The Health of Women Prisoners: Global Challenges and Solutions Nancy Stoller University of California, Santa Cruz

Health Problems for Women in California Prisons Very long sentences Overcrowding Lack of preventive care, mental health services, drug rehabilitation, access to children Poor nutrition Delayed access to medical care Poor dental services High levels of psychotropic medication

Health Problems on Release Loss of rights Continuity of care challenges Housing, income, identity, employment Family reunification

Reproductive and mothering rights of prisoners across the U.S… PRENATAL CARE 38 states -have no or inadequate policies on prenatal care 43 states -do not require a medical exam as part of prenatal care 41 states do not require nutritional counseling or pregnancy diet Source: Mothers Behind Bars: Report from National Women ’ s Law Center and Rebecca Project for Human Rights (October, 2010)

Reproductive and mothering rights of prisoners across the U.S… cont’d. SHACKLING 33 states -do not adquately limit shackling during labor and delivery, recovery, or transport when in labor 22 states have no policy at all on shackling pregnant women Source: Mothers Behind Bars: Report from National Women ’ s Law Center and Rebecca Project for Human Rights (October, 2010)

U. S. DOJ Bureau of Statistics

Federal Prisons Women in custody in federal prisons: 14, : announced ban on shackling during pregnancy Limited (58 women p. year) mother- child alternative program

ICE (Immigration and Customs Enforcement) No unified medical services Uses private prisons, local jails, state prisons Contracts medical services in its own units No consistent standards or services for care for women

World Health Organization Health in Prisons Project Founded in countries, west, south, east and northern Europe Yearly meetings Special reports Declarations Awards

WHO HIPP Philosophical and action base: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” UN declarations of rights of prisoners, women, children.

A global view from WHO Women in prison have more health problems than men Multiple chronic conditions Higher rates of drug dependency and co- morbidity; mental health issues; physical and sexual abuse histories Reproductive health needs: menstruation, pregnancy, menopause, reproductive cancers, breastfeeding

WHO-HIPP Declaration concerning women’s health in prison 1. A gender-sensitive criminal justice system is an essential first step to ensure that all stages of the criminal justice system take into account gender-specific needs and circumstances.

2. A gender-sensitive prison policy has to be developed for every prison system to meet the basic health and welfare needs of women in prison Meeting women’s special health care needs- including for girls and women. Gender-sensitive training. Appropriate female-male staff balance

3. The human rights of women and of their children must always be dominant; principles of equivalence and of appropriateness of facility and and health care must be recognized. The needs of any child involved must be dominant.

4. Specialist health care must be provided: for instance, for mental health, including help with a legacy of abuse; for HIV, hepatitis C, tuberculosis and other infectious diseases; for drug and alcohol dependence; for learning disabilities; and for reproductive health.

5. Pre-release preparations must be planned and provided to ensure continuity of care, and access to health and other services after release must be a clear part of the programme preparing for release.

Strategies of improvement Independent Monitoring Source of health care is from a health- focused agency, e.g. public health department Prioritize and advocate for health as more important than custody Breaking down isolation of prisoners and of medical staff Remove the profit motive by rejecting privatization Examples: National Health Service - Britain; San Francisco Dept. of Health; US BOP Public Health Service

Current California Projects Transitions clinic - San Francisco, focus on continuity of care for chronic health problems after release Community Health Worker training and placement with ex-prisoner focus Legal Services for Prisoners with Children- advocacy training, research reports, family connections A New Way of Life- housing, referrals, mental health services on release, advocacy

Current California Projects, continued… Litigation… Shumate, Plata, current receivership, overcrowding challenges All of Us Or None- advocacy and activism for released prisoners CURB (Californians United for a Responsible Budget) * Stop All Prison and Jail Construction. * Reduce Overcrowding and Release our Tax Dollars. * Stop the Cuts and Invest in Our Future.

Public Health Initiatives APHA –Prisoner Health Committee-- links public health professionals working in correctional settings, research, advocacy throughout the U.S. –Women’s Caucus –International Human Rights Committee –Standards for Health Services in Correctional Institutions World Federation of Public Health Associations initiative –Goal: Prioritize the health of the marginalized,especially those in jail and prison

From 1979 slide show on women’s health in prison

Women prisoners at FCI Lexington after a discussion about activism and change -1979

Women at Valley State Prison, California, 2008