August 28, 2013

How Do You Afford Healthcare in Prison on 50 Cents Per Hour?

Women entering prisons often have poor physical health, in part due to poverty and lack of access to treatment for concerns such as addiction, abuse and mental health. An article in the Journal of Health Care for the Poor and Underserved looks at a different aspect of the health of incarcerated women: how healthcare systems in prison create further harm.

For “Factors Contributing to Poor Physical Health in Incarcerated Women,” researchers Holly Harner and Suzanne Riley conducted 12 focus groups and asked 65 women in a U.S. maximum security prison what they thought about factors affecting their their physical health while imprisoned.

The women reported a wide variety of concerns, with one of the major issues being limited and complicated access to care.

While it’s a widespread belief that inmates have all of their medical care paid for, cost was a significant barrier for the women. The women earned 50 cents per hour in their prison-based jobs, and some of that income was diverted for fines and fees related to their incarceration, making even the mandatory $5 co-payments difficult. Once they have accumulated $5 for a visit, the inmates are only allowed to address one health concern per visit.

The women also reported being discouraged from seeking care, as well as fear of disciplinary action if they questioned a health care provider.

One woman reported: “I went to Medical, telling them I had more than just a cold. I got yelled at, called a hypochondriac, and escorted out with the threat of [being written up for] misconduct. Later I had an asthma attack and was diagnosed with asthma.”

Another reported that routine gynecological care such as Pap tests for cervical cancer is discouraged: “They try to make you not want your Pap because there are so many people waiting. They say, ‘You know, you don’t really have to have a Pap, right?’ They make you feel guilty if you want it.”

Poor dental care and eye care were also mentioned, with consequences that go beyond the medical. One woman with poor eyesight described not being able to do her mandatory homework because she could not obtain glasses, and she feared being disciplined for misconduct as a result. When dental care could be accessed, the women were concerned that the dentists would simply pull their teeth instead of providing other treatments.

The women also expressed concerns about the unhealthy diet causing weight gain and limited opportunities for exercise. Exercise classes were often scheduled during the prisoners’ work hours frequently canceled. Women who expressed a desire to quit smoking often could not afford the offered therapy — nicotine patches cost $187.50 for six weeks (375 hours of work at 50 cents per hour).

Women with disabilities face additional problems. Those using wheelchairs were assigned other inmates as “pushers”; these women received only 15 minutes of training on how to maneuver wheelchairs.

Harner and Riley do not offer solutions for the poor health care offered to women in prison, but they do provide characterization of the problems as expressed by the women themselves. The authors conclude with this statement: “Incarcerated women deserve timely, evidence-based, and respectful health care in prison.”

Related: Learn more about women in prison from the Sentencing Project, the ACLU, and Women + Prison, a website and publication created by incarcerated women. Also see “‘She’s Out of Sight’: Women, Healthcare and the Prison System,” an article by Monique Hassel in Manifesta, and “Inside This Place, Not of It: Narratives from Women’s Prisons,” compiled and edited by Robin Levi and Ayelet Waldman. For issues related to childbirth, see the Prison Birth Project, whose founders were among our 2010 Women’s Health Heroes. In July, the Center for Investigative Reporting broke the story that women in California were sterilized without approval. OBOS has also reported on the persistence of shackling incarcerated women during labor and pregnancy.


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