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Commentary
Improving Health Equity for Women Involved in the Criminal
Legal System
Cynthia A. Golembeski, MPH
a
,
*
, Carolyn B. Sufrin, MD, PhD
b
,
Brie Williams, MD, MS
c
, Precious S. Bedell, MA, CHW
d
, Sherry A. Glied, PhD
e
,
Ingrid A. Binswanger, MD, MPH, MS
f
, Donna Hylton, MA
g
,
Tyler N.A. Winkelman, MD, MSc
h
, Jaimie P. Meyer, MD, MS, FACP
i
a
Rutgers University School of Law and School of Public Affairs and Administration, Newark, New Jersey
b
Johns Hopkins University School of Medicine, Baltimore, Maryland
c
University of California San Francisco, Division of Geriatrics and Amend at UCSF, Francisco, California
d
University of Rochester College of Arts, Sciences, and Engineering, Turning Points Resource Center, Rochester, New York
e
New York University Robert F. Wagner Graduate School of Public Service, New York, New York
f
Kaiser Permanente Institute for Health Research and Chemical Dependency Treatment Services, University of Colorado School of Medicine,
Denver, Colorado
g
A Little Piece of Light, New York, New York
h
General Internal Medicine, Department of Medicine, Hennepin Healthcare. Health, Homelessness, and Criminal Justice Lab, Hennepin
Healthcare Research Institute, Minneapolis, Minnesota
i
Yale University School of Medicine, New Haven, Connecticut
Article history: Received 16 May 2020; Received in revised form 12 June 2020; Accepted 20 June 2020
More than 1,000,000 women in the United States are
currently under supervision of the criminal legal system (CLS),
with the majority on probation or parole.
1
Since 1980, the
number of women in prison has increased by more than 800%,
which is twice the rate of growth for men, whose rates are falling
(Bronson & Carson, 2019). Similarly, the male jail population
decreased by 9% from 2008 to 2018, whereas the female jail
population experienced a 15% increase (Zeng, 2020). Women
involved in the CLS (WICLS) have high rates of mental and
physical health conditions, socioeconomic challenges, and
trauma and violence histories (Meyer et al., 2014;McDaniels-
Wilson & Belknap, 2008;Fedock & Covington, 2017;Sufrin,
2017).
2
These high rates are consequences of pre-incarceration
factors, including poverty, structural racism, and inadequate
health care access; limited jail and prison health care; and the
health impacts of carceral systems themselves (Binswanger et al.,
2012;Cloud, Bassett, Graves, Fullilove, & Brinkley-Rubinstein,
2020;Venters, 2019). Broader efforts to address women’s
health equity should include WICLS, who are often otherwise
excluded from public health programs, policies, and initiatives.
The health and well-being of WICLS may also be adversely
shaped by intersecting forms of oppression, including racism,
poverty, ageism, ableism, homophobia, and sexism. Social de-
terminants of health and CLS involvement include aspects of the
social environment, such as discrimination and income, the
physical environment, and health services. Furthermore,
parenting and reproduction, health care needs as they age, and
reentry challenges of WICLS are underrepresented in current
policy, research, and clinical contexts (Aday & Forney, 2014;
Fedock & Covington, 2017;Sufrin, 2017). These intersectional
forces bear on women and their families before, during, and after
incarceration and may lead to poor health across the lifespan
Dr. Sufrin’s efforts were supported by grants from the National Institute on
Drug Abuse (5K23DA045934-02) and the Society for Family Planning Research
Fund (SFPRF11-09). Dr. Williams’efforts were supported by the National Insti-
tute on Aging of the National Institutes of Health under the Aging Research in
Criminal Justice Health Network (grant R24AG065175) and the University of
California, San Francisco Pepper Center (grant P30 AG044281). Dr. Meyer’s ef-
forts were supported by the Doris Duke Charitable Foundation Clinical Scientist
Development Award (DDCF CSDA).
*Correspondence to: Cynthia A. Golembeski, MPH, Rutgers University School
of Law and School of Public Affairs and Administration, 111 Washington Street,
Newark, NJ 07102. Phone: 347-664-2840.
E-mail address: cag348@rutgers.edu (C.A. Golembeski).
1
Jails are typically short-term holding facilities under local jurisdiction for the
newly arrested, those awaiting trial or sentencing, and those serving short sen-
tences. State or federal prisons are institutional facilities where those who are
convicted serve longer sentences.
2
Women and men involved in the CLS include adults serving sentences in
prisons and jails, awaiting trial or sentencing, and those under community su-
pervision. We try to use person-first and nonstigmatizing or pejorative language
(Broyles et al., 2014;Baggio et al., 2018).
www.whijournal.com
1049-3867/$ - see front matter Published by Elsevier Inc. on behalf of Jacobs Institute of Women's Health.
https://doi.org/10.1016/j.whi.2020.06.007
Women's Health Issues xxx-xx (2020) 1–7
(Hayes et al., 2020;Meyer, 2019a). CLS involvement increases
risk of physical and sexual violence, with direct or indirect health
and health care effects, which impact families and communities
(Brinkley-Rubinstein, 2013;Hatzenbuehler, Keyes, Hamilton,
Uddin, & Galea, 2015;Kajeepeta et al., 2020;Venters, 2019).
We delineate reproductive health and motherhood, aging in
prison, and reentry as critical areas exemplifying women’s
complex health related needs, which may be best addressed via
gender-responsive and trauma-informed care.
3
WICLS have
different experiences and needs in comparison with men
involved in the CLS as well as other women living in the com-
munity without CLS involvement. These complex medical, psy-
chiatric, and social conditions may require dedicated high-
quality, comprehensive, and evidence-based health care in
prisons and jails, which link women to care and support in the
community on release (Meyer, 2019b;Rich et al. 2013). Patient-
centered care is well-suited to address the heterogeneity of ex-
periences, identities, and health conditions and to support
developing well-tailored, structurally competent interventions
and programs for WICLS (Metzl & Hansen, 2014;Meyer, 2019b).
4
Paradoxically, some jails and prisons have become spaces where
women can find health care, which reflects the withering health
and social safety net that fails to advance equity in many of our
communities (Sufrin, 2017).
CLS Involvement and Health Among Women
CLS involvement among women closely affects a broad range
of health outcomes. Women have similar or lower prevalence of
chronic conditions compared to men in the general population,
yet rates of chronic illness and comorbid conditions of WICLS are
higher than other women in the community and men involved in
the CLS (Binswanger, Krueger, & Steiner, 2009). An analysis of
Bureau of Justice Statistics data and nationally representative
cross-sectional data from the early 2000s finds nearly 65% of
women in prison and jail reported having a chronic condition, in
comparison to approximately 50% of men in prison and jail
reporting a chronic condition (Harzke & Pruitt, 2018). Women’s
pathways to being enmeshed in the CLS are often associated with
their relationships, including substance use in dyads, conscrip-
tion or coercion to engage in illicit activity, and intimate partner
violence exposure (Meyer et al., 2014,2017;Jiwatram-Negr
on &
El-Bassel, 2015).
Substance use, psychiatric disorders, and prior exposure to
violence are prevalent among WICLS. According to the Bureau of
Justice Statistics, 69% of women in state prison and 72% of
women sentenced in jail in 2012 met criteria for severe sub-
stance use disorders, which require specialized approaches to
management (Bronson, Stroop, Zimmer, & Berzofsky, 2017).
Similarly, infectious diseases related to injection drug use and
high-risk sex networks, such as HIV and hepatitis C, were more
prevalent than in the general population (Binswanger et al.,
2010;Williams et al., 2013;Meyer, 2019a). Furthermore,
sexually transmitted infection rates were recorded as 10 to 20
times greater relative to women in the community without CLS
experience and, if left untreated, these infections can negatively
impact women’s health (Knittel & Lorvick, 2019;Linder, 2018;
Meyer, 2019b). Thus, the Centers for Disease Control and Pre-
vention issued recommendations to expand sexually transmitted
infection screening and treatment in prisons and jails in 2015
(Centers for Disease Control and Prevention, 2015).
The prevalence of co-occurring psychiatric disorders and
substance use disorders, often associated with trauma,
frequently exceed 75% among WICLS (Meyer et al., 2013;Prins,
2014;Staton-Tindall, Duvall, Leukefeld, & Oser, 2007;
Winkelman, Chang, & Binswanger, 2018). People with severe
psychiatric disorders have high rates of repeated contact with
the CLS, where evidence-based treatment may be lacking,
further contributing to negative psychiatric outcomes
(Baillargeon, Binswanger, Penn, Williams, & Murray, 2009;Glied
& Frank, 2009).
Girls and young women of color are disproportionately
vulnerable to “the sexual abuse to prison pipeline”(Marquardt,
2020). Girls only constitute 20% to 25% of the juvenile CLS pop-
ulation, yet 50% to 66% of those dually involved in juvenile
criminal legal and child welfare systems are girls (Saar et al.,
2015). WICLS contend with violence and trauma history as
prevalent as 95%, including sexual assault and intimate partner
violence (Meyer et al., 2014;McDaniels-Wilson & Belknap, 2008;
Richie, 2012). Nearly 40% of WICLS meet criteria for post-
traumatic stress disorder, and research shows that untreated
posttraumatic stress contributes to women’s distinct incarcera-
tion and recidivism pathways (Baranyi, Cassidy, Fazel, Priebe, &
Mundt, 2018;Fuentes, 2014;Harner, Budescu, Gillihan, Riley, &
Foa, 2015).
Exposure to degradation, body searches, shackles, cell
shakedowns, restraints, and seclusion during incarceration
further compound trauma; in addition, trauma-related symp-
toms may be mistaken for acts of aggression or defiance (Center
for Substance Abuse Treatment, 2014;Kramer & Comfort, 2011;
Fedock & Covington, 2017;Kraft-Stolar, Brundige, Kalantry, &
Getgen, 2011). Prison discipline policies punish women more
harshly than men, including disproportionate isolation for mi-
nor, nonviolent infractions (LaChance, 2018;U.S. Commission on
Civil Rights (USCCR), 2020). Disciplinary record, charges, and
punishment can be associated with gendered charges. Women
with psychiatric conditions are overrepresented in segregation
environments (LaChance, 2018). Staff sexual misconduct, lack of
respect, and potential control of women’s bodies may be
conducive to a lack of safety, abuse, exploitation, and violence
(Owen, Wells, & Pollock, 2017;Rantala, 2018). Violence targeting
transgender women is particularly perilous, given dispropor-
tionate incarceration and victimization risks (Ba
cak et al., 2018).
People who are incarcerated are the only population in the
United States with a constitutional guarantee to health care,
including protection from serious physical and psychological
harm, yet health care standards and practices widely vary
(Dolovich, 2009;Venters, 2019). Estelle v. Gamble established the
constitutional mandate that institutions of incarceration address
“serious medical needs”(Dolovich, 2009). However, there are no
mandatory standards as to what services have to be provided or
what conditions count as serious medical needs. Health care
spending, quality, and organizational structures vary across fa-
cilities where services and practices also vary, particularly for
women’s health within prison and jail contexts designed pri-
marily for men (Pew Charitable Trusts, 2017). Overall, health
3
This article focuses primarily on people whose biological sex is female and
who identify as women (also known as cis-gendered women; however, we
recognize transgender individuals’disproportionate contact with the criminal
legal system and that people, who may not identify as “women”(i.e., trans
men) might have pregnancy and other reproductive health care needs.
4
Metzl and Hansen (2014) introduce “structural competency”: 1) recognizing
the structures that shape clinical interactions, 2) developing an extra-clinical
language of structure, 3) rearticulating “cultural”formulations in structural
terms, 4) observing and imagining structural interventions, and 5) developing
structural humility.
C.A. Golembeski et al. / Women's Health Issues xxx-xx (2020) 1–72
delivery systems within prisons and jails are associated with
various levels of expertise in evaluation, quality improvement,
evidence-based practice, and implementation science (Pew
Charitable Trusts, 2017).
Reproductive Health and Parenting
Approximately 75% of women in state and federal prisons are
younger than 45, so health care needs must address reproductive
health, including family planning care, comprehensive preg-
nancy, birth, and postpartum care, and abortion access (Carson,
2020). Addressing incarcerated women’s health care within a
reproductive justice framework prioritizes health careinequities,
alongside material resourcesdsuch as safe neighborhoods, good
schools, clean water, and just court systemsdneeded to parent
(Hoff et al., 2020;Strickler & Simpson, 2017). Reproductive jus-
tice is an intersectional theory and platform for action that
emerged from and centers the experiences of women of color
and draws on the knowledge of historical legacies in which their
reproduction has been systematically devalued (Strickler &
Simpson, 2017). Three rights are central to achieving reproduc-
tive justice: the right not to have children, the right to have
children, and the right to parent children in dignity and safety.
Incarceration disrupts core reproductive justice tenets, denying
contraception and abortion access and implementing coercive
contraceptive practices, and providing substandard maternity
and postpartum care; and over-investing in systems to confine
people and under-investing in safety net systems (Hayes et al.,
2020).
Menstrual dysfunction is three times higher among incar-
cerated women, of whom 50% lack access to basic menstrual
supplies (Allsworth et al., 2007;Linder, 2018). Only four states
offer free access to menstrual products in prison (Johnson, 2019).
WICLS, in custody and upon release, experience unmet family
planning service needs, including contraceptive access and
counseling (Allsworth et al., 2007;Clarke et al., 2006;Larochelle
et al., 2012). Unlawful sterilization in California prisons as
recently as 2010 runs counter to necessary noncoercive, patient-
centered, reversible contraceptive methods access (Hayes et al.,
2020;Sufrin et al., 2009a). Although incarcerated women
retain their legal right to abortion, many facilities disallow access
(Bronson & Sufrin, 2019;Hayes et al., 2020;Sufrin, Creinin, &
Chang, 2009b).
Nearly 4,000 admissions of pregnant people to prisons and
55,000 to jails occur annually (Bronson & Sufrin, 2019;Sufrin
et al., 2020a). Until 2019, there was limited systematic data
reporting on incarcerated pregnant people and related out-
comes, including births, miscarriages, and abortions. This lack of
data collection and reporting reflects a potential disregard for
incarcerated women’s gender and reproductive specific needs
and the slow pace at which the growing female jail and prison
populations have been addressed. Shackling women in labor in
federal prisons is banned, yet only 29 states have similar laws for
state prisons, which are frequently violated (Goshin, Sissoko,
Stringer, Sufrin, & Byrnes, 2020;Sufrin, 2019;Kuhlik & Sufrin,
In Press). Pregnant people with opioid use disorder may expe-
rience withdrawal, despite this being contrary to standards of
care (Sufrin et al., 2020b). Prenatal care availability and quality
vary considerably, as do policies promoting breastfeeding and
infant bonding for birth while in custody.
Approximately 60% to 80% of incarcerated women have minor
children and most are single parents (Fedock & Covington, 2017;
De Claire, K., & Dixon, L., 2017). Compared with incarcerated men,
women in prisons and jails are five times more likely to have
children placed in foster care (Swavola, Riley, & Subramanian,
2016;De Claire, K., & Dixon, L., 2017). More than one-half of
women in prison are more than 100 miles from home and never
receive children’s visits (Women & Justice Project, 2019). Incar-
cerated parents’children, who may struggle with this separation,
are more than six times more likely to experience incarceration
themselves (Boudin, 2011;Wakefield & Wildeman, 2013).
Notably, women’s removal and return to communities associated
with incarceration can have effects on families and communities
(Boudin, 2011;Fedock & Covington, 2017).
Policy reforms should standardize and expand reproductive
health care scope and quality for incarcerated women, including
comprehensive prenatal, birth, and postpartum care; abortion
and noncoercive contraception access; menstruation manage-
ment; cervical and breast cancer screening, diagnosis, and
management; and pregnancy data collection. Further, training
and oversight will bolster policies in supporting the right to
parent in safety and dignity, alongside alternatives to incarcer-
ation, community health, and economic infrastructure (Hayes
et al., 2020). Lastly, supporting parenting skills along with con-
tact and reunification with loved ones is critical to rehabilitation
and reducing recidivism (De Claire & Dixon, 2017;Fedock &
Covington, 2017;Meyer, 2019b).
Aging
Disproportionate incarceration rates and longer sentences
than men for similar offenses often combine with histories of
violence, trauma, and poverty to compromise the health of older
WICLS. Incarcerated older women experience higher rates of
chronic disease and disability, victimization, and mental illness
in comparison with men involved in the CLS and non-
incarcerated women (Aday & Farney, 2014;Barry, Adams, Zaugg,
& Noujaim, 2020). The proportion of aging women in prison is
growing faster in comparison with men, which is associated with
greater health demands and costs largely owing to increased
comorbidity burden and physical and cognitive disabilities
(Skarupski, Gross, Schrack, Deal, & Eber, 2018). In 2018, nearly
25% of women in state and federal prisons were over the age of
45 (Carson, 2020). Between 1993 and 2013, the number of
women in state prisons age 40 and older increased by more than
300% (Carson & Sabol, 2016).
Geriatric syndromes, including cognitive and functional
impairment, dementia, falls, and incontinence, are present at
higher rates and at younger ages in incarcerated populations
than for nonincarcerated women (Bedard, Metzger, & Williams,
2016;Williams et al., 2006). Jail and prisons’environmental
conditions “designed to restrict the liberty of young people,”
poor lighting and ventilation, inadequate climate control, over-
crowding, and service barriers exacerbate older women’s phys-
ical challenges (Bedard et al., 2016;Aday & Farney, 2014).
Physically demanding work activities lacking modifications for
functional impairments persist and vary across states (Williams
et al., 2006). Additionally, daily living activities while incarcer-
ated are also more challenging for women than men (Skarupski
et al., 2018;Williams et al., 2006). Consequently, many older
women who would be independent in the community are not in
prison (Williams, Goodwin, Baillargeon, Ahalt, & Walter, 2012).
Clinicians working with patients who are incarcerated
oftentimes lack training in palliative care, which is the commu-
nity standard of care for patients with life-limiting or serious
illnesses (Bedard et al., 2016). Additionally, while medical or
C.A. Golembeski et al. / Women's Health Issues xxx-xx (2020) 1–73
“compassionate”release policies exist to allow people of
advanced age or with serious illness to leave prison before they
die, in practice few are released through these mechanisms
(Mitchell & Williams, 2017;Prost & Williams, 2020). As a result,
ideal medical release candidates frequently lack appropriative
assessments and remain unnecessarily confined (Prost &
Williams, 2020). Many older women also experience diffi-
culties and unmet needs around grief and loss as part of traumas
of incarceration, which also include personal, social, and envi-
ronmental deprivations (Aday & Farney, 2014;Aday & Krabill,
2016).
Gender-sensitive, trauma-informed, patient-centered, and
evidence-based geriatric and palliative care standards appro-
priate to carceral environments should be designed to minimize
victimization and injury. Relatedly, improving disability trajec-
tories by mitigating environmental risk factors and reducing
avoidable suffering for women with serious and life-limiting
illness while in prison is key if older women must remain incar-
cerated (Rich, Allen, & Williams, 2015). Older women, in com-
parison with older men in prison and women in the community,
are prone to fewer disciplinary infractions and lower recidivism
rates upon release (Bedard et al., 2016).Reentry supports for aging
women should facilitate securing health care continuity, housing,
employment, and social services. WICLS returning to the com-
munity may experience bias and discrimination associated with
their age, gender, class, race, and criminal records.
States continue to grapple with how to handle the aging
prison population growth. The Centers for Medicare and
Medicaid Services funds a privately owned nursing home facility
contracted by the state of Connecticut, which houses ailing
people in custody. Experts urge repeal of mandatory minimum,
“habitual offender,”and truth-in-sentencing laws and support
interim reform efforts, such as conditional release for aging men
and women in custody who pose little security risk, compas-
sionate release, parole board transparency, and federal aging
prisoner release reauthorization (Mitchell & Williams, 2017;
Williams et al., 2012). Moreover, further research in this area is
needed to improve survey methods, tools, and research to opti-
mally assess the health of older WICLS (Barry et al., 2020;Bedard
et al., 2016;Skarupski et al., 2018;Williams et al., 2012).
Reentry
Nearly 95% of those incarcerated will return to communities
(Hughes & Wilson, 2002). This reentry period is associated with
numerous health challenges, including increased mortality,
psychiatric symptoms, and victimization (Binswanger et al.,
2007,2011;2013,2016;Meyer et al., 2014). During reentry,
women’s high rates of co-occurring conditions can be exacer-
bated by care discontinuities, medication disruption, and inad-
equate insurance (Binswanger et al., 2011;Johnson et al., 2015;
Woods et al., 2019). Common health care barriers include
experienced or anticipated stigma and discrimination, low
health literacy, and difficulties navigating health care systems
(Johnson et al., 2015;Kramer & Comfort, 2011;Winkelman et al.,
2016). Many women return to under-resourced neighborhoods
amidst prevalent poverty, violence, and substance use (Fedock &
Covington, 2017;Golembeski & Fullilove, 2008). Women’s
reentry challenges include greater parental responsibilities, in-
come disparities, housing insecurity, and dependency on part-
ners for subsistence needs (Fedock & Covington, 2017;Johnson
et al., 2015;Western, 2018).
Custody revocation laws and child welfare oversight may
compromise family reunification (Sufrin, 2017). Reentry-related
stressors may lead women to deploy survival strategies,
including transactional sex, associated with recidivism (Kramer
& Comfort, 2011;Richie, 2012). Difficulties securing housing
and employment, plus exposure to potential violence, drug use,
and high-risk survival behavior, can compound trauma
(Binswanger et al., 2014;Jiwatram-Negr
on & El-Bassel, 2015;
Meyer et al., 2014). Women often shoulder greater financial
burdens and family responsibilities than men (Hersch & Meyers,
2018;Richie, 2012). Plus, collateral consequences of incarcera-
tion for women involving health, employment, housing, debt,
civic involvement, families, and communities can reduce op-
portunities to sustain healthy relationships and financial security
(Fedock & Covington, 2017;Hersch & Meyers, 2018;Kirk &
Wakefield, 2018).
Transitions to care outside of jails or prisons have improved
through the establishment of community-based clinics
providing transitional care, including primary care and case
management, as well as peer patient navigators (Binswanger
et al., 2015;Fox et al., 2014;Wang et al., 2010). For instance,
New York’s Women’s Initiative Supporting Health-Transitions
Clinic involves peer health workers in providing treatment and
support to recently released women (Bedell, Wilson, White, &
Morse, 2015;Morse et al., 2017). Cross-agency collaboration,
which incorporates psychological and emotional components
that women need to heal and recover, can facilitate and sustain
integrative continuity of care models that address structural
racism, poverty and trauma histories, and mental and physical
health conditions.
Conclusions
Adverse life events are prevalent among WICLS, who contend
with structural barriers that compromise health and well-being
and facilitate contact with the CLS. Disproportionate health
burdens and barriers to care are associated with syndemic effects
of substance use disorders, plus chronic medical and psychiatric
conditions within the context of racism and gender inequities
(Meyer et al., 2013;Williams et al., 2013). Sexual and physical
violence within the CLS is a serious concern (McDaniels-Wilson
& Belknap, 2008;Venters, 2019). Relatedly, the forced migra-
tion, also known as coercive mobility, of incarceration disrupts
social, family, and sexual networks with secondary effects on
communities (Binswanger et al., 2012;Hatzenbuehler et al.,
2015).
Most national health surveys exclude WICLS, so much is un-
known to researchers and providers about their gender and
reproductive health specific needs. This problem can be reme-
died: experts have developed ethical data collection for public
health surveillance in jails, prisons, and under community su-
pervision (Ahalt, Haney, Kinner, & Williams, 2018;Binswanger
et al., 2019;Sufrin et al., 2019b;Wang, Macmadu, & Rich,
2019).
5
Additional research, clinical, and policy efforts to
address intimate partner violence, trauma, and comorbid health
conditions are needed to improve health equity for WICLS
(Bowen & Murshid, 2016).
The transformative role of WICLS in peer support, research,
service delivery, and policy addressing inequities associated with
5
Data collection purposes include surveillance, health promotion and disease
prevention, healthcare performance and patient value, policy relevance, health
equity, and human rights and legal considerations (Binswanger et al., 2019).
C.A. Golembeski et al. / Women's Health Issues xxx-xx (2020) 1–74
the CLS is widely acknowledged (Bedell et al., 2015;Binswanger
et al., 2015;Epperson & Pettus-Davis, 2017;Kraft-Stolar et al.,
2011;Sturm & Tae, 2017). Moreover, the Share Project, a health
justice initiative, trains patients with incarceration histories,
community health workers, policymakers, and researchers in
participatory research involving a data-sharing platform (Elumn
Madera et al., 2019). Health care providers are uniquely qualified
to improve the health of WICLS via care that is patient-centered,
structurally competent, and sensitive to the complex interplay of
trauma, violence, and co-occurring mental and physical health
conditions (Goshin et al., 2019;Hayes et al., 2020;Metzl &
Hansen, 2014;Morse et al., 2017;Sufrin, 2017).
Decarceration, drug policy reform, and alternatives to incar-
ceration are necessary criminal justice reform efforts, which may
improve health outcomes further upstream and aid women in
addressing underlying challenges while maintaining and
strengthening positive ties to families and communities. From a
systems perspective, it is less costly and disruptive to avoid
incarceration altogether and deliver continuous care in the
community for chronic health conditions including substance use
and psychiatric disorders (Meyer, 2019b). Women have strengths,
needs, risks, and pathways into the justice system that often differ
from men’s(Binswanger et al., 2013;Richie, 2012;Machtinger,
Cuca, Khanna, Rose, & Kimberg, 2015). Gender-responsive,
trauma-informed, strength-based care supports women’s rein-
tegration and recovery. Relevant clinical training, capacity
building, material resources and structural support in commu-
nities are also necessary to sustain such efforts (Machtinger et al.,
2015;Meyer et al., 2017;Binswanger et al., 2014).
Bipartisan criminal justice reform legislation, which includes
improving the health of WICLS, is gaining support. The Second
Chance Act, the Fair Sentencing Act, and the First Step Act of 2018
have been enacted. The Dignity for Incarcerated Women Act,
which focuses on health, visitation, programming, oversight, and
telecommunications, was reintroduced by Senators Elizabeth
Warren and Cory Booker in April 2019. The First Step Act, which
only applies to federal contexts, contains some of the Dignity
Act’s clauses: menstrual product provision, shackling bans, and
incarceration closer to home. Moreover, the proposed 2018
Pregnant Women in Custody Act supports data collection and
reporting on pregnant women, prohibiting restrictive housing
and restraints, and addressing health care needs in federal
prisons. Relatedly, Senators Ann McLane Kuster and Booker’s
proposed Humane Correctional Health Care Act seeks to improve
health care delivery and treatment behind bars (Kuster & Booker,
2019). As a public health community committed to advancing
equity, we must evaluate and support legal and legislative reform
that seeks to improve health care quality and access for this often
overlooked population.
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Author Descriptions
Cynthia A. Golembeski, MPH, is a Rutgers University JD/PhD student who teaches
undergraduate courses in prison with NJ-STEP. She, is a Robert Wood Johnson
Foundation Health Policy Research Scholar. Research interests include criminal
justice/health policy and management, equity, ethics, nonprofit management and
philanthropy, and citizen-state relations.
Carolyn B. Sufrin, MD, PhD, is an obstetrician-gynecologist and medical anthropol-
ogist at Johns Hopkins University. Her work is situated at the intersection of repro-
ductive justice, health care, and mass incarceration, which she examines in her
book, Jailcare: Finding the Safety Net for Women Behind Bars.
Brie Williams, MD, MS, is a professor of medicine at the University of California San
Francisco in the Division of Geriatrics, who integrates a healthcare perspective into
criminal justice reform. She founded Amend at UCSF which draws on public health
to transform prison and jail culture. She also co-directs the Aging Research in
Criminal Justice Health (ARCH) Network funded by the National Institute on Aging.
Precious S. Bedell, MA, CHW, University of Rochester Department of Arts, Sciences
and Engineering and Turning Points Resource Center. Her research interests are
health issues for women in prison, formerly incarcerated individuals, their family
members, and community-based participatory research.
Sherry A. Glied, PhD, New York University Robert F. Wagner Graduate School of
Public Service, is an economist focusing on health care policy and mental health
policy. She has served as Assistant Secretary for Planning and Evaluation in the
Department of Health and Human Services.
Ingrid A. Binswanger, MD, MPH, MS, Senior Investigator, Kaiser Permanente Colo-
rado Institute for Health Research and a physician with the Colorado Permanente
Medical Group, conducts research designed to prevent overdose and improve the
health of populations that interact with the criminal legal system.
Donna Hylton, MA, wrote A Little Piece of Light. she is founder and president of A
Little Piece of Light, Inc., which works to end the criminalization of women and
girls.
Tyler N.A. Winkelman MD, MSc, is Co-Director of the Hennepin Healthcare
Research Institute’s Health, Homelessness, and Criminal Just ice Lab; Associate Di-
rector, Virtual Data Warehouse; a physician with Hennepin Healthcare; and Assis-
tant Professor, Departments of Internal Medicine and Pediatrics at the University of
Minnesota.
Jaimie Meyer, MD, MS, FACP, is Assistant Professor, Yale AIDS Program, and Clinical
Assistant Professor of Nursing. She is a board-certified physician in Medicine, Infec-
tious Diseases, and Addiction Medicine. Her lab studies HIV interventions for
women in criminal legal systems.
C.A. Golembeski et al. / Women's Health Issues xxx-xx (2020) 1–77
