A Meta-Analytic Review of Health Care Problems in Women`s Prisons

  • Uncategorized

AMeta-Analytic Review of Health Care Problems in Women’s Prisons

Tableof Contents

Abstract 3

Introduction 4

Development and significance of the problem 4

Hypotheses 5

Method 6

Sample of studies 6

Selection criteria 7

Data abstraction 8

Results 8

Description and findings of the studies 8

Discussion of results 12

Limitations of the studies 15

Conclusion and recommendations 16

Summary of findings 16

Suggestion for future research 17

Recommendations 18

References 20

Abstract

The steady risein incarceration has a great correlation to the operation ormanagement and quality of the health care strusture, especially inAmerica. States with a high rate of women prisoners showdeteriorations in the general access and excellence of health care.Furthermore, little research has been provided on the health careexperiences or outcomes of the incarcerated women especially giventheir great risk to communicable diseases. It is significant to notethat incarcerated women who are pregnant are predominantlysusceptible to health care problems and are continually marginalized.Numerous health care problems and issues exist in women prison, butgovernment agencies have only managed to provide limited evidence orinformation regarding the prevalence of the problems amongincarcerated women. To offer a broader picture of the problems, asystematic study of 7 articles published between 2008 and 2015 wasundertaken. The meta-analysis confirmed the prevalence of a litany ofhealth care problems in women’s prisons. Besides, the analysisidentified numerous methodological challenges in obtaining andproviding quality and consistent health care to the imprisoned women.

AMeta-Analytic Review of Health Care Problems in Women’s Prisons

IntroductionDevelopmentand significance of the problem

The number of women inmates has continued to increase over the years.Nijhawan et al. (2010) and Shaw, Downe, and Kingdon (2015) point outthat most women in prison facilities are imprisoned for nonviolentcrimes. Most incarcerated females come from socially, financially,emotionally, and educationally underprivileged environments with adisproportionate number of them having undetected health issues andchronic and acute diseases. It is significant to note that femalesentering the correctional facilities are at a high risk of infectiousillnesses, mental health problems, and substance abuse, all of whichrepresent health care issues. Historically, the number of imprisonedmen has far surpassed the number of imprisoned women thus, thecorrectional system has paid inadequate consideration to the uniquehealth concerns of the women. However, with the swelling number offemales entering and departing the correctional system, there is aneed to ensure that the state puts policies in place to effectivelyaddress the current health care problems. Some of the mechanismsinclude equipping the correctional facilities with the rightresources, staff, and information, and offering the incarceratedwomen appropriate and comprehensive health care services.

Hypotheses

Numerous studies especially those conducted by Binswanger, Redmond,Steiner, and Hicks (2012), Moller, Fraser, Van den Bergh, andGatherer (2011), and Plugge, Douglas, and Fitzpatrick (2008) showthat the majority of imprisoned women across the world tend to beyounger than the general populace. The studies further show that mostof these females are of the childbearing age, come from poorbackgrounds, are poorly educated, and have encountered sexual andphysical abuse. It is critical to note that most of these women areincarcerated because of nonviolent wrongdoings especially drug abuse(Gatherer, Moller, Van den Bergh, 2009 Moller et al., 2012). Thismeans that they have a higher prevalence of blood-borne infectionssuch as Hepatitis C and HIV. These women encounter problems whenaccessing health care, for example, stigma, physical isolation,limited access to therapies and medicine, organizational constraints,and interruptions in their therapies when released from the prison.In this regards, study’s hypotheses include

  1. Majority of incarcerated women encounter numerous health care challenges ranging from limited access, high prevalence of communicable diseases and STIs, depression, and lack of maternal care

  2. Most women in prison have encountered a degree of exclusion and stigma when trying to access health care

MethodSampleof studies

It wasproblematic to develop a pertinent procedural strategy to theappraisal process because of the array of organizational andepistemological conventions. After careful consideration, thestrategy proposed by Sandelwoski, Voils, and Barroso (2006) wasutilized. Sandelwoski et al. (2006) propose a mixed approach whereextraction, grouping, and formatting of results are significant inreviewing the studies. The approach was utilized as it provided aneasier framework for accessing and reviewing the studies. Asystematic evaluation of scholarly articles was conducted torecognize and categorize studies that presented the health careproblems of incarcerated women. The meta-analysis comprised articlesthat were issued in English-language, peer-reviewed periodicalspublished between 2008 and 2015. The paper relied on articles thatanalyzed the prevalence of health care problems, the systemavailable, and the estimates of the health care challenges. Inaddition, the analysis focused on articles that unambiguouslyacknowledged the denominator for occurrence magnitudes. However, thepaper included articles that dealt with foreign prisons but with afocus on American prisons and dealt exclusively with diseases presentin prisons.

Reports relatedto health care problems in women’s prisons were retrieved by meansof multiple processes. Computerized databases such as Social ServicesAbstracts, Sociological Abstracts, MEDLINE, PsycINFO, Social WorkAbstracts, Dissertation Abstracts International, and NationalCriminal Justice Reference Service were used. For all the databases,the searched keywords included therapy, prisoners,women prisons, health care, prevalence, drugor substance abuse, incarceration, USA, problems,issues, challenges, diseases, and incidence.KWIC (Key Word in Context) was utilized to test for the consistencyof word usage while word occurrence counts were used to classifywords of probable interest. The articles were then appraised andcoded and their core reports skimmed. The bibliography entries of thearticles and other articles focusing on health care problems inprisons were assessed to retrieve further articles to be reviewed.Journal of Women’s Health, American Journal of PublicHealth, and Journal of Correctional Health Care weremanually searched for the articles. All the articles retrieved fromthe databases and journals were uploaded into EndNotex4 software tosort entries. The initial yielded 250 articles but based on abstractsand titles, 200 articles failed to meet the inclusion criteria. Thefull texts of the remaining articles were scanned and reviewed and anextra 43 studies were omitted based on the outlined exclusioncriterion. Thus, 7 articles were contained within the meta-analysis.

Selectioncriteria

The analysisutilized the following criteria to include articles or studies

  1. The article provided good quality study designed towards exploring incarceration and mental health

  2. The articles were published in English and focused on inmates

  3. The analysis included longitudinal studies that relied on data from reputable sources, for example, government sources, as these studies provided significant information on mental issues in correctional facilities

  4. Studies from outside the US, especially from European countries, were included if they included descriptive statistics and touched exclusively on incarcerated women and their experience on health matters.

  5. The paper excluded articles that provided a systematic analysis, if they failed to present original information, focused exclusively on men’s prisons, selected samples of women facing a single challenge, for example, mental illness, and dealt exclusively with foreign prisons.

Dataabstraction

Theresearcher comprehensively undertook the iterative progress of thesearch strategy. Searches were undertaken and the selected studiesindependently and effectively examined against the inclusion andexclusion criteria. After the 7 studies were picked for analysis anddiscussion, they were tabularized for features and a summary ofresults recorded. The articles were tabulated to reveal the methodused in undertaking each study, the sample used, findings of eachresearch, and the description. The assessment plan helped to developthe line of argument or discussion iteratively.

ResultsDescriptionand findings of the studies

Table 1

Summary of thefindings and study characteristics

Reference

Method

Description

Sample

Findings

Baillargeon et al., 2009

– The study used a surveying unit study of 234,031 inmates in one year

-The study related the incidence of suicide among prisoners with bipolar disorder, major depressive disorder, non-schizophrenic psychotic disorder, and schizophrenia, and

– A sample size of 234,031 people imprisoned in Texas Department of Criminal Justice was used

– The occurrence of disorders varied greatly according to demographics

– Women presented a prevalence of 10.3% while men presented an incidence level of 3.5%

– Women reported zero cases of suicide while men reported 19% cases of suicide

– The prison had a higher rate of disorders than the US population, but they compared to rates in other prison populations

Douglas et al., 2009

– Interviews and focus groups aligned to qualitative study were employed in 2 closed local prisons

– Data was documented, coded, and analyzed thematically

– The study evaluated the perception of female inmates on the implication of incarceration on their health

– The researchers used 6 focus groups and 12 interviews in 2 local English prisoners

-Using purposive sampling, 37 females were recruited

-The researchers conducted 12 individual interviews for 30 to 60 minutes

– A high number of women perceived imprisonment as negatively affecting their health

– Women complained of unhygienic facilities

-To some, prison offered a respite from substance use, social exclusion, poverty, and abuse

Harner and Riley, 2013

– The study focused on how incarceration affects women’s mental health

– Focus groups and descriptive surveys

– Many women who enter prison already suffer from mental illnesses such as PTSD, depression, anxiety, and addiction

– A number of women become mentally ill while in hospital

-Prisons provide a system centered on crisis-aligned model

-Two studies were conducted (a health survey and a focus group)

-In the survey, 900 women partook in the study, but only 450 returned completed the survey. The mean age for the inmates was 38 years and the majority were white (68%). Majority were sentenced for drug-related wrongdoings and murder

– There were 12 focus groups each with 65 women. The mean age was 43 years and the majority were white (62%).

– Majority condemned for murder and drug-related cases

– The study revealed a mixed result regarding the incarceration of women and their mental illness.

– women’s mental illness might improve, stagnate, or worsen when incarcerated

– There lacks a consistent and effective health care system for incarcerated women

Massoglia, 2008

The study utilized data from NLSY (National Longitudinal Survey of Youth) to test more than 20 different indicators of health

– Multiple analytic strategies were employed to develop patterns

-The researcher assessed the correlation between incarceration and health

-The research examined the relationship using data from NLYS

– The study revealed that ex-inmates are more probable to suffer from infectious illnesses and diseases linked to stress

-The study did not observe any association between imprisonment and illnesses unrelated to depression or infectious illnesses.

Plugge et al., 2008

– Interviews and focus groups aligned to qualitative study

– Data was documented, coded, and analyzed thematically

– The study was designed to evaluate imprisoned women’s problems and experiences of health care provision

– 12 semi-structured personal interviews were taken

– The study included six focus groups with 37 women

– Incarcerated women’s view on the quality of health care was mixed

-The majority viewed the quality as poor with lack of confidentiality, difficulty accessing care, and biased and disrespectful treatment.

Schnittker et al., 2015

– The authors utilized a multilevel approach, which involved a cross-sectional specific data and an aggregate analysis

– The study examined the spillover impacts of increased imprisonment levels on the quality and functioning of the America Healthcare structure

-The study addressed between-state dynamism and trends over time in access and utilization of health care

– The study utilized the Community Tracking Study (CTS) to collect data. Each study had at least 37,000 respondents

– The study utilized data from 1996/1997, 1998/1999, 2000/2001, and 2003

– The CTS sample was included in 60 sites

– The study revealed that people living in regions with a great number of former prisoners have less access to health care professionals and care

-The former inmates had less trust in professionals and less contented with the provided care

-The study also revealed that former prisoners have a bigger need for health care and services

Wilper et al., 2009

– The study used the 2002 and 2004 surveys of convicts in resident detentions and state and federal penitentiaries respectively

-The surveys utilized a 2-step sample design. First, prisons were selected and then inmates selected

– The study examined the occurrence of chronic diseases and the access to care and services among inmates

– The researchers chose 301 prisons from 1585 state prisons, but only 287 partook in the study

– 16,152 inmates were indiscriminately chosen, but only 14,499 successfully completed the interviews

– The Census Bureau chose 21 state prisons and the remainder were stratified by survey region

– Three federal prisons were pre-picked and the remaining stratified. From 148 federal prisons, 40 were picked, but only 39 participated.

-Only 3686 inmates completed the interviews from a sample of 4253

– A high number of inmates (40% overall) suffered from chronic diseases

– A small number of inmates were taking psychiatric medication during arrest

-After admission, a high number of patients were taking medication

– Prisons are treating many inmates with mental problems who before admission were off treatment

Discussionof results

The resultsprovided a significant aspect of the health and health care problemsexperienced by incarcerated women. To provide a comprehensiveanalysis of the issues present, the meta-analysis looked at both thehealth problems faced such as depression, HIV, psychotic disorders,infectious diseases, and mental illnesses and health care problemssuch as diminished care, poor hygiene, and biased care. This allowedthe analysis to provide a link between the care and health problems.Furthermore, the analysis of both care and health problems helped inassessing whether the existing health care was effectivelycontributing to the treatment of the diseases.

The analyzedarticles employed different methodologies and hypotheses, but theyall revealed that the existing health care system is notcomprehensive and accommodative to inmates. Baillargeon et al. (2009)employed a surveying cohort study to analyze the occurrence ofsuicide among prisoners. The study conducted a comprehensiveassessment for 234,031 inmates both males and females and revealedthat women (10.3) presented a high rate of disorders occurrence suchas bipolar disorder and schizophrenia than men (3.5%). However, womenhad a zero incidence of suicide against a 19% rate of men. This showsthat incarcerated women are at a great risk of depressive illnessesthan men. The findings from the study compared to data from prisonsacross America, which reveals that most incarcerated women report ahigh incidence level of depression. The cohort study of 234,031inmates provided reliable information on the incidence level andallowed the meta-analysis to include depression and other depressivediseases as major health problems experienced by women.

The studies byDouglas et al. (2009) and Plugge et al. (2008) were conducted inEnglish prisons rather than American prisons, but they provided asignificant situation on the experience of incarcerated women. Thestudies were included as they offered descriptive statistics, dealtwith incarcerated women exclusively, and focused on the healthproblems they faced. Additionally, they helped reveal thedisproportionate treatment of female inmates in countries thatcollaborate with America on criminal justice. Both studies usedinterviews and focus groups to assess the issue. However, Douglas etal. (2009) study looked at women’s perception of imprisonment ontheir health while Plugge et al. (2008) looked at the women’sexperiences. Douglas et al (2009) revealed that women perceivedimprisonment as negatively affecting their health especially giventhe unhygienic facilities in prisons, lack of comprehensive healthcare, and mistreatment by guards and staff. However, women who camefrom poor backgrounds or who had bad experiences of sexual andphysical abuse or chronic abuse of drugs suggested that thecorrectional facilities offered them a respite. Plugge et al. (2008)provided that majority of women perceived correctional facilities asdemeaning with poor health quality, disrespectful and biasedtreatment, lack of confidentiality, and stigma especially with HIV.The two studies show that health care systems do not provide acompassionate and effective environment for prisoners.

Although Wilperet al. (2009) study focused on both females and males, it providedcomprehensive data on the incidence of chronic illnesses in prisons.The study showed that majority of prisoners compared to the generalpopulation suffered from chronic diseases. In addition, only a smallfraction of inmates with chronic illnesses and mental problems weretaking drugs before they were apprehended. However, after admission,prisoners with mental problems were included in the treatment plan.This shows the prisons gave the prisoners psychiatric medicine andbegan treating them, which means that prisons offered care to thementally ill. Using descriptive surveys and focus groups, Harner andRiley (2013) showed that many females who enter correctionalfacilities report at least one mental illness, for example,depression, addiction, major depressive disorder, and PTSD. The studyrevealed that although there lacks an effective and consistent healthcare system in prisons, the mental health of inmates especially thosesuffering from addiction and some form of depression improved.However, some women reported a stagnating or declining mental health,perhaps because the prison environment was too restrictive. Harnerand Riley (2013) and Wilper et al. (2009) studies revealed that mostprisons offer a crisis-aligned model for treating mental problemsthus, the high success rate compared to other health problems.Furthermore, most mentally ill inmates are usually isolated fromother prisoners thus, the high success rate.

Although thestudies by Harner and Riley (2013) and Wilper et al. (2009) showedthat women with mental illnesses reported some improvements while inprison, the same studies suggested that some women developed mentalproblems while in prison. This aspect was supported by Massoglia(2008) study, which revealed that ex-inmates were more probable tosuffer from communicable and stress-related illnesses. The study didnot observe any correlation between incarceration and diseases notrelated to stress or communicable diseases. This showed that therestrictive environment in prison especially for women was acontributing factor to the poor health issues experienced by womenwhile in prison and after their release. Schnittker et al. (2015)reported that former inmates reported diminished care, had less trustin the health care system and medical practitioners, and were lesssatisfied with the care than the general population. Furthermore, thestudy reported that former inmates required greater need for servicesand care because of their experiences in prison in past experiences,for example, drug abuse, sexual abuse, depression, social exclusion,pregnancy, and economic or health deprivation.

Limitationsof the studies

Because of the lack of an extensive literature dealing with healthproblems experienced by incarcerated women, the meta-analysisincluded only 7 studies for the review. The studies employeddifferent methodologies, sample sizes, diagnostic instruments, andstudy designs thus, they did not correlate. Furthermore, they didnot deal with a specific problem, for example, it was problematic todiscover a study focused only on one health problem or health careproblem. Although all the studies used validated instruments for datacollection and analysis, none conducted a clinical review, whichmeans the reported data was from the view of incarcerated women. Thiswas good from the view of the study’s problem, but it inhibited theprovision of a dynamically reliable and unbiased data.

Conclusionand recommendationsof findings

The meta-analysis coded and analyzed 7 studies, which studied thehealth care problems experienced by incarcerated women. However, theanalysis also included studies that dealt with health care system inAmerican prison in general. To draw some comparisons, the study usedarticles that focused on prisons outside America. Plugge et al.(2008) dealt with prisons in Southern England, but it was used as itprovided a critical evaluation of the development and quality ofhealth care and services in two females’ penitentiaries in England.The article focused exclusively on the experiences of imprisonedwomen thus, it was significant to draw a comparison with prisons inUSA and reveal whether the health care problems experienced were aworldwide occurrence. Schnittker et al. (2015) did not focus on thehealth care challenges experienced by women, but it was used as itprovided a comprehensive study on the lives of former inmates. Thestudy revealed that former inmates had trust issues in theprofessionals and health care system, had diminished access to healthcare, and were less satisfied with the offered care. Furthermore, thearticle was used as it provided a large sample size (the CTS used wasin state-level, collected data from 60 sites and at 2 periods and 6stages and each stage had more than 37,000 participants). The articleallowed the study to draw a correlation between the health caresystem in prison and outside since the high level of spillover effectshowed that the US health care system within prisons is notcomprehensive or effective.

It is critical to note that the study focused on health careproblems, but it also focused on the system itself, to determine howthe system reacted to these health care problems and issues. Themeta-analysis showed that mental health is a major health problemacross prisons in America and the rest of the world. Women were foundto present a higher incidence of chronic and depressive illnessesthan men. Previous experiences of the women especially drug abuse andsexual abuse greatly influenced their behavior and health wellbeingwhile at the correctional facilities. From the studies, it wasaccurate to conclusively assert that female inmates experienced amyriad of health problems ranging from depression, communicablediseases, addiction, mental illnesses, and chronic diseases. Thestudies also revealed that the existing health care systems are notcomprehensive or effective enough in the provision of humane andcompassion care to female inmates. The analysis showed that thesystem is too restrictive, lacks enough human and capital resources,is not synchronized effectively with the criminal justice system, andthe existing policies had not effectively addressed the provision ofcare to prisoners.

Suggestionfor future research

Themeta-analysis should have utilized more articles, but the presence oflimited research on the considered problem and tight timeframe meantthat the utilization of 7 articles for the review. However, theanalysis used other studies and articles to support other aspects ofthe study, for example, the existing problem, need for the study, andthe current state of health care system within US prisons. Themeta-analysis should have employed studies that utilized proxyindicators of health care issues, for instance, health care budget inprisons and the development of the problems. The study should haveutilized multiple articles focusing on different prisons across theUS. This would have allowed the analysis to focus on all states,unpublished reports, government publications, and expanded thetimeframe.

Recommendations

From theanalyzed articles, it is critical to note that the US government hasneither comprehensively considered the quality of health care norhealth problems. This scenario as Binswanger et al. (2012), Mignon(2016) and Shaw et al. (2015) point out emanates from the fact thatthere are more men in prisons than women thus, the allocation ofdisproportionate fewer resources in women prisons. Given that the UShas the highest imprisonment rate in the world and the number ofincarcerated women continues increasing, the government shouldallocate more resources to prisons’ health care. Mignon (2016)study reveals that most (95% from a sample of 154 women) women whoare imprisoned report a minimum of one health symptom, for example,dental, menstrual cycle problems, depression, substance abuse issues,and pregnancy. The majority of the incarcerated women report physicalor sexual abuse and given that most come from poor backgrounds or areimprisoned because of drug-related cases, the government needs torestructure the health care system.

Healthinstitutions should conduct a health assessment for all prisonersupon admission. The assessment will allow incarcerated women to bescreened for mental health problems, substance abuse, pregnancy,depression or stress, and chronic diseases. The assessment shouldalso include screening women for other forms of diseases such asSTIS, trauma, and allergies. The health assessment will allow prisonsto develop a health plan for every prisoner and ensure that prisonersreceive medical attention effectively. Schnittker et al. (2015) intheir analysis of the spillover effects of incarceration suggest thatzones with a great figure of former convicts report contracted healthcare, less satisfaction in health care, and a mistrust of health careprofessionals. This shows that prisoners do not have a high regardfor the health care organization because of their experience behindbars (Nijhawan et al., 2010). In this regards, prisons should placewomen offenders in less restrictive correction environmentsespecially those sentenced for petty crimes.

Health care and services should be expanded to serve all offenderseffectively, consistently, and unbiased. The criminal justice systemshould develop mechanisms to ensure pregnant women are notincarcerated unless their pose risk to other people. For example,Sered and Norton-Hawk (2013) suggest that a pregnant woman found inpossession of marijuana should be sentenced to a community-basedsentence or a fine instead of being imprisoned. This approach wouldnot only help in decreasing the high number of incarceration, but itwould also help in advancing health care. Gender-sensitivity trainingshould be offered to prison staff and medical practitioners servingin prisons to improve their relationships with prisoners. Health careand services offered should be restructured to include programs formental patients and the terminally ill. Further, community-alignedtherapeutic programs should be introduced to stimulate society livingfor prisoners. The government should standardize care in the prisonsand develop a multidisciplinary approach in providing psychologicalcare and treatment to people in need of the care.

References

Referencesutilized in the meta-analysis have been asterisked

*Baillargeon, J., Penn, J. V., Thomas, C. R., Temple, J. R.,Baillargeon, G., &amp Murray, O. J. (2009). Psychiatric disordersand suicide in the nation`s largest state prison system.&nbspJournalof the American Academy of Psychiatry and the Law Online,&nbsp37(2),188-193.

Binswanger, I. A., Redmond, N., Steiner, J. F., &amp Hicks, L. S.(2012). Health Disparities and the Criminal Justice System: An Agendafor Further Research and Action. Journal of Urban Health,89(1), 98–107.

*Douglas, N., Plugge, E., &amp Fitzpatrick, R. (2009). The impact ofimprisonment on health: what do women prisoners say?&nbspJournalof epidemiology and community health,&nbsp63(9), 749-754.

Gatherer, A., Moller, L. F., Van den Bergh, B. J. (2009). Women areHealth in Prison: Urgent Needs for Improvement in Gender Equity andSocial Justice. Bulletin of World Health Organization, 87(6),406.

* Harner, H. M., &ampRiley, S. (2013). The impact of incarceration on women’s mentalhealth: Responses from women in a maximum-security prison.Qualitative Health Research,&nbsp23(1), 26-42.

*Massoglia, M. (2008). Incarceration as exposure: the prison,infectious disease, and other stress-related illnesses.&nbspJournalof Health and Social Behavior,&nbsp49(1), 56-71.

Mignon, S. (2016). Health issues of incarcerated women in the UnitedStates.&nbspCiência &amp Saúde Coletiva,&nbsp21(7),2051-2060.

Moller, L., Fraser, A., Van den Bergh, B. J., &amp Gatherer, A.(2011). Imprisonment and Women’s Health: Concerns about GenderSensitivity, Human Rights, and Public Health. Bulletin of theWorld Health Organization, 89(9), 689-694.

Nijhawan, A. E., Salloway, R., Nunn, A. S., Poshkus, M., &ampClarke, J. G. (2010). Preventative Healthcare for Underserved Women:Results of a Prison Survey. Journal of Women’s Health.19(1), 17-22.

*Plugge, E., Douglas, N., &amp Fitzpatrick, R. (2008). Patients,prisoners, or people? Women prisoners` experiences of primary care inprison: a qualitative study.&nbspBr J Gen Pract,&nbsp58(554),e1-e8.

Sandelwoski, M., Voils, C. I., &amp Barroso, J. (2006). Defining anddesigning mixed research synthesis studies. Research in theSchools, 13(1), 29.

*Schnittker, J., Uggen, C., Shannon, S. K., &amp MCELRATH, S.(2015). The institutional effects of incarceration: spillovers fromcriminal justice to health care.&nbspMilbank Quarterly,&nbsp93(3),516-560.

Sered, S. &amp Norton-Hawk, M. (2013). Criminalized Women and theHealth Care System. Journal of Correctional Health Care,19(3), 164-177.

Shaw, J., Downe, S., &amp Kingdon, C. (2015). Systematicmixed‐methods review ofinterventions, outcomes and experiences for imprisoned pregnantwomen.&nbspJournal of advanced nursing,&nbsp71(7),1451-1463.

*Wilper, A. P., Woolhandler, S., Boyd, W. J., Lasser, K. E.,McCormick, D., Bor, D. H., &amp Himmelstein, D. U. (2009). TheHealth and Health Care of US Prisoners: Results of a National WideSurvey. American Journal of Public Health, 99(4),666-672.

A Meta-Analytic Review of Health Care Problems in Women`s Prisons

  • Uncategorized

AMeta-Analytic Review of Health Care Problems in Women’s Prisons

Tableof Contents

Abstract 3

Introduction 4

Development and significance of the problem 4

Hypotheses 5

Method 6

Sample of studies 6

Selection criteria 7

Data abstraction 8

Results 8

Description and findings of the studies 8

Discussion of results 12

Limitations of the studies 15

Conclusion and recommendations 16

Summary of findings 16

Suggestion for future research 17

Recommendations 18

References 20

Abstract

The steady risein incarceration has a great correlation to the operation ormanagement and quality of the health care strusture, especially inAmerica. States with a high rate of women prisoners showdeteriorations in the general access and excellence of health care.Furthermore, little research has been provided on the health careexperiences or outcomes of the incarcerated women especially giventheir great risk to communicable diseases. It is significant to notethat incarcerated women who are pregnant are predominantlysusceptible to health care problems and are continually marginalized.Numerous health care problems and issues exist in women prison, butgovernment agencies have only managed to provide limited evidence orinformation regarding the prevalence of the problems amongincarcerated women. To offer a broader picture of the problems, asystematic study of 7 articles published between 2008 and 2015 wasundertaken. The meta-analysis confirmed the prevalence of a litany ofhealth care problems in women’s prisons. Besides, the analysisidentified numerous methodological challenges in obtaining andproviding quality and consistent health care to the imprisoned women.

AMeta-Analytic Review of Health Care Problems in Women’s Prisons

IntroductionDevelopmentand significance of the problem

The number of women inmates has continued to increase over the years.Nijhawan et al. (2010) and Shaw, Downe, and Kingdon (2015) point outthat most women in prison facilities are imprisoned for nonviolentcrimes. Most incarcerated females come from socially, financially,emotionally, and educationally underprivileged environments with adisproportionate number of them having undetected health issues andchronic and acute diseases. It is significant to note that femalesentering the correctional facilities are at a high risk of infectiousillnesses, mental health problems, and substance abuse, all of whichrepresent health care issues. Historically, the number of imprisonedmen has far surpassed the number of imprisoned women thus, thecorrectional system has paid inadequate consideration to the uniquehealth concerns of the women. However, with the swelling number offemales entering and departing the correctional system, there is aneed to ensure that the state puts policies in place to effectivelyaddress the current health care problems. Some of the mechanismsinclude equipping the correctional facilities with the rightresources, staff, and information, and offering the incarceratedwomen appropriate and comprehensive health care services.

Hypotheses

Numerous studies especially those conducted by Binswanger, Redmond,Steiner, and Hicks (2012), Moller, Fraser, Van den Bergh, andGatherer (2011), and Plugge, Douglas, and Fitzpatrick (2008) showthat the majority of imprisoned women across the world tend to beyounger than the general populace. The studies further show that mostof these females are of the childbearing age, come from poorbackgrounds, are poorly educated, and have encountered sexual andphysical abuse. It is critical to note that most of these women areincarcerated because of nonviolent wrongdoings especially drug abuse(Gatherer, Moller, Van den Bergh, 2009 Moller et al., 2012). Thismeans that they have a higher prevalence of blood-borne infectionssuch as Hepatitis C and HIV. These women encounter problems whenaccessing health care, for example, stigma, physical isolation,limited access to therapies and medicine, organizational constraints,and interruptions in their therapies when released from the prison.In this regards, study’s hypotheses include

  1. Majority of incarcerated women encounter numerous health care challenges ranging from limited access, high prevalence of communicable diseases and STIs, depression, and lack of maternal care

  2. Most women in prison have encountered a degree of exclusion and stigma when trying to access health care

MethodSampleof studies

It wasproblematic to develop a pertinent procedural strategy to theappraisal process because of the array of organizational andepistemological conventions. After careful consideration, thestrategy proposed by Sandelwoski, Voils, and Barroso (2006) wasutilized. Sandelwoski et al. (2006) propose a mixed approach whereextraction, grouping, and formatting of results are significant inreviewing the studies. The approach was utilized as it provided aneasier framework for accessing and reviewing the studies. Asystematic evaluation of scholarly articles was conducted torecognize and categorize studies that presented the health careproblems of incarcerated women. The meta-analysis comprised articlesthat were issued in English-language, peer-reviewed periodicalspublished between 2008 and 2015. The paper relied on articles thatanalyzed the prevalence of health care problems, the systemavailable, and the estimates of the health care challenges. Inaddition, the analysis focused on articles that unambiguouslyacknowledged the denominator for occurrence magnitudes. However, thepaper included articles that dealt with foreign prisons but with afocus on American prisons and dealt exclusively with diseases presentin prisons.

Reports relatedto health care problems in women’s prisons were retrieved by meansof multiple processes. Computerized databases such as Social ServicesAbstracts, Sociological Abstracts, MEDLINE, PsycINFO, Social WorkAbstracts, Dissertation Abstracts International, and NationalCriminal Justice Reference Service were used. For all the databases,the searched keywords included therapy, prisoners,women prisons, health care, prevalence, drugor substance abuse, incarceration, USA, problems,issues, challenges, diseases, and incidence.KWIC (Key Word in Context) was utilized to test for the consistencyof word usage while word occurrence counts were used to classifywords of probable interest. The articles were then appraised andcoded and their core reports skimmed. The bibliography entries of thearticles and other articles focusing on health care problems inprisons were assessed to retrieve further articles to be reviewed.Journal of Women’s Health, American Journal of PublicHealth, and Journal of Correctional Health Care weremanually searched for the articles. All the articles retrieved fromthe databases and journals were uploaded into EndNotex4 software tosort entries. The initial yielded 250 articles but based on abstractsand titles, 200 articles failed to meet the inclusion criteria. Thefull texts of the remaining articles were scanned and reviewed and anextra 43 studies were omitted based on the outlined exclusioncriterion. Thus, 7 articles were contained within the meta-analysis.

Selectioncriteria

The analysisutilized the following criteria to include articles or studies

  1. The article provided good quality study designed towards exploring incarceration and mental health

  2. The articles were published in English and focused on inmates

  3. The analysis included longitudinal studies that relied on data from reputable sources, for example, government sources, as these studies provided significant information on mental issues in correctional facilities

  4. Studies from outside the US, especially from European countries, were included if they included descriptive statistics and touched exclusively on incarcerated women and their experience on health matters.

  5. The paper excluded articles that provided a systematic analysis, if they failed to present original information, focused exclusively on men’s prisons, selected samples of women facing a single challenge, for example, mental illness, and dealt exclusively with foreign prisons.

Dataabstraction

Theresearcher comprehensively undertook the iterative progress of thesearch strategy. Searches were undertaken and the selected studiesindependently and effectively examined against the inclusion andexclusion criteria. After the 7 studies were picked for analysis anddiscussion, they were tabularized for features and a summary ofresults recorded. The articles were tabulated to reveal the methodused in undertaking each study, the sample used, findings of eachresearch, and the description. The assessment plan helped to developthe line of argument or discussion iteratively.

ResultsDescriptionand findings of the studies

Table 1

Summary of thefindings and study characteristics

Reference

Method

Description

Sample

Findings

Baillargeon et al., 2009

– The study used a surveying unit study of 234,031 inmates in one year

-The study related the incidence of suicide among prisoners with bipolar disorder, major depressive disorder, non-schizophrenic psychotic disorder, and schizophrenia, and

– A sample size of 234,031 people imprisoned in Texas Department of Criminal Justice was used

– The occurrence of disorders varied greatly according to demographics

– Women presented a prevalence of 10.3% while men presented an incidence level of 3.5%

– Women reported zero cases of suicide while men reported 19% cases of suicide

– The prison had a higher rate of disorders than the US population, but they compared to rates in other prison populations

Douglas et al., 2009

– Interviews and focus groups aligned to qualitative study were employed in 2 closed local prisons

– Data was documented, coded, and analyzed thematically

– The study evaluated the perception of female inmates on the implication of incarceration on their health

– The researchers used 6 focus groups and 12 interviews in 2 local English prisoners

-Using purposive sampling, 37 females were recruited

-The researchers conducted 12 individual interviews for 30 to 60 minutes

– A high number of women perceived imprisonment as negatively affecting their health

– Women complained of unhygienic facilities

-To some, prison offered a respite from substance use, social exclusion, poverty, and abuse

Harner and Riley, 2013

– The study focused on how incarceration affects women’s mental health

– Focus groups and descriptive surveys

– Many women who enter prison already suffer from mental illnesses such as PTSD, depression, anxiety, and addiction

– A number of women become mentally ill while in hospital

-Prisons provide a system centered on crisis-aligned model

-Two studies were conducted (a health survey and a focus group)

-In the survey, 900 women partook in the study, but only 450 returned completed the survey. The mean age for the inmates was 38 years and the majority were white (68%). Majority were sentenced for drug-related wrongdoings and murder

– There were 12 focus groups each with 65 women. The mean age was 43 years and the majority were white (62%).

– Majority condemned for murder and drug-related cases

– The study revealed a mixed result regarding the incarceration of women and their mental illness.

– women’s mental illness might improve, stagnate, or worsen when incarcerated

– There lacks a consistent and effective health care system for incarcerated women

Massoglia, 2008

The study utilized data from NLSY (National Longitudinal Survey of Youth) to test more than 20 different indicators of health

– Multiple analytic strategies were employed to develop patterns

-The researcher assessed the correlation between incarceration and health

-The research examined the relationship using data from NLYS

– The study revealed that ex-inmates are more probable to suffer from infectious illnesses and diseases linked to stress

-The study did not observe any association between imprisonment and illnesses unrelated to depression or infectious illnesses.

Plugge et al., 2008

– Interviews and focus groups aligned to qualitative study

– Data was documented, coded, and analyzed thematically

– The study was designed to evaluate imprisoned women’s problems and experiences of health care provision

– 12 semi-structured personal interviews were taken

– The study included six focus groups with 37 women

– Incarcerated women’s view on the quality of health care was mixed

-The majority viewed the quality as poor with lack of confidentiality, difficulty accessing care, and biased and disrespectful treatment.

Schnittker et al., 2015

– The authors utilized a multilevel approach, which involved a cross-sectional specific data and an aggregate analysis

– The study examined the spillover impacts of increased imprisonment levels on the quality and functioning of the America Healthcare structure

-The study addressed between-state dynamism and trends over time in access and utilization of health care

– The study utilized the Community Tracking Study (CTS) to collect data. Each study had at least 37,000 respondents

– The study utilized data from 1996/1997, 1998/1999, 2000/2001, and 2003

– The CTS sample was included in 60 sites

– The study revealed that people living in regions with a great number of former prisoners have less access to health care professionals and care

-The former inmates had less trust in professionals and less contented with the provided care

-The study also revealed that former prisoners have a bigger need for health care and services

Wilper et al., 2009

– The study used the 2002 and 2004 surveys of convicts in resident detentions and state and federal penitentiaries respectively

-The surveys utilized a 2-step sample design. First, prisons were selected and then inmates selected

– The study examined the occurrence of chronic diseases and the access to care and services among inmates

– The researchers chose 301 prisons from 1585 state prisons, but only 287 partook in the study

– 16,152 inmates were indiscriminately chosen, but only 14,499 successfully completed the interviews

– The Census Bureau chose 21 state prisons and the remainder were stratified by survey region

– Three federal prisons were pre-picked and the remaining stratified. From 148 federal prisons, 40 were picked, but only 39 participated.

-Only 3686 inmates completed the interviews from a sample of 4253

– A high number of inmates (40% overall) suffered from chronic diseases

– A small number of inmates were taking psychiatric medication during arrest

-After admission, a high number of patients were taking medication

– Prisons are treating many inmates with mental problems who before admission were off treatment

Discussionof results

The resultsprovided a significant aspect of the health and health care problemsexperienced by incarcerated women. To provide a comprehensiveanalysis of the issues present, the meta-analysis looked at both thehealth problems faced such as depression, HIV, psychotic disorders,infectious diseases, and mental illnesses and health care problemssuch as diminished care, poor hygiene, and biased care. This allowedthe analysis to provide a link between the care and health problems.Furthermore, the analysis of both care and health problems helped inassessing whether the existing health care was effectivelycontributing to the treatment of the diseases.

The analyzedarticles employed different methodologies and hypotheses, but theyall revealed that the existing health care system is notcomprehensive and accommodative to inmates. Baillargeon et al. (2009)employed a surveying cohort study to analyze the occurrence ofsuicide among prisoners. The study conducted a comprehensiveassessment for 234,031 inmates both males and females and revealedthat women (10.3) presented a high rate of disorders occurrence suchas bipolar disorder and schizophrenia than men (3.5%). However, womenhad a zero incidence of suicide against a 19% rate of men. This showsthat incarcerated women are at a great risk of depressive illnessesthan men. The findings from the study compared to data from prisonsacross America, which reveals that most incarcerated women report ahigh incidence level of depression. The cohort study of 234,031inmates provided reliable information on the incidence level andallowed the meta-analysis to include depression and other depressivediseases as major health problems experienced by women.

The studies byDouglas et al. (2009) and Plugge et al. (2008) were conducted inEnglish prisons rather than American prisons, but they provided asignificant situation on the experience of incarcerated women. Thestudies were included as they offered descriptive statistics, dealtwith incarcerated women exclusively, and focused on the healthproblems they faced. Additionally, they helped reveal thedisproportionate treatment of female inmates in countries thatcollaborate with America on criminal justice. Both studies usedinterviews and focus groups to assess the issue. However, Douglas etal. (2009) study looked at women’s perception of imprisonment ontheir health while Plugge et al. (2008) looked at the women’sexperiences. Douglas et al (2009) revealed that women perceivedimprisonment as negatively affecting their health especially giventhe unhygienic facilities in prisons, lack of comprehensive healthcare, and mistreatment by guards and staff. However, women who camefrom poor backgrounds or who had bad experiences of sexual andphysical abuse or chronic abuse of drugs suggested that thecorrectional facilities offered them a respite. Plugge et al. (2008)provided that majority of women perceived correctional facilities asdemeaning with poor health quality, disrespectful and biasedtreatment, lack of confidentiality, and stigma especially with HIV.The two studies show that health care systems do not provide acompassionate and effective environment for prisoners.

Although Wilperet al. (2009) study focused on both females and males, it providedcomprehensive data on the incidence of chronic illnesses in prisons.The study showed that majority of prisoners compared to the generalpopulation suffered from chronic diseases. In addition, only a smallfraction of inmates with chronic illnesses and mental problems weretaking drugs before they were apprehended. However, after admission,prisoners with mental problems were included in the treatment plan.This shows the prisons gave the prisoners psychiatric medicine andbegan treating them, which means that prisons offered care to thementally ill. Using descriptive surveys and focus groups, Harner andRiley (2013) showed that many females who enter correctionalfacilities report at least one mental illness, for example,depression, addiction, major depressive disorder, and PTSD. The studyrevealed that although there lacks an effective and consistent healthcare system in prisons, the mental health of inmates especially thosesuffering from addiction and some form of depression improved.However, some women reported a stagnating or declining mental health,perhaps because the prison environment was too restrictive. Harnerand Riley (2013) and Wilper et al. (2009) studies revealed that mostprisons offer a crisis-aligned model for treating mental problemsthus, the high success rate compared to other health problems.Furthermore, most mentally ill inmates are usually isolated fromother prisoners thus, the high success rate.

Although thestudies by Harner and Riley (2013) and Wilper et al. (2009) showedthat women with mental illnesses reported some improvements while inprison, the same studies suggested that some women developed mentalproblems while in prison. This aspect was supported by Massoglia(2008) study, which revealed that ex-inmates were more probable tosuffer from communicable and stress-related illnesses. The study didnot observe any correlation between incarceration and diseases notrelated to stress or communicable diseases. This showed that therestrictive environment in prison especially for women was acontributing factor to the poor health issues experienced by womenwhile in prison and after their release. Schnittker et al. (2015)reported that former inmates reported diminished care, had less trustin the health care system and medical practitioners, and were lesssatisfied with the care than the general population. Furthermore, thestudy reported that former inmates required greater need for servicesand care because of their experiences in prison in past experiences,for example, drug abuse, sexual abuse, depression, social exclusion,pregnancy, and economic or health deprivation.

Limitationsof the studies

Because of the lack of an extensive literature dealing with healthproblems experienced by incarcerated women, the meta-analysisincluded only 7 studies for the review. The studies employeddifferent methodologies, sample sizes, diagnostic instruments, andstudy designs thus, they did not correlate. Furthermore, they didnot deal with a specific problem, for example, it was problematic todiscover a study focused only on one health problem or health careproblem. Although all the studies used validated instruments for datacollection and analysis, none conducted a clinical review, whichmeans the reported data was from the view of incarcerated women. Thiswas good from the view of the study’s problem, but it inhibited theprovision of a dynamically reliable and unbiased data.

Conclusionand recommendationsof findings

The meta-analysis coded and analyzed 7 studies, which studied thehealth care problems experienced by incarcerated women. However, theanalysis also included studies that dealt with health care system inAmerican prison in general. To draw some comparisons, the study usedarticles that focused on prisons outside America. Plugge et al.(2008) dealt with prisons in Southern England, but it was used as itprovided a critical evaluation of the development and quality ofhealth care and services in two females’ penitentiaries in England.The article focused exclusively on the experiences of imprisonedwomen thus, it was significant to draw a comparison with prisons inUSA and reveal whether the health care problems experienced were aworldwide occurrence. Schnittker et al. (2015) did not focus on thehealth care challenges experienced by women, but it was used as itprovided a comprehensive study on the lives of former inmates. Thestudy revealed that former inmates had trust issues in theprofessionals and health care system, had diminished access to healthcare, and were less satisfied with the offered care. Furthermore, thearticle was used as it provided a large sample size (the CTS used wasin state-level, collected data from 60 sites and at 2 periods and 6stages and each stage had more than 37,000 participants). The articleallowed the study to draw a correlation between the health caresystem in prison and outside since the high level of spillover effectshowed that the US health care system within prisons is notcomprehensive or effective.

It is critical to note that the study focused on health careproblems, but it also focused on the system itself, to determine howthe system reacted to these health care problems and issues. Themeta-analysis showed that mental health is a major health problemacross prisons in America and the rest of the world. Women were foundto present a higher incidence of chronic and depressive illnessesthan men. Previous experiences of the women especially drug abuse andsexual abuse greatly influenced their behavior and health wellbeingwhile at the correctional facilities. From the studies, it wasaccurate to conclusively assert that female inmates experienced amyriad of health problems ranging from depression, communicablediseases, addiction, mental illnesses, and chronic diseases. Thestudies also revealed that the existing health care systems are notcomprehensive or effective enough in the provision of humane andcompassion care to female inmates. The analysis showed that thesystem is too restrictive, lacks enough human and capital resources,is not synchronized effectively with the criminal justice system, andthe existing policies had not effectively addressed the provision ofcare to prisoners.

Suggestionfor future research

Themeta-analysis should have utilized more articles, but the presence oflimited research on the considered problem and tight timeframe meantthat the utilization of 7 articles for the review. However, theanalysis used other studies and articles to support other aspects ofthe study, for example, the existing problem, need for the study, andthe current state of health care system within US prisons. Themeta-analysis should have employed studies that utilized proxyindicators of health care issues, for instance, health care budget inprisons and the development of the problems. The study should haveutilized multiple articles focusing on different prisons across theUS. This would have allowed the analysis to focus on all states,unpublished reports, government publications, and expanded thetimeframe.

Recommendations

From theanalyzed articles, it is critical to note that the US government hasneither comprehensively considered the quality of health care norhealth problems. This scenario as Binswanger et al. (2012), Mignon(2016) and Shaw et al. (2015) point out emanates from the fact thatthere are more men in prisons than women thus, the allocation ofdisproportionate fewer resources in women prisons. Given that the UShas the highest imprisonment rate in the world and the number ofincarcerated women continues increasing, the government shouldallocate more resources to prisons’ health care. Mignon (2016)study reveals that most (95% from a sample of 154 women) women whoare imprisoned report a minimum of one health symptom, for example,dental, menstrual cycle problems, depression, substance abuse issues,and pregnancy. The majority of the incarcerated women report physicalor sexual abuse and given that most come from poor backgrounds or areimprisoned because of drug-related cases, the government needs torestructure the health care system.

Healthinstitutions should conduct a health assessment for all prisonersupon admission. The assessment will allow incarcerated women to bescreened for mental health problems, substance abuse, pregnancy,depression or stress, and chronic diseases. The assessment shouldalso include screening women for other forms of diseases such asSTIS, trauma, and allergies. The health assessment will allow prisonsto develop a health plan for every prisoner and ensure that prisonersreceive medical attention effectively. Schnittker et al. (2015) intheir analysis of the spillover effects of incarceration suggest thatzones with a great figure of former convicts report contracted healthcare, less satisfaction in health care, and a mistrust of health careprofessionals. This shows that prisoners do not have a high regardfor the health care organization because of their experience behindbars (Nijhawan et al., 2010). In this regards, prisons should placewomen offenders in less restrictive correction environmentsespecially those sentenced for petty crimes.

Health care and services should be expanded to serve all offenderseffectively, consistently, and unbiased. The criminal justice systemshould develop mechanisms to ensure pregnant women are notincarcerated unless their pose risk to other people. For example,Sered and Norton-Hawk (2013) suggest that a pregnant woman found inpossession of marijuana should be sentenced to a community-basedsentence or a fine instead of being imprisoned. This approach wouldnot only help in decreasing the high number of incarceration, but itwould also help in advancing health care. Gender-sensitivity trainingshould be offered to prison staff and medical practitioners servingin prisons to improve their relationships with prisoners. Health careand services offered should be restructured to include programs formental patients and the terminally ill. Further, community-alignedtherapeutic programs should be introduced to stimulate society livingfor prisoners. The government should standardize care in the prisonsand develop a multidisciplinary approach in providing psychologicalcare and treatment to people in need of the care.

References

Referencesutilized in the meta-analysis have been asterisked

*Baillargeon, J., Penn, J. V., Thomas, C. R., Temple, J. R.,Baillargeon, G., &amp Murray, O. J. (2009). Psychiatric disordersand suicide in the nation`s largest state prison system.&nbspJournalof the American Academy of Psychiatry and the Law Online,&nbsp37(2),188-193.

Binswanger, I. A., Redmond, N., Steiner, J. F., &amp Hicks, L. S.(2012). Health Disparities and the Criminal Justice System: An Agendafor Further Research and Action. Journal of Urban Health,89(1), 98–107.

*Douglas, N., Plugge, E., &amp Fitzpatrick, R. (2009). The impact ofimprisonment on health: what do women prisoners say?&nbspJournalof epidemiology and community health,&nbsp63(9), 749-754.

Gatherer, A., Moller, L. F., Van den Bergh, B. J. (2009). Women areHealth in Prison: Urgent Needs for Improvement in Gender Equity andSocial Justice. Bulletin of World Health Organization, 87(6),406.

* Harner, H. M., &ampRiley, S. (2013). The impact of incarceration on women’s mentalhealth: Responses from women in a maximum-security prison.Qualitative Health Research,&nbsp23(1), 26-42.

*Massoglia, M. (2008). Incarceration as exposure: the prison,infectious disease, and other stress-related illnesses.&nbspJournalof Health and Social Behavior,&nbsp49(1), 56-71.

Mignon, S. (2016). Health issues of incarcerated women in the UnitedStates.&nbspCiência &amp Saúde Coletiva,&nbsp21(7),2051-2060.

Moller, L., Fraser, A., Van den Bergh, B. J., &amp Gatherer, A.(2011). Imprisonment and Women’s Health: Concerns about GenderSensitivity, Human Rights, and Public Health. Bulletin of theWorld Health Organization, 89(9), 689-694.

Nijhawan, A. E., Salloway, R., Nunn, A. S., Poshkus, M., &ampClarke, J. G. (2010). Preventative Healthcare for Underserved Women:Results of a Prison Survey. Journal of Women’s Health.19(1), 17-22.

*Plugge, E., Douglas, N., &amp Fitzpatrick, R. (2008). Patients,prisoners, or people? Women prisoners` experiences of primary care inprison: a qualitative study.&nbspBr J Gen Pract,&nbsp58(554),e1-e8.

Sandelwoski, M., Voils, C. I., &amp Barroso, J. (2006). Defining anddesigning mixed research synthesis studies. Research in theSchools, 13(1), 29.

*Schnittker, J., Uggen, C., Shannon, S. K., &amp MCELRATH, S.(2015). The institutional effects of incarceration: spillovers fromcriminal justice to health care.&nbspMilbank Quarterly,&nbsp93(3),516-560.

Sered, S. &amp Norton-Hawk, M. (2013). Criminalized Women and theHealth Care System. Journal of Correctional Health Care,19(3), 164-177.

Shaw, J., Downe, S., &amp Kingdon, C. (2015). Systematicmixed‐methods review ofinterventions, outcomes and experiences for imprisoned pregnantwomen.&nbspJournal of advanced nursing,&nbsp71(7),1451-1463.

*Wilper, A. P., Woolhandler, S., Boyd, W. J., Lasser, K. E.,McCormick, D., Bor, D. H., &amp Himmelstein, D. U. (2009). TheHealth and Health Care of US Prisoners: Results of a National WideSurvey. American Journal of Public Health, 99(4),666-672.

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