contribute to female inmates' distrust of them.
[28] A lack of resources, specifically of adequate staff, within facilities is largely what contributes to the substandard care of inmates.
[14] Dr. Valda Chijide, a former HIV doctor in an Alabama prison, for instance, resigned from her position due to inadequate support.
[10] Lack of accountability also results due to varying state and federal laws on private contractors' liability for medical abuse and neglect.
[10] Private contractors can be challenged under the same federal civil rights law that applies to state and local governments, but these corporations cannot be sued for unconstitutional medical practices.