The Spiral of Risk: Health Care Provision to Incarcerated Women

By law, prisoners in the United States have a fundamental right to receive adequate health care. However, most prisoners in this nation face numerous obstacles when attempting to receive quality health services. This is especially true for incarcerated women, who suffer from physical and mental health disorders at rates higher than incarcerated men, yet receive fewer targeted services. The state of California leads the nation in the number of women it incarcerates, second only to Texas. The vast majority of these women are in custody for nonviolent, drug-related offenses, and few receive adequate health care. Female offenders commonly face a wide range of serious health problems including substance abuse, infectious disease, mental illness, hypertension, asthma, and diabetes. Their health problems typically predate their involvement in the justice system, are often exacerbated while they are imprisoned, and continue to deteriorate after release. Furthermore, the majority of women in custody are racial and ethnic minorities, who receive inadequate or inappropriate health services that fail to be culturally competent. This paper presents the results of an intensive investigation of the health care delivery system for women imprisoned in California. We characterize the current system for providing health care to incarcerated women in California and address gaps in current service provision and cultural competency. We conclude by outlining a strategy to improve quality and access of holistic health care within the system and during transition back into the community.