‘You have to be almost dead before they ever really work on you in prison’: A qualitative study of formerly incarcerated women’s health care experiences during incarceration in Louisiana, U.S.

Abstract

Globally, the rate of incarceration among women is rising, and in the U.S., women's incarceration has grown at twice the rate for men over the last four decades. Louisiana has the second highest rate of incarceration in the U.S. There is evidence that men in Louisiana prisons do not receive adequate healthcare, but little is known about their women counterparts. We aimed to document formerly incarcerated women's experiences with receiving healthcare during incarceration in Louisiana to inform policy and practice change. In partnership with two community-based organisations in New Orleans, Louisiana, between August 2016 and April 2018, we conducted semi-structured 1-hr interviews with 22 formerly incarcerated women who had been incarcerated in the state for at least one consecutive year. A convenience sample of participants was recruited through community-based organisations' re-entry and health programmes. Our interview guide included questions about experiences with accessing care, reproductive health needs, interactions with providers and preventive care during incarceration. We used applied thematic analysis techniques to interpret data. Over 90% of interviewees identified as Black. Their mean age was 50.7. The average length of incarceration was 8.4 years. Participants reported multiple barriers to accessing care including punishment for seeking care, long wait times, costs, lack of respect from providers and health concerns being dismissed. Participants reported limited mental health, preventive and dental services; an insufficient number of providers; and poor health outcomes as a result of delayed care. Overall, women did not have access to adequate, timely care during incarceration. Findings suggest a need for policy changes related to the provision of carceral healthcare services and external oversight of prison conditions and healthcare delivery. Further research into women's experiences of ageing during incarceration and tailored transitional health models is needed.

General and reproductive healthcare experiences of formerly incarcerated women in the United States: a qualitative study

“…Some of our findings expanded on known issues. As seen previously, our participants reported significant delays in reaching health-care services as is discussed in almost every qualitative exploration of the prisoner experience (Hatton et al , 2006; Plugge et al , 2008; Bowen et al , 2009; Ahmed et al , 2016; Kendall et al , 2020; Wennerstrom et al , 2021; Liauw et al , 2021). This delay in care can be particularly challenging for patients adjusted to specific medication regimens and timings, especially psychotropic medications (Bowen et al , 2009).…”

What is Known About Reproductive Autonomy Among Justice-Involved Black Women?: A Scoping Review

“…Eight studies explored concepts related to women’s right to bodily autonomy (Hemberg et al, 2021; Johnston et al, 2016; Pan et al, 2021; Schonberg et al, 2020; Sufrin et al, 2009; Thomas et al, 2019; Thompson et al, 2021; Wennerstrom et al, 2022). In the work by Hemberg et al (2021), in which abortion-related knowledge was studied, respondents in Kansas City (KS/MO) and Birmingham (AL) had lower odds of high abortion-related knowledge than did respondents in Oakland (CA) (odds ratio [ OR ] = 0.19, 95% confidence interval [CI] = [0.10, 0.38] and OR = 0.17, 95% CI = [0.11, 0.28], respectively).…”

“…Tables 2 to 4 provide a summary of the data extracted from the nine studies. These data consist of the studies’ locations, carceral states (jail, prison, parole, probation), samples, the studies’ aims, and methods (Table 2); the tenets of reproductive justice that the studies used, as well as their measures (Table 3); and qualitative themes and exemplars from Schonberg et al (2020) and Wennerstrom et al (2022) (Table 4). The team reviewed and confirmed the extraction process through discussion.…”

Mixed Method Evaluation of Louisiana’s Prerelease Medicaid Enrollment Program, 2017–2019

“…Our qualitative findings of concerns about the lack of access to quality health care while incarcerated mirror recent legal findings. 28 Prior studies 12,29 have indicated that people incarcerated in Louisiana face barriers to receiving care (eg, cost-prohibitive co-pays, lack of respect from providers, health concerns being ignored), which may explain why over 98% of participants had an outpatient visit and nearly half had an emergency department visit within 6 months of release. In contrast, in 2018, 79.6% of the general adult Louisiana Medicaid population had an ambulatory visit, 30 and 37% of adult Medicaid members nationwide had an emergency department visit.…”