Health Care for Women Inmates. Part 8
In the end, the influence of the correctional facility on the overall health of an inmate is unclear. In their survey of free-world care versus that provided in prisons, Marquart et al. (1996, p. 345) tentatively suggest that “most inmates experience no change in their health status during incarceration.” The care they receive within a facility is better than they would have otherwise received, but the potential of this care to remedy their health problems is negated by the depth of their existing problems prior to admission. Vaughn and Smith (1999), however, dispute this view arguing that it disregards the effect of penal harm medicine on an inmate’s health. (Marquart and other colleagues (1997) do account for prison conditions in their evaluations.) Maeve (1999, p. 66), likewise, with regard to inmates, argues that inmates become “less healthy” in prison (see Murphy, 2003, for a discussion of rationed health care within the Bureau of Prisons). However, because Marquart et al. (1996) did not consider the health care of women inmates specifically, their findings may not be generalizable regarding this particular inmate population.
Health Care Received by Women Inmates
This section addresses the health care received by inmates. First, we examine challenges that exist to providing care to these women; this is followed by a discussion of what women and corrections officials report with regard to the health care that has been provided.
Challenges to Providing Medical Care to Women Inmates
The fact that women constitute a small portion of the correctional population has been used to justify a lack of adequate programming and treatment for them (Belknap, 2001). This is especially true with regard to their health care. Overall, scholars report that effective health care for inmates is insufficient, particularly in preventive care (Belknap, 1997). Ross and Lawrence (1998, p. 126) attribute the inability to provide sufficient health care to inmates to a “systematic denial to women of parity of services readily and regularly available to incarcerated men.”
The workload of medical care providers in correctional facilities is considerable. Maeve (1999, p. 51) notes that “health care for women in prison is largely an effort to ‘catch up’ in that considerable effort is most often necessary to raise women’s health status to legally mandated, acceptable levels.” Given the extent of problems many of these women have, catching up constitutes a massive undertaking. In addition to providing health care to a “very needy” population, the isolation and security concerns within prisons and jails makes inmates entirely dependent on care providers, which is especially cumbersome with inmates suffering from chronic conditions. For example, care providers must devote time simply to distributing medications to affected inmates, who would not require this outside the institutionalization context (Marquart et al., 1997), or providing other routine treatment. Care providers may also need to evaluate the well-being of inmates who are not ill, such as those confined to segregation or placed in restraints (Ammar & Erez, 2000).
Aggravating the workload for medical care providers in correctional facilities is the insufficiency of staffing and provision of resources for women’s correctional health care. Women inmates in state and federal prisons reported having medical problems after being admitted in higher percentages than men — 23 percent of women in state prisons compared to 16 percent of men and 25 percent of women in federal prison compared to 15 percent of men (Maruschak & Beck, 2001). Because the health care provided in women’s prisons and jails is often based on what is needed and provided in men’s correctional facilities (Ross & Lawrence, 1998), the estimate of staffing levels on the part of correctional officials can be inaccurate. A nurse reported this problem within Ohio’s women’s facilities, commenting that, “Staffing of the women prisons follows the male mode: 300 men to three nurses. But women in prison go to doctors two and a half times the rate of men. Women have problems that men do not have….” (Ammar & Erez, 2000, p. 20). A similar problem has been reported in California’s women’s correctional system, where resource needs are determined “using a healthy, young male as its model prisoner” (Hill, 2002, p. 232). The resulting lack of adequate staffing resources often translates into delayed care for the women who have difficulty being seen by a medical doctor, such as those studied by Belknap (1997) and Dobash, Dobash, and Gutteridge (1986). Problems of higher rates of utilization of health services by female inmates as well as difficulty in seeing doctors have been reported in Lindquist & Lindquist’s (1999) study of men and women’s use of health services in jails.