A Trying Transition

Female inmates have unique health care challenges that often persist as they reenter their communities. A fast-growing part of today’s prison population, women often confront a history of addiction, domestic abuse, and sexual violence, all compounded by the trauma of prison life. Gloria Bachmann NCAS’70, RWJMS’72, associate dean of Women’s Health at Rutgers Robert Wood Johnson Medical School and co-director of the school’s Women’s Health Institute, is the medical director of New Jersey’s Commission on Reentry Services for Women. The commission, created by the State Legislature in 2020, evaluates what women face in health care, employment, domestic life, and housing as they attempt to make the transition from prison and provides solutions and services.

What does the commission want to accomplish?
The commission seeks to identify physical and psychological hardships endured by women while incarcerated that may impede their successful reentry into society; identify services that are necessary for successful reentry; and propose solutions to any obstacles they might have in obtaining those services.

I was asked to lead the commission’s health committee, which is addressing the physical and mental health care needs for women who either are incarcerated, about to reenter society, or have reentered society. We want to bring dignity to individuals and promote ways that the health care team can enhance their health and wellness. I have experience caring for incarcerated patients and know there is so much more we could do.

What are the most pressing needs of incarcerated women?
Women who have been in prison have more health issues than women in the community and therefore need more focused and comprehensive care. Published data on more than 1,000 recently released women indicated that nine in 10 suffered from diagnosed health conditions requiring active treatment and management. Two-thirds of those women reported having been diagnosed with a physical health condition that can be classified as chronic, such as asthma, diabetes, cancer, hepatitis, sexually transmitted diseases, tuberculosis, and HIV/AIDS, which means they need long-term care. They also have a higher rate of stroke.

Since so many had trauma pre-incarceration and because incarceration itself is traumatic, many have mental health issues such as anxiety, depression, or post-traumatic stress disorder. One survey found that approximately two-thirds had abused substances in the six months leading up to incarceration. In addition, many have dealt with poverty, intimate partner violence, and structural racism. Those who are LGBTQ+ might have been disowned by their families and have had food and housing insecurity. It is important that these women receive trauma-informed care that takes these stressors into account.

What issues are the commission addressing?
Since prisons have been set up for men, prison systems might not consider women’s issues like pregnancy, painful menstruation, breast cancer, or the quality and quantity of hygiene products given to female prisoners. In addition, more than 60 percent of women in state prisons have a child under 18, so we need to look at how childbirth occurs for female prisoners, the amount of time allowed for a mother to bond with a child she had while incarcerated, and how technology can be used for visitation/rooming in with a child. We also are investigating what additional testing is needed and what should be included in their wellness visits for both their physical and mental health, both while incarcerated and upon reentry.

What changes should be made in the health care system to help women reentering society? 
Many clinicians incorrectly assume that they are not involved in the care of incarcerated people, but 95 percent [of incarcerated people] return to society. Since people who were incarcerated have higher rates of infectious disease, chronic conditions, and trauma, it’s important to know this history. If a patient has been incarcerated and medical records from the correctional facility are not available, clinicians should do a thorough evaluation for baseline health values, with testing that may include evaluation for tuberculosis, HIV/AIDS, diabetes, cancer, arthritis, and pulmonary conditions.

One of my recommendations is to have health care providers ask every woman during her wellness visits if she has been incarcerated—and do so in a way that it is a standard medical history question and does not put a woman in a negative spotlight. Instead of asking ‘Have you been incarcerated?’ I say, ‘Many of the patients I care for have experienced intimate partner violence, been incarcerated, and/or have trauma. Have you had any of these problems?’ If so, I validate their feelings by saying, ‘I understand this has been traumatic. Let’s talk about how we can work together to address your mental and medical health needs.’

These women face bias for being incarcerated and have a tough time bringing it up even to their clinician. A health care provider who brings this up will break down those barriers. We should approach all patients—especially those who have been incarcerated—with acceptance and the elimination of negative stigma.

What other outreach is the health committee doing?
We are bringing attention to incarcerated women’s health care through community outreach, educational initiatives, and research. We’re also engaging undergraduate, graduate, and medical students at Rutgers in this work. Recently, the Journal of Perinatal Medicine published a study by members of the health care team and me on pregnancy among incarcerated women, which emphasized that we need continued legislation that sets the templates of obstetrical care for women, including mother-baby units. We also recommend that prisons consider allowing mothers who are not a danger to themselves or to their children to enter halfway houses after birth so they are not separated from their children. We presented information on this topic at the National Conference on Correctional Health Care during the fall of 2021. We also were part of a team that launched the Journal of Women and Criminal Justice, which gives incarcerated women and their advocates a voice and lets them know their perspectives are important.

This story originally appeared in Rutgers Magazine.