TOPIC : ASSESSMENT OF MENTAL AND PHYSICAL ISSUES
FACED BY WOMEN OFFENDERS
SUBMITTED BY
SHUBHEKSHU KUMAR SINGH A90821519031
RIA DALMIA A90821519061
INTRODUCTION
In 2016, over 3 lakh women were arrested for crimes under the Indian Penal Code (IPC)
and Special and Local Laws (SLL). A large number of these women were arrested for
crimes under the Prohibition Act, for cruelty by relatives of husband and rioting etc. By
observing combined figures of both convicted and undertrial prisoners we see that at
37%, a large proportion of women are in prison for murder, followed by 15% women
who are incarcerated for dowry deaths.
Overall crimes by women
The overall number of crimes by women has been relatively consistent over the past
decade or so. There is a relatively consistent pattern over the last 15 years, with the
number of women arrested for various offences remaining between 3-3.6 lakh. While
this number is relatively large, only a proportion of arrested women are incarcerated in
prison, either following conviction or under trial.
As per Prison Statistics India 2015, NCRB, from the end of 2015, there are 4,19,623
persons in jail in India. Women constitute 4.3% of this figure, numbering a total of
17,834 women. Of these, 66.8% (11,916) are undertrial prisoners. In India, an analysis
of prison statistics at five-year intervals reveals an increasing trend in the number of
women prisoners – 3.3% of all prisoners in 2000, 3.9% in 2005, 4.1% in 2010 and 4.3%
in 2015 were women. While women prisoners continue to be a minority in all parts of
the world (less than 10%), the female prison population has increased faster than the
male prison population on every continent.
A majority of female inmates are in the age group of 30 - 50 years (50.5%), followed by
18-30 years (31.3% ). Of the total 1,401 prisons in India, only 18 are exclusive for
women, housing 2,985 female prisoners. Thus, a majority of women inmates are
housed in women’s enclosures of general prisons.
The geographical spread of women prisoners varies across the country. Uttar Pradesh
by far has the highest number of women in prison (3,533), followed by West
Bengal (1,506), Maharashtra (1,336) and Madhya Pradesh (1,322). The Union
Territories, apart from Delhi (579), have a particularly low number of women in prison.
ACTS RELATED TO WOMEN PRISONERS
As per the State List provided in the Seventh Schedule of Indian Constitution, all issues
related to prisons, reformatories, borstal institutions and other institutions of a like
nature, and persons detained therein; arrangements with other States for the use of
prisons and other institutions come under the domain of State Governments. The rules
of incarceration are determined by following laws:
• Indian Penal Code, 1860
• Prison Act, 1894
• Prisoner’s Act, 1900
• Identification of Prisoner’s Act, 1920
• Exchange of Prisoner’s Act, 1948
• Transfer of Prisoner’s Act, 1950
• Prisoner (Attendance in Court) Act, 1955
• Probation of Offenders Act, 1958
• Code of Criminal Procedure, 1973
• Repatriation of Prisoner’s Act, 2003
• Model Prison Manual, 2003
• Model Prison Manual, 2016
A National Policy on Prison Reforms and Correctional Administration had also been
framed in 2007, which gave a number of directives relevant to women prisoners –
maintenance of human rights of prisoners, avoiding overstay of undertrials etc. It
further states, “Women prisoners shall be protected against all exploitation. Work and
treatment programmes shall be devised for them in consonance with their special
needs.”
RULES RELATED TO WOMEN IN PRISONERS
The key features of the updated Model Prison Manual 2016 include emphasis on prison
computerization, special provisions for women prisoners, focus on after-care services,
prison inspections, rights of prisoners sentenced to death, repatriation of prisoners
from abroad, enhanced focus on prison correctional staff.
The CrPC contains certain special provisions for the arrest of women – the arrest of
women after sunset and before sunrise (except with the prior permission of Judicial
Magistrate First Class) is prohibited and a female arrestee is mandated to only be
searched by a female officer with due regard to decency.
The police official arresting the woman should ideally be dressed in plain clothes and
not their uniform so as to reduce the stigma associated with incarceration.
Provisions should also be made for the custody of minor children of the woman at the
time of arrest. She must provide in writing the name and details of the person with
whom she wishes her minor children to stay during her period of incarceration, and this
must be complied with strictly. In case where no family/friends are available to care for
the child and he/she cannot accompany the mother to prison, the child should be
appropriately plac ed in a Child Care Institution.
RULES APPLICABLE FOR PREGNANT WOMEN
In case of pregnant prisoners, the provisions of the National Model Prison Manual must
be followed strictly to make arrangements for temporary release for delivery of children
in a hospital outside the prison. Suspension of sentence may be considered in the case
of casual offenders. Information about a woman’s pregnant status should also be made
to the Court that has ordered the detention, to enable the Court to grant bail (where
appropriate) or modify the detention order as deemed necessary.
The birth certificate of the child born to a woman in prison should never mention the
prison as place of birth to protect them against social stigma.
Pregnant and lactating women should be provided with special diet as per the National
Prison Manual. Mothers in postnatal stage should also be allowed separate
accommodation to maintain hygiene and protect their infant from contagion, for at
least a year after childbirth. Further, instruments of restraint, punishment by close
confinement or disciplinary segregation should never be used on pregnant or lactating
women.
Pregnant and lactating women should receive advice on their health and diet under a
programme to be drawn up by a qualified health practitioner. Inmates should not be
discouraged from breastfeeding their children. Medical and nutritional needs of women
prisoners who have recently given birth whose babies are not with them in prison,
women who have undergone abort ion or have had a miscarriage should also be
included in treatment and nutrition programmes.
Women prisoners must have access to urine pregnancy test kits within prison , as per
their requirement, free of cost. Pregnant women must also be provided information
and access to abortion during incarceration, to the extent permitted by law.
Pregnant women must be given the option to take up work during their pregnancies
and in the post - natal phase if they so choose. Work provided to them must be suited
to their health conditions.
Aadhar cards must be made for all inmates, especially for mothers and infants to
enable them to become beneficiaries of various government welfare schemes.
When deciding on the prison to which the woman is to be sent, regard should be had to
her caretaking responsibilities if she has a child, and as far as possible, the woman must
be given the choice of selecting the prison.
Children must be kept in the prison in a manner that t hey are not made to feel like
offenders. Administration should ensure that the facilities provided are tailored towards
children living under their care. NGOs, schools and paediatricians can be engaged to
ensure that children in prisons have access to basic facilities of education, day care,
recreation and a healthy lifestyle.
To the extent possible, prison administration shall strive to create a suitable
environment for children's upbringing , which is as close as possible to that of a child
outside prison. E.g. airy room s with adequate natural light, minimum security
restrictions, outdoor play area, opportunity to socialize with peers outside prison if not
available within prison etc.
The Board of visitors shall inspect these facilities at regular intervals. Women prisoners
whose children are in prison with them shall be provided with the maximum possible
opportunities to spend time with their children.
Children should receive a special diet and be regularly examined by a Lady Medical
Officer at least once a month to monitor their physical growth and condition of physical
and mental health. They should have access to a Lady Medical Officer as per their need.
Children, whether living in prison or visiting, should never be treated as prisoners. The
prison staff must display sensitivity, respect and dignity when searching children. Body
cavity searches should never be applied to children.
Ideally, no child shall be admitted into or retained in prison if he/she has attained the
age of six years. The best interest of the child should be the determining criteria to
determine whether and for how long they should stay with their mothers in prison.
Prior to or on admission, women with caretaking responsibilities for children should be
permitted to make arrangements for those children including the possibility of a
reasonable suspension of detention, taking into account the best interests of the child.
In case where no family/friends are available to care for the child and he/she cannot
accompany the mother to prison, the child should be appropriately placed in a Child
Care Institution. It must be ensured that children of the same woman prisoner are
housed together in alternative care. The prison administration must ensure that the
child be placed in a manner that she/ he can interact with the mother regularly at least
once a week.
Children must be removed from the mother’s care with utmost sensitivity, and only
after making adequate arrangements for his/her stay. A register recording particulars of
guardians/persons in whose custody the children of women prisoners are kept must be
maintained. It should also be ensured that the inmate could take custody of her child
from the Child Care Institution on her release from prison. In case of foreign nationals,
removal and alternative arrangements should only be done in consultation with their
consular representatives.
Prison administration should ensure that links between inmates and children outside
prison are maintained throughout h er incarceration . The place of interaction between
inmates and their children living outside prison should be one where easy conversation
can take place, in a positive environment, where physical contact is possible between
mother and child.
Overnight visits for minor children living outside prison to maintain a bond with their
mothers must be allowed at least once every quarter. A separate area with a positive
homely environment must be provided within the prison for purpose of this stay with
the m other.
Prisons should provide educational scholarships for women inmates’ children above 6
years. E.g. In Tihar Jail, Delhi, children of inmates who are from Delhi are provided
educational scholarship of Rs. 3,500 for one child and Rs. 6,000 for two children per
month, subject to conditions like income etc. This could be replicated in other states as
well.
SOME IMPORTANT PROVISIONS RELATED TO WOMEN
PRISONERS
Women prisoners sentenced to six months imprisonment or below should be issued 3
sets of clothing, 2 towels and 3 sets of customary undergarments. This number will
increase to 5 sets of clothing, 3 towels and 5 sets of customary undergarments for
women sentenced to over six months. Inmates should be able to choose type of
clothing from a set of options as per preference. At a minimum this should include
saree with blouse and petticoat, kurta with salwar and dupatta, shirt with trouser/long
skirt in light colours, but not necessarily white.
Women in their post-natal phase must be given separate accommodation for one year
after delivery to maintain a certain standard of hygiene and to protect the child from
infections and other diseases. Also, sick women prisoners must be kept isolated for
health purposes.
Comprehensive health screening of women must be done on admission, with due
regard to their right to privacy, dignity and confidentiality, including their right to refuse
screening. This will help in identifying health issues, providing adequate treatment and
in preparing an individualised health and diet plan for the inmate. Routine tests must
be done periodically thereafter.
There should be comprehensive medical check-ups on an annual basis, regular medical
check-ups on a monthly basis and access to a lady medical officer at all times for check-
up, testing, treatment etc. as needed by the inmate. Papanicolaou tests and screening
for breast and gynaecological cancer should be done for women on a regular basis. In
case lady medical officer is not available, prisoner will be transferred to the nearest
medical facility where a lady doctor is available.
Women with mental health issues must be transferred to appropriate institutions
rather than keeping them in prisons. Inmates should have access to female
counsellors/psychologists at least on a weekly basis or as frequently as needed by
them. First-time offenders must especially be counselled on admission, to prevent
recidivism.
Sterilized sanitary pads should be issued free of cost to women prisoners as per their
requirements with no maximum limit.
Information about preventive measures for HIV, STDs or other gender-specific diseases
must be provided.
The prison staff must undergo mandatory training in gender - specific needs of women,
first aid and basic medicine to tackle emergencies and minor issues effectively.
Body searches must be conducted as per clearly formulated guidelines. While searching
women prisoners, the least intrusive mode should be adopted as considered
appropriate in the situation. The type of search to be conducted should be
communicated clearly to the inmate and reason for the same should be explained. In
case of strip searches, they should be conducted in two distinct steps with upper body
and lower body examined one after the other to avoid complete nudity at a given time.
Body cavity searches should be avoided, as far as possible. CCTV cameras must be used
with due regard to the dignity and privacy of women prisoners.
A written record should be kept of the type and frequency of searches for all inmates,
which should be available for examination by official visitors.
All staff involved in the custody, interrogation and treatment of prisoner must be
sensitised on gender-issues, human rights and sexual misconduct.
MENTAL AND PHYSICAL ISSUES FACED BY WOMEN PRISONERS
The health of prisoners is among the poorest of any population group and the apparent
inequalities pose both a challenge and an opportunity for country health systems. The
high rates of imprisonment in many countries, the resulting overcrowding,
characteristics of prison populations and the disproportionate prevalence of health
problems in prison should make prison health a matter of public health importance.
Women prisoners constitute a minority within all prison systems and their special
health needs are frequently neglected. The urgent need to review current services is
clear from research, expert opinion and experience from countries worldwide. Current
provision of health care to imprisoned women fails to meet their needs and is, in too
many cases, far short of what is required by human rights and international
recommendations.
The evidence includes a lack of gender sensitivity in policies and practices in prisons,
violations of women’s human rights and failure to accept that imprisoned women have
more and different health-care needs compared with male prisoners, often related to
reproductive health issues, mental health problems, drug dependencies and histories of
violence and abuse. Additional needs stem from their frequent status as a mother and
usually the primary carer for her children.
National governments, policy-makers and prison management need to address gender
insensitivity and social injustice in prisons. There are immediate steps which could be
taken to deal with public health neglect, abuses of human rights and failures in gender
sensitivity.
The public health importance of imprisonment is insufficiently recognized. This is
despite the high numbers held in prisons in many parts of the world, the characteristics
of prison populations and the disproportionate numbers of prisoners with serious
health problems. Worldwide, around 10 million people are held in penal
institutions.1 Almost half of the world prison population is imprisoned in three
countries: China, the Russian Federation and the United States of America (USA), even
though their total populations amount to only one quarter of the world population. If
one looks at imprisonment rates, the number of prisoners per 100 000 population,
considerable variation occurs between countries and regions. While nearly three fifths
of countries have rates less than 150 prisoners per 100 000 and the median rate for the
world as a whole is 145 per 100 000, the rate range is from 756 per 100 000 in the USA
to 35 per 100 000 in the western part of Africa.
In recent decades, there has been a marked rise in the numbers of prisoners in many
countries. Prison populations have risen in 71% of the countries listed in the World
Prison Population List.1 In the USA, the total number has risen from 450 000 in 1978 to
more than 2 million by 2005 and in the United Kingdom of Great Britain and Northern
Ireland, the prison population has doubled since 1990.2 The rise in prison populations
has in many countries resulted in considerable overcrowding. The reasons for the
increase in the number of prisoners in developed countries are only partly explained by
variations in rates of crime. The main reasons are stricter sentencing policies; despite
the introduction, at the same time, of new restorative justice approaches.
Prison health is an inevitable part of public health; there is an intensive interaction
between prisons and society.
Addressing health in prisons is essential in any public health initiative that aims to
improve overall public health. The World Health Organization (WHO) Regional Office for
Europe has specifically acknowledged this by its Health in Prisons Project since
1995,4 supporting Member States in improving public health by addressing health care
in prisons and facilitating links between prison health and public health.
Prisoners do not represent a homogeneous segment of society. Many have lived at the
margins of society, are poorly educated and come from socioeconomically
disadvantaged groups. They often have unhealthy lifestyles and addictions such as
alcoholism, smoking and drug use, which contribute to poor general health and put
them at risk of disease. The prevalence of mental health problems is very high: some
prisoners are seriously mentally ill and should be in a psychiatric facility, not prison.
Moreover, communicable diseases such as HIV, hepatitis and tuberculosis are more
prevalent in prisons than in the community.4 Many prisoners have had no contact, or
very limited contact, with health services in the community before they were detained
in prison. Access to, as well as quality of, health services in prison is of vital importance.
Most prisoners return to the community, sometimes after relatively short periods of
time in prison. The high numbers imprisoned, their vulnerability and the prevalence of
serious health conditions create a situation requiring attention. Moore & Elkavich state
that public health is a discipline in a prime position to call attention to these issues, to
design programmes to assist prisoners and their families and to influence the social
environment so as to “change the political climate and social policy surrounding who’s
using and who’s doing time”.
A close look at the needs of women in prison and related health aspects raised issues of
gender inequity and insensitivity, of human rights neglect and showed a general lack of
public health concern. A full report about the specific health problems and needs of
women prisoners is available.6 In this paper we aim to draw attention to some of the
main findings and to stress the necessity for action.
Profile of women prisoners
Worldwide, more than 500 000 women and girls are held in penitentiary institutions,
either as pre-trial detainees or sentenced prisoners. They constitute a small proportion
of the total prison population; in about 80% of prison systems worldwide, the
proportion of women varies between 2% and 9% with a median of 4.3% in
2006.7 Women who enter prison usually come from marginalized and disadvantaged
backgrounds and are often characterized by histories of violence, physical and sexual
abuse. Disadvantaged ethnic minorities, foreign nationals and indigenous people
constitute a larger proportion of the female prison population relative to their
proportion within the general community, often due to the specific problems these
vulnerable groups face in society.
Women prisoners are a small minority of the total prison population but there has been
a noticeable rise in women’s imprisonment in recent years. In some countries the rate
of this increase has been higher than that of male prisoners.8 For instance in England
and Wales, the number of imprisoned women has increased by more than 200% in the
past 10 years, compared with a 50% increase in the number of imprisoned men during
the same period.
Since their foundation, prisons have been built and run to cope with the needs of the
male majority. Until recent times, the small numbers of women prisoners were simply
admitted to the same prisons and were expected to cope with the same routines and
facilities as men. Lack of attention to the very different and often more complex needs
of women has resulted in neglect of their human rights, disregard to international
recommendations and many instances of social injustice. In a world where there are
widespread and persistent inequities between women and men, societies continue to
fail to meet the health needs of women at key moments of their lives.10 A review of
gender equity in health states that the present position is “unequal, unfair, ineffective
and inefficient”.
The small numbers of imprisoned women mean that there are fewer prisons for them,
resulting in women often being imprisoned further away from their homes. This causes
difficulties for the woman in maintaining her family ties and is especially a problem if
she has dependent children. Many imprisoned women are mothers and usually primary
or sole carers for their children.6 When a mother is imprisoned, her family will often
break up, resulting in many children ending up in state care institutions or alternative
care. Imprisonment far from home also complicates a woman's resettlement after
release. The small number of women prisons also results in the collective
accommodation of women convicted for a wide range of offences in a prison with a
high level of security, needed only for very few women. In fact, by far the majority of
offences for which women are imprisoned are non-violent, property or drug
related12 for which they serve short sentences. A high security level is disproportionate
to the risk they pose. Drug-related offences (usually for personal use) are one of the
most common crimes committed by women.13
Health care needs
Women in prison generally have more, and more specific, health problems than male
prisoners and tend to place a greater demand on the prison health service than men
do. This is the case right from the start of their imprisonment, as so many women
prisoners have had no contact with health services during the period before admission
to prison.6 As a consequence, most women in prison have little idea of their own health
status and may be less aware than most people of healthy lifestyles.
Women prisoners frequently suffer from mental health problems, among which post
traumatic stress disorder, depression and self-harming are regularly reported.6 They
suffer from mental health problems to a higher degree than for both male prisoners
and the general population,8 with rates as high as 90%.13 Evidence shows that women
prisoners are more likely to self-harm and commit suicide than male prisoners, while
this is the opposite in the community.11 In England and Wales, women were found to
be 14 times more likely than men to harm themselves and women are more likely than
men to do so repeatedly.14 In the USA, female prisoners are three times more likely
than male prisoners to report having experienced physical or sexual abuse before their
imprisonment, often resulting in poor physical and mental health.6 A high proportion of
women in prison suffer from an alcohol or drug dependency and problematic drug use
rates are higher among women than men.12 In the European Union Member States
and Norway, female prisoners are also more likely to inject drugs than male
prisoners,15 thereby exposing themselves to the risk of contracting HIV and other
bloodborne viruses. Women are at greater risk than men of entering prison with
sexually transmitted infections such as chlamydia, gonorrhoea, syphilis and HIV/AIDS,
often as a result of past high-risk sexual behaviours including prostitution, sex work and
being a victim of sexual abuse.16 A Scottish survey in 2002 concluded that the severity
of tooth decay was considerably worse in the prison population than in the community,
especially for female prisoners.17 Moreover, women in prison have specific health
issues; the most prominent are related to reproductive health such as menstruation,
menopause, pregnancy and breastfeeding.
Because of the short sentences that women often serve, there is a high turnover rate in
women’s prisons which means that there is an intensive interaction between the
prison, the community and wider society.6 Added to the distance that often exists
between women prisoners and their home, this exacerbates the problems which can
arise if prison health is isolated from other health services and in which there is little or
no link between services in prisons and the community. Continuity of care is important
in ensuring post-release services for any health problems identified during
imprisonment. The rate of post-release overdose mortality among ex-prisoners,
especially in the first weeks after release, is unacceptably high and more could be done
to reduce It.
The current situation
National governments are responsible for the provision of adequate health care to
prisoners. Its quality and access should be broadly equivalent to the services provided
in the community. However, in the majority of countries worldwide, responsibility for
prison health lies with the ministry of justice or interior, instead of the ministry of
health. This can contribute to isolation of prison health services from public health
services, leading to difficulties in staff recruitment and quality assurance. Several
countries have transferred the responsibility for prison health to the ministry of health
and there are some others considering the move. A guidance document has been
requested from the WHO Regional Office for Europe.
There are substantial differences between countries regarding health-care provision to
women prisoners. For instance, there is considerable variation in the availability of
treatment and care for drug dependency including opioid substitution treatment and
harm reduction measures such as needle and syringe exchange programmes. Services
designed specifically for women, helping them to feel safe and supported and
considering gender-specific issues, are seldom provided.12 There are differences in the
ways that mental health issues are addressed. In some systems, mental health
screening is not part of the normal procedure on entrance and women prisoners are
not differentiated based on their mental health status. Mental health programmes are
either non-existent or inadequate to address women’s specific needs,19 which may
result in severe damage to their mental health.20
The way in which prison services meet the reproductive health needs of women
prisoners varies considerably. Unfortunately, in too many prison services, women’s
physiology, including menstruation and reproduction are still medicalized. Access to
regular showers, free provision of hygiene products and sanitary napkins and possibility
of regular exercise are not standard services. Furthermore, health-care for pregnant
women in prison is often far from equivalent to that available in the community.
Women in prison seldom have access to any maternal education during pregnancy to
help prepare them for the birth. The nutrition offered in prisons often fails to meet
pregnant women’s needs. After giving birth, women in prison are frequently
discouraged from breastfeeding as it is perceived as interfering with prison routines,
even while it is widely recognized that breastfeeding is the best method of infant
feeding.6 Furthermore, there is often a lack of support for women who have been
victims of sexual or physical violence before their imprisonment.
Discussion
The evidence is systematic and consistent; women’s specific needs are often unmet by
prison services and by the prison environment. Moreover, there are considerable gaps
between prison health and public health services. Politicians and the general public still
seem to be unaware of these evident and unacceptable inequities.
Human rights and, in some cases, even basic standards of decency are unmet; prison
systems not only fail to meet the gender and biological health needs of imprisoned
women, but also the standards of humane care called for by international bodies, such
as those highlighted by Amnesty International in its report on women in custody in the
USA21 and the Institute on Women and Criminal Justice in its report on mothers,
infants and imprisonment.
METHODS THAT CAN BE USE TO IMPROVE THE ASSESSEMENT
OF WOMEN
To improve the situation will require awareness, thought and action at all levels of the
policy-making chain: politicians, prison management, health advocates and prison staff.
The following should be considered.
First, the principles that should define a health-care system for women in prison were
defined in the WHO/United Nations Office on Drugs and Crime (UNODC) Declaration.6
The first of these is that imprisonment of women should be considered only when all
other alternatives are unavailable or unsuitable. This is even more important for
pregnant women and women with young children. Its importance becomes very clear
when the personal and social costs of imprisonment of women are considered, in the
context of their pathways to crime and their roles in their social, family and community
context.
To prevent imprisonment in the first place, community-based services need to be
strengthened and more widely used, especially for substance use, sexual and
reproductive health and mental health; these should also provide adequate care on
release from prison. Evidence concerning community-based residential parenting
programmes has led to the recommendation that, whenever possible, custodial parents
and pregnant women within the criminal justice system should be housed in
community-based settings. A recent report points out that community corrections
programmes have been shown to protect public safety and reduce recidivism at a
fraction of the human and economic costs of imprisonment.
Second, important gaps remain in staff training. The determinants of criminal behaviour
in women and the long-lasting effects of histories of violence and abuse should be
known and understood by those providing supervision and care for women prisoners.
All staff working with women prisoners should have followed gender-sensitivity training
to raise awareness of and improve response to these gender-related issues.
Third, international standards are of vital importance and contain regulations
specifically directed to prisoners or women, but they are necessarily general in their
terms and do not always sufficiently guarantee the provision of services to meet
women prisoners’ specific needs. The Quaker Council for European Affairs has
published a gender critique of the European Prison Rules, which lists amendments and
additions to the European Prison Rules with the status, rights and welfare of
imprisoned women in mind.
Fourth, an important part of gender equity is acceptance of women’s preferences with
regard to health care. Health services for women in prison should be individualized as
far as possible to meet the specific expressed needs of the women; this would include
access to a female practitioner or the rigorous use of chaperones where this is not
possible.
STEPS THAT HAS BEEN UNDERTAKEN TO IMPROVE THE
STANDARDS OF WOMEN PRISONERS
There are encouraging signs that new approaches and plans are being produced in
various parts of the world. There are changes planned in several of the relevant public
services such as the police, probation services and community facilities, and reflected in
initiatives of nongovernmental organizations. The trend is towards more emphasis on
alternatives to custody, with more effort towards assessing and supporting women in
their own place of residence in cases where they have committed a non-violent or
minor offence. The legal and criminal justice systems are also changing, with new
restorative justice approaches.
During recent years, prison systems in many countries have developed initiatives such
as mother-and-baby units for imprisoned mothers; in most countries in Europe it is
possible for babies and small children to stay with their mother in prison, up to an
average age of 3 years. Nonetheless, this option raises difficult problems and dilemmas.
Ideas relating to health promotion in prisons, especially in women’s prisons, are
developing. These include a more participatory approach,25 using community
development methods, which could help considerably in making women prisoners
more health literate and more confident to look after their own health and the health
of their children.
There are two current initiatives well worth mentioning. First, the Thai government
initiated a project called Enhancing Lives of Female Inmates (ELFI) in 2008, eventually
leading to the development of a supplement to the United Nations Standard Minimum
Rules for the Treatment of Prisoners.26 The supplementary rules (“Bangkok Rules”)
were approved in December 2010 by the Third Committee of the United Nations
General Assembly at its 65th session and provide clear guidelines for countries
worldwide The Rules aim to raise awareness and set important standards. They are a
useful tool for human rights and prison organizations to advocate for better conditions
as well as gender-sensitive care and diversion schemes for imprisoned women
worldwide.
Second, the WHO Regional Office for Europe and UNODC are following up on their
Declaration on Women’s Health in Prison by developing practical checklists and
guidance notes. The checklists will be aimed at three levels:
(i) ministers and policy-makers;
(ii) prison management; and
(iii) prison health staff. The aim is to support Member States with practical means to
assess their current situation regarding women prisoners’ health and the health
services provided. The checklists and guidance notes are expected to be published later
this year.
Conclusion
The high cost of imprisonment of women, in financial, social and health terms, makes
crime and punishment a challenging political problem. When the degree of social
disadvantage and the amount of serious disease in prison populations is considered,
imprisonment becomes an important public health challenge, especially as most
prisoners will be released into the community. An appeal to human rights and
internationally agreed recommendations should be enough to correct many of the
present difficulties; when combined with strong public health reasons, the case for
priority and action is overwhelming. The case for women is even stronger.
Considerable review, policy development and change are required. While there may
have been increased awareness of the problems and perhaps of willingness to change,
the overall current position remains unacceptable. Radical change in criminal justice
systems would take considerable time, but there are immediate steps that could be
taken to deal with the more gross examples of public health neglect, abuses of human
rights and failures in gender sensitivity
