The health needs of women in sub-Saharan African prisons are both neglected and poorly understood. Outside South Africa, little research exists on African prison health; what is available tends to be gender-blind and concerned with disease prevention rather than with health promotion. While Vetten (2008) has raised this concern previously, a comprehensive overview of women's health and health promotion in African jails is clearly absent. Available evidence shows that the conditions in African prisons are harmful to health, justifying a need for a health promoting prisons agenda rooted in the needs of sub-Saharan Africa. Women prisoners have significant mental and physical health needs, and international conventions on health care are not being respected globally. The health promoting prison concept has considerable attention in the Global North, with a commitment to equivalence of health care, gender sensitivity and to prisoners' social as well as health needs. This article provides an opportunity for critical reflection on women's health in prison, shows the lack of research in this area, questions the suitability of the health promoting prisons' agenda for sub-Saharan Africa, draws on our limited experience of the women's prison in Lusaka, Zambia, and produces recommendations to tackle women's health and wellbeing needs within the criminal justice systems of sub-Saharan Africa.