Built for Men: How Prisons Fail Incarcerated Women's Health Needs

Approximately 190,600 women are incarcerated in the United States. Although this comprises only around ten percent of the total prison population, rates of incarceration for women have increased by 834% over the last forty years—more than twice the rate of men’s incarceration (Sawyer, 2018). While prison conditions are deplorable for all genders, the prison system was constructed for men, not women, thus neglecting concerns specific to the female experience, including gynecological services, menstruation needs. Women’s prisons also lack other specialized healthcare like thorough mental health and substance abuse services, because such issues are more prevalent in incarcerated women than incarcerated men (World Health Organization & United Nations Office on Drugs and Crime, 2009).

In many ways, prison is an intensified microcosm of society, where women face additional burdens as a result of living in a world built for men. In prison, they have even fewer avenues through which to challenge these inequities. Although not all the healthcare concerns noted here are unique to women, it’s important to shed light on the differences between male and female care, as well as the circumstances leading to their incarceration. It’s important to note that even though the majority of those facing these specific healthcare challenges are women, and are in women’s prisons, trans men and nonbinary people may also struggle to receive adequate healthcare, in both male and female prisons. Hence, every prison should be equipped to provide the necessary care for each individual sent there, no matter their genitalia or assigned sex at birth.

A primary issue in women’s prisons is the lack of comprehensive medical care. Most incarcerated women are from low income communities, resulting in complex health conditions and often inconsistent healthcare, even when outside prison. Incarcerated women have more health issues than male prisoners, due to their upbringing and the additional struggles women face with the healthcare system as a whole (World Health Organization & United Nations Office on Drugs and Crime, 2009). Soliant Health’s 2024 State of Healthcare Report found 66.1% of women surveyed had received a misdiagnosis by a medical professional. This response demonstrates the results of another American institution, the healthcare system, applying studies done mostly on men to women’s care and the detrimental effects it has had on women's care and their trust in the healthcare system (Soliant Health, 2024). Such issues only worsen with the psychological and physical tolls prison takes on a person. 

In addition to these challenges, around two thirds of women in prison suffer from substance abuse disorders (World Health Organization & United Nations Office on Drugs and Crime, 2009). According to the same report, the effects of substance abuse extend beyond the physical risks of drug use, contributing to higher rates of hepatitis, tuberculosis, toxemia, and obesity among incarcerated women. Intravenous drug use also increases the risk of sexually transmitted infections (STIs), such as HIV and hepatitis C, due to shared needle use. Due to high-risk interactions associated with substance abuse, including sex work and increased chances of sexual abuse, women are more likely to come into prison with STIs and can pass them to others while incarcerated (World Health Organization & United Nations Office on Drugs and Crime, 2009). These realities increase the need for a comprehensive health evaluation for each woman entering prison, so they can receive the proper treatment and information about their health to avoid spreading infection. Standard care should include gynecological evaluations, both in the service of identifying infections and as a general necessity for the health of incarcerated women—especially since they are less likely to receive such care prior to incarceration. 

Another issue often overlooked and intensified by incarceration is mental illness. Women entering prison are more likely than men to have pre-existing mental health issues, with the UN Office on Drugs and Crime reporting that 80% of incarcerated women have a mental illness. Adverse or often traumatic circumstances before their incarceration increases the likelihood of mental disorders. Anxiety and mood conditions are most prevalent in female prison populations, and two thirds have PTSD according to the same report. Mental illness often correlates with substance use disorders, and the combination makes the lives of these women much more complicated—especially with inconsistent treatment, or no treatment at all, prior to their incarceration. 

These factors reinforce the importance of consistent and high-quality care for incarcerated persons, because this may be the only place they can get it. Overall, the state of the United States’ healthcare system is poor, but providing healthcare to incarcerated people seems to be a relatively simple responsibility: with their freedom severely restricted in institutions funded and regulated by state and federal governments, there is no doubt whose responsibility their healthcare is. There are no excuses for inadequate medical services in prison when it is undoubtedly the prison’s responsibility to provide the resources to sustain incarcerated persons during their sentence. Such care doesn’t just include their physical health at the present moment.

If the correction system truly wants to reform the lives of those who have committed crimes against our society, they have to set those women up for success by providing thorough physical, reproductive, and mental health services. They also must provide relevant education so incarcerated persons can maintain their health after they’re released. 

Continuing care after incarceration is a challenge for many. Most women return to situations similarly challenging as they faced prior to incarceration, in addition to the challenge of reentering society marked by their conviction. A study done by the University of Arkansas for Medical Sciences interviewed incarcerated and previously-incarcerated women on healthcare in prison and in their communities. The authors found that 22% of the women they interviewed noted the lack of support during transition as an issue requiring attention. Interviewees also consistently requested more comprehensive screenings, specialized care in prison, and more accessible care outside of prison. The researchers recognized a significant gap in research in their area of inquiry, which would be the first step in moving forward improvements to the prison healthcare system.

Without a detailed, evidence-based structure on how to improve, it is unlikely the US government will take the necessary steps to rectify the crisis that is women’s health in prison. Incarcerated people are a population often forgotten, whether that be because they aren’t in society’s view or because it dismisses them as one-dimensional criminals who are unworthy of our care and attention. These common assumptions are false. Though the gap in research extends to all incarcerated populations, women’s prisons face the additional risk of being lumped in with the rest because they’re a relatively small fraction of the incarcerated community. Incarcerated women have a unique set of needs that must be taken into account when federal and state governments make policy decisions. So far, these needs aren’t being properly acknowledged. On an individual level, negligence subjects women in prison to unsafe and unhealthy circumstances, setting them up for failure upon release. Meanwhile, on a societal level, it perpetuates the standard of building institutions to function for men and applying them to women, without regard for the relevant needs between them.