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Health and human rights of women imprisoned in Zambia



The healthcare needs and general experience of women in detention in sub-Saharan Africa are rarely studied and poorly understood. A mixed-methods study was conducted including in-depth interviews with 38 adult female prisoners and 21 prison officers in four Zambian prisons to assess the health and human rights concerns of female detainees. Key informant interviews with 46 officials from government and non-governmental organizations and a legal and policy review were also conducted. Despite special protection under international and regional law, incarcerated women's health needs-including prenatal care, prevention of mother-to-child transmission of HIV, and nutritional support during pregnancy and breastfeeding-are not being adequately met in Zambian prisons. Women are underserved by general healthcare programs including those offering tuberculosis and HIV testing, and reported physical and sexual abuse conducted by police and prison officers that could amount to torture under international law. There is an urgent need for women's healthcare services to be expanded, and for general prison health campaigns, including HIV and tuberculosis testing and treatment, to ensure the inclusion of female inmates. Abuses against women in Zambian police and prison custody, which violate their rights and compromise their health, must be halted immediately.
RESEA R C H ART I C L E Open Access
Health and human rights of women imprisoned
in Zambia
Katherine W Todrys and Joseph J Amon
Background: The healthcare needs and general experience of women in detention in sub-Saharan Africa are rarely
studied and poorly understood.
Methods: A mixed-methods study was conducted including in-depth interviews with 38 adult female prisoners
and 21 prison officers in four Zambian prisons to assess the health and human rights concer ns of female
detainees. Key informant interviews with 46 officials from government and non-governmental organizations and a
legal and policy review were also conducted.
Results: Despite special protection under international and regional law, incarcerated womens health needs
including prenatal care, prevention of mother-to-child transmission of HIV, and nutritional support during
pregnancy and breastfeedingare not being adequately met in Zambian prisons. Women are underserved by
general healthcare programs including those offering tuberculosis and HIV testing, and reported physical and
sexual abuse conducted by police and prison officers that could amount to torture under international law.
Conclusions: There is an urgent need for womens healthcare services to be expanded, and for gen eral priso n
health campaigns, including HIV and tuberculosis testing and treatment, to ensure the inclusion of female inmates.
Abuses against women in Zambian police and prison custody, which violate their rights and compromise their
health, must be halted immediately.
In African countries, female prisoners comprise between
one percent (in Burkina Faso) and 6.3 percent (in
Mozamb ique) of the total convicted population [1]. Like
their male counterparts, women in African prisons fre-
quently face overcrow ded and unsanitary conditions
conducive to poor health a nd the spread of infectious
dis ease [1]. Yet women are also confronted with unique
challengesrelated to menstruation; pregnancy and
childbirth; care for children both inside and outside of
prison; and violence and abuse (including sexual abuse)
by prison officers or male prisoners with whom they are
sometimes held [1]. Women prisoners often have
experienced violence and sexual abuse prior to incar-
ceration, and may suffer from post-traumatic stress dis-
orders while detained [2]. Despite recognition of these
challenges, there has been little r esearch on this popula-
tion to date.
In Zambia, female inmates comprise approximately 1.5
percent of the total prison population, with an estimated
250 female prisoners incarcerated nationwide in March
2011 [3,4]. While o ne of Zambias86prisonsisdedi-
cated exclusively to female inmates, and housed 66
women in March 2011 [4], women live in separate sec-
tions of prisons located throughout the country.
In addition to the international human rights law pro-
tections afforded to all prisoners and all women, female
detainees benefit from special legal protections. African
regional law, for example, provides that women in
detention should be held in an env ironment suitable to
their condition and ensures their right to b e treated
with dignity [5]. The Southern African Development
Community Protocol on Gender and Developm ent,
which Zambia has signed, commits states by 2015 to
ensure the provision of hygiene and sanitary facilities
and nutritional needs of women, including women in
prison [6].
This study examines women prisoners experiences of
imprisonment in Zambia, with particular emphasis on
* Correspondence:
Human Rights Watch, New York, USA
Todrys and Amon BMC International Health and Human Rights 2011, 11:8
© 2011 Todrys and Amon; licensee BioMed Central Ltd. This is an Open Access article d istributed under the terms of the Creative
Commons Attribution License ( .0), which permits unrestricted use, distribut ion, and
reprodu ction in any medium, provided the original work is properly cited.
access to HIV and tuberculosis (TB) prev ention, testing,
and treatment, womens unique healthcare needs, and
treatment in police and prison custody. The main objec-
tive of the investigation was to document and respond
to specific human rights issues, monitor human rights
conditions, and assess human rights protections in Zam-
bian prisons . Analysis of male inmates conditions of
detention and the criminal justice system attributes
leading to their extended detention in Zambian prisons
has been published elsewhere [7,8].
In July 2009, the Priso ns Care and Counselling Associa-
tion (PRISCCA) of Z ambia s ought approval from the
Zambian Ministry of Home Affairs and M inistry of For-
eign Affairs for a mixed-method study of he alth condi-
tions in Zambian prisons. In September 2009 both
Ministries granted permission. Between September 2009
and February 2010, researche rs from P RISCCA, the
AIDS and Rights Alliance of Southern Africa (ARASA)
and Human Rights Watch conducted in-depth inter-
views with female prisoners in four Zambian p risons:
Lusaka Central Prison (Lusaka province), Kamfinsa State
Prison (Copperbelt province), Mumbwa Prison (Central
province), and Choma State Prison (Southern province).
In each prison visit ed, researchers requested from the
officer in charge a private location to conduct inter-
views. Officers identified prisoners w ho were then pro-
vided by researchers with a verbal explanation of the
research (in English or French, and translated into
Bemba, Ny anja, or Tonga if necessary), asked if they
were willing to part icipate, and offered anonymity. Indi-
viduals were assured that they could decline to partici-
pate, end the interview at any time, or decline to answer
any specific questions without negative consequence.
The names of all prisoners who participated in this
study have been changed to protect their anonymity and
security. Responses were recorded in written notes and
all interviews were conduc ted outside of t he hearin g of
prison officers and other prisoners, in a private setting.
recording devices.
Interviews took approximately 45 minutes and were
conducted in En glish or French by f emale researche rs
from one of two organizations (Human Rights Watch or
ARASA) o r in Bemba, Nyanja, and Tonga, with transla-
tion to English provided by members of PRISCCA.
Interviewers used a brief verbal questionnaire to gather
information on the prisoners incarceration h istory,
medical care, and experience of HIV/ AIDS and TB test-
ing and treatment. Researchers then probed responses
and asked further questions regarding prison conditions,
discipline, and HIV/ TB risk behavior in open-ended, in-
depth interviews.
Qualitative prisoner data were hand-coded by the
authors, who conducted a content analysis to identify
key t hemes corresponding to the interview guide, as
well as emergent topics. In the first analysis of the data,
an initial set of codes was generated to capture key con-
structs. Subsequent analyses were undertaken to exam-
ine the consistency of reports across themes and
examine negative evidence [9].
At each facility visited, researchers also requested
interviews with the officer in charge, deputy officer in
charge, medical officer and f emale officer in charge;
additional officers were invited to participate if sufficient
time allowed. Prison officers were provided with an
explanation of the purpose of the study and how the
information obtained would be used; they were given
the opport unity to decline the interview or to end the
interview at any time. Prison officer interviews focused
on HIV and tuberculosis testing and treatment availabil-
ity in the prison, healthcare delivery, deaths in custody,
prison admini stration, prisoner discipline and tre atment,
and prison officers working conditions.
Interviews with key informants from government and
national and international non-governmental organiza-
tions (N GOs) were also cond ucted, prior to and follow-
ing prison-based interviews, to identify salient issues and
probe specific findings raised in the research.
In addition, national legislation and policy governing
the administration of the prison and criminal justice sys-
tems were reviewed. Researchers reviewed all existing
Zambian legislat ion, extracting relevant portions related
to prison administration, criminal procedure, criminal
law, and immigration law. All available national policies
related to HIV/AIDS, health, and prison administration
were also examined.
Human Rights Watch does not generally identify its
work as research, defined as seeking to develop general-
izable knowledge [10]. Rather, its investigations aim to
document and respond to specific human rights issues,
monitor human rights conditions, and assess human rights
protections in Zambian prisons. Each of these purposes is
consistent with what has b een defined as public health
non-research [11] or practice [10]. However, because
public health non-research and practice also raise et hical
and human participant protection issues, all investigations
conducted by Hum an Rights Watch are subject to rigor-
ous internal review, and external ethics and subject-area
experts are consulted when investigations involve particu-
larly difficult settings, populations, or issues. The present
studys methods, and human participant protections asso-
ciated with the research, were reviewed by PRISCCA,
ARASA, and Human Rights Watch prior to undertaking
this study, and all interviewers were trained in human par-
ticipant protection and information security. Following the
interviews, and after initial reports of the study had been
Todrys and Amon BMC International Health and Human Rights 2011, 11:8
Page 2 of 7
released, PRISCCA and Human Rights Watch cont inued
to monitor to ensure no adverse consequences to subjects
from participation.
Thirty-eight adult female p risoners from four Zambian
prisons were interviewed, including 20 convicted, 14 pre-
trial, and four immigration detainees. Their ages ranged
from 22 to 77 years, with an average age of 37 y ears.
Thirty-two of the 38 w omen (84 percent) were of Zam-
bian nationality. Female prisoners interviewed reported
having be en detained at the faci lity at which the y we re
interviewed for an average of nin e months (with a range
from zero to 44 months). Twenty-one (55 percent) of the
women had reached secondary-level education o r higher ,
while six (16 percent) had received no education and 11
(29 percent) had only a pri mary-level education. In addi-
tion, 22 prison officers and 18 Zambian government offi-
cials from relevant ministries were approached for
interviews; one prison officer declined. Twenty-eight
representatives from local and international NGOs a nd
donor governments and agencies were also interviewed.
General Conditions
Women in Zambian prisons live in conditions of severe
overcrowding. Zambian prisons are over 300 percent o f
capacity, and female inmates reported sleeping four to a
mattress, packed together in unventilated cells with
young children and the s ick [12] . As one female inm ate
reported: Our cells are nor mally stuffed. There is no
ventilation, no windows. The sick and healthy are mixed
up. There are those with diarrhea. We are breathing th e
same air [13].
Both prisoners a nd prison officials reported that the
food provided by the government to prisoners is insuffi-
cient and nutritionally inadequate. Prisoners rely on
their relatives to supplement the meager food ra tions or
trade work for food. As o ne fem ale inmate noted,
Some people have no relativesif you have no food,
you are nobody in this place. You can trade a cup of
sugar for work [14].
The Zambia Prisons Service does not provide i nmates
with basic necessities including soap, toothpaste, or sani-
tary pads. As one inmate noted, If others dontbring
them for us, we have nothing. There are lots of people
with no relatives here. They have nothing [14]. Female
prisoners reported that sanitation and hygiene are poor,
and water frequently unclean. It tastes foul, but we drink
it, stated one female HIV-positive inmate [15].
In April 2010 only 14 health personnel served 16,666
prisoners, and of Zambias86prisons,only15hadany
health clinic or sick bay [3]. For those at prisons with-
out a clinicand for those with more serious medical
conditions at those with a clinicaccess to care is con-
trolled by medically unqualified and untrained prison
officers. According to prisoners a nd prison officers, a
lack of adequate prison staff for the transfer of sick
prisoners, inadequate vehicles for transportation and
fuel, and security fears keep inmates from accessing
medical care outside of prisons, in some cases for weeks
after they fall ill. As one inmate reported:
There are delays in getting to the clinic. It depends
not. Sometimes you can go as long as a month wait-
ing to go to the clinic....They don t open the door i n
the cell at night for anything. There are no windows,
no air. Someone who was 28 years old died at night
in my cell and they didnt open the door until the
morning [16].
Pregnancy and women with children
International standards dictate that for women in deten-
tion, there shall be special accommodation for all
necessary prenatal and p ostnatal ca re and treatment
[17]. Zambia Prisons Service policy requires that
Women inmates, including those who are HIV infected,
should receive...[p]rovision of antenatal care services as
offeredtoallwomeninthegeneralpopulation [18].
But although prenatal care i s widely available in the
Zambian general population [19], incarcerated pregnant
women interviewed described inadequate, and in some
cases non-existent, prenatal care. One pregnant woman
reported: I had no initial exam when I came to the
facility, even t hough I am pregnant. There is no special
treatment for pregnant women, I take whatever I can
[20]. Another female inmate, who reported she was six
months pregnant, said:
I have n ot been to the clinic yet, no antenatal care.
I went to the clinic once but was told the nurses
were no t working. Since th en I have not asked. I do
not feel well, lots of ups and downs [21].
For some prisoners, prenatal care existed but did not
meet international standards. The World Health Organi-
zation (WHO) protocol for prevention of mother-to-
child transmission (PMTCT) of HIV not es that [a]ll
HIV-infected pregnant women who are not in need of
ART [antiretroviral therapy for HIV treatment] for their
own health require an effective ARV prophylaxis str at-
egy to prevent HIV transmission to the infant. ARV pro-
phylaxis should be started from as early as 14 weeks
gestation [22]. How ever, one fe mal e prisoner, who was
eight months pregnant, reported:
Todrys and Amon BMC International Health and Human Rights 2011, 11:8
Page 3 of 7
I had VCT [voluntary counseling and testing for
HIV]they tested my b lood again and told me I was
high for ART. I wasntgivenanyHIVdrugstopre-
vent transmission, only folic acid and vitamins [23].
Indeed, there is no PMTCT program under the
prison medical directorate, though PMTCT programs
have been scaled up in recent years in the general
population. The estimated percentage of women in
Zambias general population living with HIV who
received ART for prevention of mother-to-child trans-
mission increased between 2004 and 2007 from 18 to
47 percent [24].
Inadequate nutrition is a serious problem for pregnant
women and women w ith children in prison. Prisoners
across facilities reported that meals consisted of
approximately 400 to 450 grams of maize meal per day
(400 grams of maize meal is equivalent to roughly 1,400
calories [25]), in addition to small quantities of beans
and/or kapenta (tiny fish commonly eaten in Zambia).
Normal-weight pregnant women require between 1,900
and 2, 500 calories per da y during the last six months of
pregnancy for healthy weight gain [26]. Yet there is no
special diet fo r pregnant women or for women who are
Despit e international standards calling for special pro-
visions for children incarcerated with their parents [27]
and Zambian law, which states that, the infant child
[up to age four years] of a woman prisoner may be
received into the prison with its mother and may be
supplied with clothing and necessaries at public
expense [18,28,29], the Prison s Service allocates no
food to children who live with their mothers in prison
facilities. In situations where women are unable to
breastfeed, the prison does not offer infant formula. As
the officer in charge at on e prison reported: Igetno
budget for the children s food, they must eat their
mothers food. They are hungry a lot [30]. As the incar-
cerated mother of a nine-month-old boy said:
My child is not considered for foodI give my share
to the baby, beans and kapentawe each eat once a
day. I am not given any extra food, and no special
him out of my nshima. The baby has started losing
weight and has resorted to breast milk because t he
maize meal is not appetizing [31].
Another female inmate said: I am worried about the
children who are here. There w as a baby w ho died.
They dont pay any particular attention to the children.
They are mixed in with everyone, they donthavetheir
own cell or better food [21].
HIV and TB testing
HIV and TB are major health threats for the entire
prison populationwhen last measured in 1999, HIV
prevalence was 27 percent for the Zambian prison
population, and 33 percent among female inmates [32].
Whereas TB prevalence was estimated to be 0.3 percent
in the Zambian general population in 2009 [33], a 2000-
2001 study i n 13 Zambian prisons estimated the preva-
lence of pulmonary TB to be between 15 and 20 percent
[34]. HIV testing and treatment are offered at six pris-
ons nationwide with the assistance of an NGO, and as
of March 2011, prison-base d TB screening and treat-
ment were offered only at three prisons nationwide as
part of a pilot program. For both diseases, researchers
found that female inmates were less likely to have been
tested than their male counterparts [8].
Female prisoners face potential breaches of consent
with HIV testing. The National HIV/AIDS/STI/TB Pol-
icy requires tha t women co nsidering havi ng a child be
encouraged to seek counseling and testing and ensures
that every pregnant woman has access to HIV/STI
screening and treatment. It does not requi re mandatory
prenat al testing [35]; Zambia Prisons Service policy pro-
hibits compulsory HIV testing [18]. However, interviews
with prison officers suggested that this prohibition was
either not understood or not respected for female
inmates. One prison officer said: For those who are
pregnant, they are tested for HIV....Whether you like it
or not you are tested to prevent transmission to the
baby [36].
Abuse of female inmates in police and prison custody
Female in mates, particularly wome n previou sly held in
police custody, r eported physical and sexual ab use indi-
cative of a widespread and systematic pattern of brutal-
ity. Prisoners repeatedly reported that they were beaten
in police custody in o rder to try to coerce a confession,
often leading to serious injuries. One female inmate
who had previously been held in police custody, said:
When I was in police custody, they beat me, a tor-
ture I have never experienced in my lifetime. They
beat me, undressed me, whipped me. They put
handcuffs on me so hard that the blood couldn t
flow. They turned me upside down and hung me
upside down, with a steel cord between my legs.
They swung me an d beat me. They saw I was crying
and screaming and put a cloth in my mouth to suf-
focate me. I faintedI couldnt handle the pain. They
were abusing me with their l anguage, calling me a
prostitute. They put me somewhere where I couldnt
talk to anyone. They were trying to get me to say
somethingIdont know. They we re just tortu ring
me for four d ays, beating me. A fter, there was lots
Todrys and Amon BMC International Health and Human Rights 2011, 11:8
Page 4 of 7
of blood where I was beaten. My hands were green
and swelling.
They hit me on my ears and face with a metal band.
There were scratches on my face. They said, you
have to give us information about who had killed
the pers on. They tried to find out who had killed
the personIdidntknow.Thepolicearesupposed
to investigate a case, not to torture.
After, they were scared to take me to a doctor
one month, when the swelling was down. When I
went to the doctor, the police [officer] followed me
into the doctorsroomandlistenedtome.The
police told the doctor th at I was lying. Just a simple
torture that she was given, not much, he said [13].
Several female detainees reported that police officers
tried to coerce them into sex in exchange for their
release. One female prisoner who had been detained in
police custody reported:
They arrested and they b eat me, a sking questions.
They beat me up when I said I didnt know any-
thing. They said, we want you to say this, then we
will let you go. They didnt s exually abuse me, but
they asked me to have sex with them. They said
they would release me if I did, and I said no [37].
Female inmates also reported particularly brutal forms
of punishment that they were subjected to once incar-
cerated in prisons. Women in prison were subjected to
beatings by their fellow inmates at the instigation of the
When I arrived h ere, the officers shouted to the
inmates to say, the woman coming is a witch, a
murdererdeal with her! Shouting you witch, you
murderer, they rose up, hitting me. The officers just
watched. My injuries we re largely bruises and swel-
lings on my arms where I was beaten....I f elt humi-
liated and dehumanized to the extent that I almost
committed suicide. I couldnt bear it [38].
Reported another female inmate:
Truthfully, each officer has her own problems.
Some are harsh, some dont accommodate us. To
tell the truth, we were told to say that there are no
problems, but each has their own problems. They
beat and shout at us, so we cant share a probl em
they are not approachable....They degrade us, shout,
call us names, make reference to the fact that we are
criminals [31].
In addition to beatings, at one prison, female prisoners
reported sexual humiliation as punishment. Prisoners
reported being stripped naked, smeared with mud, and
placed in the direct sunlight of the pri son central court-
yard to be view ed by al l female prisoners for an entire
punishment as aimed at humiliating or insulting our
personality and asked: How can they make me strip
naked before younger women who could be my daugh-
ter, without taking to consideration how I would feel as
a woman, as a mother? [38]
Further forms of sexual humiliation and verbal abuse
exist for female inmates. One inmate reported that as
punishment, the of ficers may put the inmate into the
center of a c ircle of the other prisoners at bath time,
where each
showers insults at her, calling her the
names of private parts [15].
Female prisoners also reported feeling abused b y rou-
tine strip searching by officers. Inmates reported that
they were strip searched, both when returning from
court, a nd at regular interv als in the cells themselves.
Multiple inmates reported the shame involved. Ifeel
grieved about i t,onesaid,IevenpraytoGodthatI
can just die. The pain and shame is too tough to bear
[38]. In one instance, researchers received a report from
a prisoner that a body cavity search for all female
inmates was carried out with a single pair of gloves [13].
This study is the first indepe ndent resea rch conducted
on issues related to the health and human rights of
female detainees in Zambian prisons. Our findings indi-
cate that b oth the healthcare available to and the abuse
endured by women in detention in Zambia violate inter-
national human rights law. Women i n Zambian prisons
are not provided with healthcare services to address
their specific health needs, and are underserved by t he
HIV and TB testing which does exist.
While there has been relatively little research con-
ducted to date addressing the distinct healthcare needs
faced by women in detention worldwide [2,39,40], and
even less in Africa, news accounts suggest major pro-
blems, including: poor conditions and no medical care
for women detained in a Sudanese prison [41]; physical
abuse against women in a Mauritius prison [42]; and
rape and sexual violence against female detainees by
male inmates in the Democratic Republic of the Congo
Understanding t he human rights abuses impacting
female prisoners health in incarceration facilities is key
to devising appropriate, effective services for this popu-
lation, and may become increasingly important i n com-
ing years: Female prison populations have increased in
Todrys and Amon BMC International Health and Human Rights 2011, 11:8
Page 5 of 7
both absolute numbers and in proportion to the male
population in some countries recently [44].
Under international human rights law, people in
detention retain their human rights and fundamental
freedomsaside fr om such res trictions on their rights as
are required by the fact of incarceration [17,45,46] and
except as necessary for the justifiable segregation or the
maintenance of discipline [17]. States have an obligation
to ensure medical care for prisoners at least equivalent
to that available to the general population [47-49]. The
current lack of access to health careevidenced by the
lack of facilities in Zambian prisons and the evaluation
of medical needs by untrained and unqualified guards
falls far below the equivalent standard of available treat-
ment in the community. Further, the Convention on the
Elimination of All Forms of Discrimination a gainst
Women obligates states to ensure to all womenin and
outside of prisonappropriate services for pregna ncy,
including adequate nutrition [50].
Respecting female detainees humanrightsisalso
esse ntial to preventing abuse and ensuring the health of
female detainees. The most fundamental protection for
detainees is the absolute prohibition on torture, inhu-
man or degrading treatment or puni shment. In additio n
to being a well -established norm of internatio nal law by
which Zambia is bound, the prohibit ion is also reflected
in the Zambian Constitution and in several of the
human rights treaties to which Zambia is a party
[47,48,51,52]. Yet the physical abuse suffered by Zam-
bian female detainees in police and prison custody vio-
late nation al a nd i nternational law prohibitions o n
torture or cruel, inhuman or degrading treatment or
punishment, as well as having negative consequences for
their health.
There were several limitations to our research.
Women prisoners in only four of 86 prisons nationwide
were interviewed, and the recruitment of prisoners
required cooperation o f prison officers. Researchers did
not have access to the one female prison in Zambia, and
so were restrict ed to interviewing female detainees held
interviews took place were participating in an ongoing
HIV prevention program run by a non-governm ental
organization (PRISCCA), and subject to visits by NGO
staff, conditions may have been better than in prisons
not participating in the program. S imilarly, the selection
of prisoners by prison officers likely biased t he sample
to healthy prisoners not currently in punishment cells,
who were possibly more likely to portray prison staff
and conditions in a positive light.
However, using mixed-method approaches and trian-
gulating informat ion from prisoners with in-depth inter-
views with prison officers and NGO and government
representatives strengthened our confidence in our main
findings. Even if our results suggest more positive condi-
tions than those experienced by a more representative
sample of female Zambian prisoners, the findings iden-
tify serious human rights abuses and failures to provide
healthcare that compel further investigation, monitoring
and response by the Zambian government.
Although women detainees are entitled to protection
under international human rights law and enjoy specific
protections under regional human rights standards, in
Zambia, incarcerated womens specific health needs are
not being met, and they are underserved by general health
services. There is an urgent need for he althcare services
targeted to female inmates, including prenatal care, to be
expanded, and for general prison health campaigns includ-
ing HIV and TB prevention, testing and treatment to
include women pri soners. Abuses against women both in
police and prison custody which violate their rights and
compromise their health must be eliminated.
The authors would like to thank Godfrey Malembeka, Michaela Clayton,
Kathleen Myer, Megan McLemore, Rebecca Shaeffer, Darin Portnoy, Chris
Mumba, Nyaradzo Chari-Imbayago, Kelvin Musonda, Shadreck Lubita,
Rodgers Siyingwa, and George Chikoti for support in data collection and
This research was funded by Human Rights Watch and the AIDS and Rights
Alliance for Southern Africa, both independent, non-governmental
organizations, as well as the Bernstein fellowship program at Yale Law
Authors contributions
KWT and JJA conceived the study. KWT led the field research and KWT and
JJA drafted the manuscript. Both authors read and approved the final
Competing interests
The authors declare that they have no competing interests.
Received: 15 October 2010 Accepted: 22 June 2011
Published: 22 June 2011
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Cite this article as: Todrys and Amon: Health and human rights of
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Todrys and Amon BMC International Health and Human Rights 2011, 11:8
Page 7 of 7
... Zambian news reporting in 2014 also reported that conditions for pregnant women, mothers and children in prisons were not safe [34]. In 2011, Todrys and Amon [35] conducted in-depth interviews with 46 key informants (government and NGO), 38 adult female prisoners and 21 prison officers in four Zambian prisons (Lusaka Central, Kamfinsa State, Mumbwa, and Choma State), in order to assess perspectives on the health and human rights concerns of female prisoners. Their general conclusion was that: "women in Zambian prisons live in conditions of severe overcrowding. ...
... Their general conclusion was that: "women in Zambian prisons live in conditions of severe overcrowding. Zambian prisons are over 300 percent of capacity, and female inmates reported sleeping four to a mattress, packed together in unventilated cells with young children and the sick" [35]. A later qualitative study by Topp et al. in 2016 in four Zambian prisons (23 female prisoners and 21 prison officers) reported some improvement but with variations in levels of overcrowding in cells across sampled prisons [36]. ...
... There were many reports of the accommodation of women with their children in inhumane, poorly sanitised, ventilated, and in unhygienic conditions across the SSA region [21,33,35,36,44,47,48,[50][51][52][53][54][55][56][57]. More than half of the 27 SSA countries where literature was available, reported poor sanitation in prisons, with little change since 2001. ...
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Background In recent times, sub-Saharan African (SSA) prisons have seen a substantial increase in women prisoners, including those incarcerated with children. Methods A scoping review mapped what is currently known about the health situation and unique rights violations of children incarcerated with their mothers in SSA prisons. A systematic search collected and reviewed all available and relevant published and grey literature (2000–2018). Following application of exclusion measures, 64 records remained, which represented 27 of the 49 SSA countries. These records were charted and thematically analysed. Results Four main themes were generated as follows: 1) the prison physical environment; 2) food availability, adequacy and quality; 3) provision of basic necessities and 4) availability and accessibility of health services for incarcerated children. Conclusions The review highlights the grave situation of children incarcerated with their mothers in SSA prisons, underpinned by the lack of basic necessities, inadequate hygiene, sanitation and safe drinking water, exposure to diseases in overcrowded cells, inadequate nutrition, lack of provision of clothing and bedding, and difficulties accessing paediatric care. Reported paediatric morbidity and mortality associated with such prison conditions is deeply concerning and contrary to international mandates for the rights of the child, right to health and standards of care. Electronic supplementary material The online version of this article (10.1186/s12914-019-0194-6) contains supplementary material, which is available to authorized users.
... Former researchers notice the lack of provision of adequate clean and warm baby clothes in Cameroon, Ethiopia, Kenya, Malawi, Mozambique, Namibia, Sierra Leone, Somalia, South Africa, Tanzania, Zambia, and Zimbabwe [13]. The situation is opposite to what is done in Zambia where "the infant child up to age four years residing with their mothers in prison may be supplied with clothing and necessaries at the public expense [14]. We send for Burundi to follow the example of Zambia and accomplish the requirements of the African Charter on the Rights and Welfare of the child. ...
... 31 Additionally, women are exposed to sexual abuse while in custody and they have more access barriers to HIV prevention, testing and treatment services compared with men. 32 Despite the very high rates of HIV in this group, relative to the study done by Simooya et al in 1999, which showed a prevalence of 33% in females, the prevalence of HIV has reduced. 33 There has been a 37.6% reduction in overall prevalence of HIV since the study in 2010-2011. ...
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Objective To determine the prevalence of tuberculosis (TB) and HIV in 13 Zambian correctional facilities. Methods Cross-sectional study. Setting 13 correctional facilities in seven of the 10 provinces in Zambia. Participants All incarcerated individuals were eligible for TB and HIV screening and testing. Of the total study population of 9695 individuals, which represent 46.2% of total correctional population at the beginning of the study, 8267 and 8160 were screened for TB and HIV, respectively. Interventions TB and HIV screening and testing was done between July 2018 and February 2019. Primary outcome measures All forms of TB, bacteriologically confirmed TB, drug-resistant TB, HIV. Results Prevalence of all forms of TB and bacteriologically confirmed TB was 1599 (1340–1894) per 100 000 population and 1056 (847–1301) per 100 000 population, respectively. Among those with bacteriologically confirmed TB, 4.6% (1.3%–11.4%) had drug-resistant TB. There was no statistically significant difference in the prevalence of all forms of TB, bacteriologically confirmed TB and drug resistant TB between adults and juveniles: (p=0.82), (p=0.23), (p=0.68) respectively. Of the bacteriologically confirmed TB cases, 28.7% were asymptomatic. The prevalence of HIV was 14.3% (13.6%–15.1%). The prevalence of HIV among females was 1.8 times the prevalence of HIV among males (p=0.01). Conclusion Compared with the study in 2011 which screened inmates representing 30% of the country’s inmate population, then the prevalence of all forms of TB and HIV in correctional facilities has reduced by about 75% and 37.6%, respectively. However, compared with the general population, the prevalence of all forms of TB and HIV was 3.5 and 1.3 times higher, respectively. TB/HIV programmes in correctional facilities need further strengthening to include aspects of juvenile-specific TB programming and gender responsive HIV programming.
... 36 Therefore, researchers have provided recommendations for improving the nutritional care of incarcerated pregnant women in accordance with the guidelines provided by the Academy of Nutrition and Dietetics. 36,69,70 In this way, the limited opportunity of imprisonment can be used to provide nutritional education to this population in order to have benefits beyond imprisonment. In another study which examined low birth weight (LBW) and fetal death rates for women incarcerated during pregnancy, it was concluded that the role of nutrition in promoting health and improving the consequences of pregnancy in female prisoners is very important basic principle. ...
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Background: With increasing the number of female prisoners, it seems necessary to follow up the conditions of pregnant women in prison in order to identify their needs and provide healthcare and social services to improve their health, accordingly. Therefore, a systematic review was conducted to examine the needs of incarcerated pregnant women. Methods: In this systematic review, the search was conducted in databases including PubMed, Scopus, Web of Science, EMBASE، PsycINFO, and the Cochran Library. All studies including cross-sectional, retrospective, and prospective cohorts well as case series, which addressed the needs and expectations of incarcerated pregnant women, were included in this review. The retrieved articles were independently evaluated by two reviewers, and the discrepancies were discussed and a consensus was achieved. Results: A total of 31 eligible studies consisting of 6020 incarcerated pregnant women were included in the review. The needs of incarcerated pregnant women embraced six general categories: healthcare needs including prenatal, labor, delivery, and postpartum services; educational needs on pregnancy, childbirth, and parenting; the support needs to be provided by government agencies, social workers, and doula services; the need for psychological counseling services; nutritional needs during pregnancy, and the needs related to the substance abuse management. Conclusion: The needs of incarcerated pregnant women included healthcare, educational, supportive, counseling, and nutritional needs as well as the needs related to the substance abuse management. Identifying these needs can be useful in developing accurate and appropriate policies and programs to promote the health status of this vulnerable group. Key Words: Need Assessment, Pregnancy, Prison, Women
... While the reasons for this are unknown, it may be explained by higher background HIV and depression prevalence among women in the general population [56], by factors associated with both HIV and incarceration, such as sex work, or that incarcerated women come from the most marginalized segments of society, and thus face disproportionately higher risk of HIV and MHDs. Further, due to their relatively small numbers, women may be deprioritized in the planning and resourcing of correctional health services resulting in critical access barriers not experienced by men [57,58]. ...
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Purpose: Despite evidence of disproportionate burden of HIV and mental health disorders among incarcerated people, scarce services exist to address common mental health disorders, including major depressive and anxiety disorders, post-traumatic stress disorder, and substance use disorders, among incarcerated people living with HIV (PLHIV) in sub-Saharan Africa (SSA). This paper aims to summarize current knowledge on mental health interventions of relevance to incarcerated PLHIV and apply implementation science theory to highlight strategies and approaches to deliver mental health services for PLHIV in correctional settings in SSA. Recent findings: Scarce evidence-based mental health interventions have been rigorously evaluated among incarcerated PLHIV in SSA. Emerging evidence from low- and middle-income countries and correctional settings outside SSA point to a role for cognitive behavioral therapy-based talking and group interventions implemented using task-shifting strategies involving lay health workers and peer educators. Several mental health interventions and implementation strategies hold promise for addressing common mental health disorders among incarcerated PLHIV in SSA. However, to deliver these approaches, there must first be pragmatic efforts to build corrections health system capacity, address human rights abuses that exacerbate HIV and mental health, and re-conceptualize mental health services as integral to quality HIV service delivery and universal access to primary healthcare for all incarcerated people.
... However, a study in Brazil found that time spent in prison increases the risk of contracting TB for women [10]. For example, in Zambia, TB screening rates among female prisoners are lower than those of their male counterparts [11,12]. The proportion of minors (less than 14.80% and 8.90%) in these prisons has increased compared to the national average which according to this report of the INS in 2014 in Cameroon estimated at 2.3%. ...
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This paper seeks to provide a scoping review of international conventions and policies tackling health and nutrition from a human rights angle as well as studies assessing health security, nutrition status and adequacy of diet in prisons through a selective bibliography from several countries representing different economical statuses, ethnicities, cultures, judiciary structures, and health systems. The review highlights the influence of social factors in prisons with regards to food security, fulfilment of basic nutrition and health rights, weight status in prison, quality of diet, and medical nourishment therapy. The review concludes that women and children in prisons often suffer from inadequate nutrition and health services. In comparison between countries, under-developed countries seem to offer poor health and nutrition services in prisons. Further research should be undertaken, especially in the geographical areas that were not covered in available literature, such as the Middle Eastern and North African regions, to establish whether human rights standards and international policies pertaining to health and nutrition are applied in prisons in these regions. It would also be interesting to develop a complete and reliable verified tool designed to assess individuals in detention while taking into consideration human rights, social, nutrition, and health determinants.
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Zimbabwe has successfully reduced its HIV prevalence rate and AIDS-related deaths in recent years, but women, particularly those who are in prison, remain at high risk. Poor prison conditions, discrimination, stigma, and the neglect of the sexual and reproductive health of women prisoners living with HIV result in poor health outcomes for women prisoners. Inadequate and inappropriate health provision in prison is a breach of their human rights and a public health problem. This paper analyzes the political commitment of Zimbabwe to address the underlying determinants of health by incorporating into its health laws and policies measures that promote the health rights of women prisoners living with HIV.
Prisons signify different things in different cultures in Africa and around the world. In a legal context, prison is synonymous with confinement and justice, but its socio-medical implications must also be recognized. This chapter is a critical examination of the impact of prison confinement on the mental health and social well-being of female prisoners in Africa. A postcolonial analytic approach is used to explore the historical, social, and particular ideology of the prison system and the institution’s ability to serve justice and promote mental health at the same time as it utilize deprivation, constraint, and control as forms of punishment. Narratives and prison studies literature on incarcerated women’s experiences in African prisons were examined to identify the origin and constructs of prisons in Africa. The intersections of gender, health, and socioeconomic realities of African female prisoners are explored via three themes: the construction of womanhood in African societies, factors that predispose women to crimes or criminal actions, and the negative social and mental effects of incarceration on female prisoners in African prisons. The chapter argues that the “correctional” functions of prisons
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Although HIV and tuberculosis (TB) prevalence are high in prisons throughout sub-Saharan Africa, little research has been conducted on factors related to prevention, testing and treatment services. To better understand the relationship between prison conditions, the criminal justice system, and HIV and TB in Zambian prisons, we conducted a mixed-method study, including: facility assessments and in-depth interviews with 246 prisoners and 30 prison officers at six Zambian prisons; a review of Zambian legislation and policy governing prisons and the criminal justice system; and 46 key informant interviews with government and non-governmental organization officials and representatives of international agencies and donors. The facility assessments, in-depth interviews and key informant interviews found serious barriers to HIV and TB prevention and treatment, and extended pre-trial detention that contributed to overcrowded conditions. Disparities both between prisons and among different categories of prisoners within prisons were noted, with juveniles, women, pre-trial detainees and immigration detainees significantly less likely to access health services. Current conditions and the lack of available medical care in Zambia's prisons violate human rights protections and threaten prisoners' health. In order to protect the health of prisoners, prison-based health services, linkages to community-based health care, general prison conditions and failures of the criminal justice system that exacerbate overcrowding must be immediately improved. International donors should work with the Zambian government to support prison and justice system reform and ensure that their provision of funding in such areas as health services respect human rights standards, including non-discrimination. Human rights protections against torture and cruel, inhuman or degrading treatment, and criminal justice system rights, are essential to curbing the spread of HIV and TB in Zambian prisons, and to achieving broader goals to reduce HIV and TB in Zambia.
Qualitative Data is meant for the novice researcher who needs guidance on what specifically to do when faced with a sea of information. It takes readers through the qualitative research process, beginning with an examination of the basic philosophy of qualitative research, and ending with planning and carrying out a qualitative research study. It provides an explicit, step-by-step procedure that will take the researcher from the raw text of interview data through data analysis and theory construction to the creation of a publishable work. The volume provides actual examples based on the authors' own work, including two published pieces in the appendix, so that readers can follow examples for each step of the process, from the project's inception to its finished product. The volume also includes an appendix explaining how to implement these data analysis procedures using NVIVO, a qualitative data analysis program.
Jeremy Sarkin, editor of Human Rights in African Prisons, is a visiting professor of human rights at Fletcher School at Tufts University, United States, and senior professor of law at the University of the Western Cape in Cape Town. He has utilized essays on the topic written by pan-African scholars and other experts to constitute the book. Among them is Ghana-born attorney Victor Dankwa, the former chair of the African Commission on Human and Peoples’ Rights. As an Oxford- and Yale-educated lawyer and a former law professor, Dankwa was the first special rapporteur on prisons and conditions of detention in Africa. This publication is a collection of essays that chronicle the circumstances of African prisons and an examination of how various agencies have handled such modalities as pretrial detentions, general healthcare, lack of space (overcrowding), and the circumstances of imprisoned women and youngsters. All the contributors deal with areas in which they specialize. For example, of the ten chapters, Dankwa discusses overcrowding in African prisons, and causes and measures for amelioration, and offers a conclusion, with guidelines and solutions. An area about which international bodies like Amnesty International and the International Red Cross have often had concerns is that of pretrial detention and human rights, especially since these organizations hold that one is innocent until properly tried and convicted. Attorney Martin Schonteich, a senior legal officer of national criminal justice reform at the Open Society Justice Initiative of New York, wrote the essay for chapter 5 of the book, which deals with pretrial detention in the context of human rights. The issue of children in African prisons, chapter 6 of the publication, was contributed by law professor Julia Sloth-Nielsen of the University of the Western Cape in South Africa. To provide an overview of the imprisonment of women across the African continent, Johannesburgbased senior policy analyst Lisa Vetten provided chapter 7, “The Imprisonment of Women in Africa,” which spells out the logistics of imprisoning women. Topics also present in the edited volume are a brief history of human rights in prisons of Africa (chapter 2, by Stephen Pete); challenges to good prison governance in Africa (chapter 3, by Chris Tapscott); rehabilitation and reintegration in African prisons (chapter 8, by Amanda Dissel); alternative sentencing in Africa (chapter 9, by Lukas Muntingh); and the African Commission’s approach to prison (chapter 10, by Rachel Murray). The first chapter, written by Sarkin, gives an overview of human rights in prisons worldwide, which discusses the importance of prison research, why the edited volume was produced, the historical context of the book, resources that are available, prison governance, and prison reform in general in African countries; its conclusion provides useful suggestions, and a reminder that “prisons have always been a key focus of those interested in human rights, the rule of law, and a host of other matters” (chapter 1). To assist general readers and researchers, the book contains several useful tables (page viii); acknowledgments (p. ix); and a glossary of acronyms and abbreviations (page x). Useful information is provided by each contributor, who ends each essay with suggestions for future research and facts that can be probed further by others. References supporting the contents of the book are found on pages 226–244, and pages 247–254 constitute the book’s index.
Inmate populations include a large number of individuals at risk of HIV infection. However, there is insufficient data about HIV/AIDS epidemiology in prisons. Our study, conducted in Zambia, a sub-Saharan African nation with an estimated HIV prevalence of 19% in adults, was designed to address this shortfall.
Document collected by the University of Texas Libraries from the web-site of the Reseau Documentaire International Sur La Region Des Grands Lacs Africains (International Documentation Network on the Great African Lakes Region). The Reseau distributes "gray literature", non-published or limited distribution government or NGO documents regarding the Great Lakes area of central Africa including Rwanda, Burundi, and the Democratic Republic of Congo. UT Libraries
The needs of women held in detention have received little attention and con-tinue to be neglected by health systems and prison authorities. One reason for this, too readily accepted until now, is that women prisoners are a clear minor-ity group within prisons all over the world. It is only recently that attention has been drawn to the fact that a minor-ity status does not justify the widespread ignorance of women’s basic rights and the considerable gender insensitivity still dominating criminal justice systems.In Europe alone, there are about 100 000 women and girls in prison.