Reproductive health care in New York state prisons: Current conditions and suggestions for improvement

Background and Significance: More than 2,300 women are serving time in New York State prisons, a 510 percent increase since 1973, when the Rockefeller drug laws went into effect. Imprisoned women are typically among the most disadvantaged people in society – overwhelmingly poor, disproportionately women of color, with significant health needs.

Objective: This research assesses the state of reproductive health care for women in New York State prisons.

Methods: We developed an original survey about reproductive health care across the life span, including closed and open-ended questions, for distribution in November 2009 in New York's five all-women's prisons. We also interviewed women and medical staff in prison, reviewed medical charts, and analyzed prison policies and data.

Our primary goal is learning from women about their experiences with reproductive health care. Specific research questions include:

• the relationship between women's assessments of access to and quality of care and official prison policies on reproductive health care • the relationship between professional guidelines and community standards and official prison policies (on frequency of cancer screenings, e.g.) • whether women report differences in access or quality of care across prisons

Results: 351 women completed the survey, representing about 15% of women in custody. The reproductive health survey is one component of a multi-faceted investigation that also includes a survey on general prison conditions, completed by 1,060 women (or 43% of women in custody), and interviews with 651 women between 2010 and 2012. We used SPSS to analyze the data.

Discussion: Our research identified significant problems with access to gynecological care. Women recount challenges from the seemingly banal – such as access to sanitary supplies – to the absolutely critical – such as timely diagnosis and treatment of cancer. Women in disciplinary confinement (a.k.a. solitary confinement) face especially daunting barriers to care, including an almost total lack of confidentiality.

The well-being of women in prison is a vital public health concern, and yet absent from national debates about health care. By illuminating the experiences and perspectives of this group of underserved women, our research creates a knowledge base to evaluate and improve reproductive health policies and services in New York State prisons.