Since the war on drugs in the 1980s, the United States has seen an exponential rise in the number of imprisoned individuals. This increase has been particularly dramatic for women. Nationwide, the population of women in prison has grown by 834% over the past 40 years, more than double the growth rate of men. Compared with incarcerated men, women in prison have higher rates of substance abuse, histories of physical and sexual abuse, mental illness, infectious disease and chronic illness. Most women in prison are defined by a challenging intersection of lower socioeconomic status and largely racial, ethnic, and minority gender status. This combination of identity factors both contributes to their health disparities and influences their experiences with health care. Given that the majority of women in prison are of reproductive age, gynecological care is a central aspect of women’s overall health care. However, women in prison are a small minority of the overall incarcerated population, and because of this, their gender-specific health needs are frequently unacknowledged.
Using a feminist epistemology, this qualitative multiple case study provides an examination of the experiences of women before prison and in prison with gynecological care and prison staff’s experiences providing this care. The Gelberg Andersen Behavioral Model for Vulnerable Populations is adapted here for the study of women in prison. The model explains factors enabling and impeding women’s utilization of health care services, including previous health care experiences, prison infrastructure, and personal autonomy.
Women in contact with the criminal justice system face difficulties accessing health care both outside and inside prison. Barriers on the outside included lack of health insurance, being addicted to drugs, and prioritizing children’s needs first. On the inside women cited a lack of confidentiality, the absence of trust in providers, and the inability to participate in treatment decision-making. In the case of women in prison, multiple external oppressions result in internalized negative beliefs. Such feelings of powerlessness, lack of control, curtailed agency, and threatened self-worth ultimately influence how women experience gynecological care in prison. Policy, practice and research implications are provided to meet the gender specific health needs of women in prison.