Health-promoting prisons in the female estate: an analysis of prison inspection data

Abstract

Background Women in prison have comparatively greater health needs than men, often compounded by structures and policies within the prison system. The notion of a ‘health-promoting’ prison is a concept which has been put forward to address health inequalities and health deterioration in prisons. It has, however, not been fully discussed in relation to women in prison. The paper aims to distil the learning and evidence in relation to health promotion in female prisons using prison inspection reports of women’s prisons in England and Wales. Methods Prison inspection reports are one way of ascertaining the contemporary situation in prisons. Prison inspections are often unannounced and use a myriad of methods to draw conclusions around various aspects of prison life. Thirteen prison inspection reports were analysed thematically focusing on health promotion within the institutions. Two analysts conducted the work using NVivo 12. Results Five core thematic areas were identified during the analysis of the reports. Saliently, a joined-up approach to health promotion was not a common feature in the prisons and indeed the focus tended to be on screening and ‘lifestyle issues’ rather than a concern for the underlying determinants of health. There was often an absence of a strategic approach to health promotion. There were some good examples of the democratic inclusion of women in prison in shaping services, but this was not widespread and often tokenistic. There were some examples of inequity and the inspection reports from a small number of institutions, illustrated that the health needs of some women remained unmet. Conclusions The paper suggests that there is potentially some work before conditions in women’s prisons could be described as ‘health-promoting’, although there are some examples of individual prisons demonstrating good practice. The health promoting prison movement has, implicitly at least, focused on the needs of men in prison and this has been to the exclusion of the female prison population. This does lead to several challenges and the potential for exacerbating health challenges faced by an already marginalised and vulnerable group. Greater focus on the health promotion needs of women in prison is required.

A human rights assessment of menopausal women's access to age- and gender-sensitive nondiscriminatory health care in prison

“…The final data set (n = 16) consisted of a broad range of methodologies based on consultations, prison inspections, and prescribing/ chart data with qualitative studies using interviews with women in prison and healthcare providers (the United States, Brazil, Canada, New Zealand; n = 5) [39][40][41][42][43] ; mixed-method studies with women who experienced incarceration and healthcare providers (the United States, Canada; n = 3) [44][45][46] ; global reviews/opinion pieces (n = 2), 33,34 and US-based social legal reviews (n = 1) 35 and editorials (n = 3) [36][37][38] ; and secondary analysis of data (the United States, the United Kingdom; n = 2). 47,48 Environmental conditions and menopausal sequelae Despite the observed increases in numbers of older women in prisons globally, and although menopause was described as a unique and yet common health issue within the detention space, documentation around detention conditions experienced during menopause in prison remains underexplored. 33,34,[39][40][41]45,46 The assessment reveals a violation of Bangkok Rule 5; "accommodation of women prisoners shall have facilities and materials required to meet women's specific hygiene needs, including sanitary towels provided free of charge."…”

“…Appropriate health policies and pharmacological and lifestyle practices to manage menopause in prison remain underdeveloped 33,37,40-42,45,48 . US-focused editorials and sociolegal reviews, in particular, underscore the need for evidence-based policies, prescribing guidance and health care recommendations to support menopausal women in prison 35-38 .…”

“…35 Evidence-based age/gender-sensitive prison health policies Appropriate health policies and pharmacological and lifestyle practices to manage menopause in prison remain underdeveloped. 33,37,[40][41][42]45,48 US-focused editorials and sociolegal reviews, in particular, underscore the need for evidence-based policies, prescribing guidance and health care recommendations TABLE 4. Bangkok Rules relevant to menopausal health in prison Rule 5: The accommodation of women prisoners shall have facilities and materials required to meet women's specific hygiene needs, including sanitary towels provided free of charge and a regular supply of water to be made available for the personal care of children and women, in particular women involved in cooking and those who are pregnant, breastfeeding, or menstruating.…”

“…The final data set (n = 16) consisted of a broad range of methodologies based on consultations, prison inspections, and prescribing/chart data with qualitative studies using interviews with women in prison and healthcare providers (the United States, Brazil, Canada, New Zealand; n = 5) 39-43 ; mixed-method studies with women who experienced incarceration and healthcare providers (the United States, Canada; n = 3) 44-46 ; global reviews/opinion pieces (n = 2), 33,34 and US-based social legal reviews (n = 1) 35 and editorials (n = 3) 36-38 ; and secondary analysis of data (the United States, the United Kingdom; n = 2) 47,48 …”

“…Participants in a different Canadian consultation 42 (p38) described menopause as “an overlooked area of reproductive health.” This view is supported by prison healthcare professionals themselves in the United States 39 . In the United Kingdom, health-promoting prisons with screening programs for communicable and noncommunicable diseases, including sexual health services, were described during inspection reviews as supporting healthy lifestyles among older women, despite a lack of strategic approach to health promotion and omitting menopause-specific care 48 . US healthcare providers suggested that preferred housing unit or age-segregated housing could help older women in prison to access health care to meet their unique health needs, including menopause care more conveniently, and could potentially enhance older persons' quality of life 39 …”