"Prison Ain't Free Like Everyone Thinks": Financial Stressors Faced by Incarcerated Women.

Most women in prison are poor and suffer from health problems prior to and during incarceration. Policies that impose inmate medical co-payment fees do not consider gender-specific health needs or other financial stressors faced by women in prison. We examine the financial needs and concerns of incarcerated women through the lens of gender and behavioral economics. We conducted individual interviews with 95 women incarcerated in a medium/maximum security prison in the United States. Women described several common financial stressors during confinement: paying for medical care, "working for pennies," staying in contact with loved ones, and relying on others. In an attempt to remain gender neutral, prison polices often do not consider gender-based differences between male and female prisoners. When gender neutrality is applied to financial policies surrounding access to healthcare, incarcerated women are profoundly disadvantaged and left to make consequential trade-offs with scarce financial resources. Our findings provide important insight into financial stressors facing incarcerated women and provide evidence to support the elimination of mandatory medical co-payment fees for incarcerated women.

Posttraumatic stress disorder in incarcerated women: A call for evidence-based treatment.

The majority of women who enter the criminal justice system, most of whom are poor and women of color, have suffered from significant lifetime trauma exposure that can lead to posttraumatic stress disorder (PTSD). It is essential to identify the prevalence of PTSD among this population in order to identify treatment needs. Most studies on PTSD among incarcerated women have focused on PTSD in jailed populations, including women awaiting trial. Using a cross-sectional study design, we estimated the prevalence of PTSD and comorbid physical and mental health conditions in 387 incarcerated women sentenced to a maximum-security prison in the United States. Almost half (44%) of our sample met the diagnostic criteria for PTSD. Women with moderate to severe PTSD symptoms were more likely to report several comorbid physical and mental health conditions than were women without PTSD. Women with the most severe symptoms were most likely to report receiving mental health treatment in prison; women with moderate to severe symptoms were less likely to report receiving similar mental health care. Our findings add support to the link between PTSD and comorbid physical and mental health conditions and suggest that many women with PTSD are not receiving mental health treatment that is likely to benefit them. Because prison has become the mental health safety net for some of the nation's most vulnerable women, it is imperative that prisons provide evidence-based PTSD treatment during incarceration.

Sleep quality and risk for sleep apnea in incarcerated women.

BACKGROUND: Little is known about characteristics of women's sleep during incarceration. OBJECTIVES: The study objectives were to describe incarcerated women's sleep quality, document incarcerated women's risk for sleep apnea, and identify other factors that contribute to poor sleep quality during incarceration. METHODS: This cross-sectional descriptive exploratory investigation was conducted in a maximum security women's prison in the United States. Incarcerated women's sleep quality and their risk for sleep apnea was assessed by using the Pittsburgh Sleep Quality Index and the Multivariable Apnea Prediction Score, respectively. RESULTS: Four hundred thirty-eight incarcerated women participated in this investigation. Results indicate that 72% of the sample met the Pittsburgh Sleep Quality Index criteria for "poor sleepers." Poor sleepers were significantly more likely to report sleep disturbances and scored significantly higher on the risk for sleep apnea scale compared to women who did not meet the poor sleep threshold. Approximately 10% of the sample had a probability for sleep apnea higher than .50. Factors that contributed to poor sleep included (a) "racing thoughts/worry/thinking about things," (b) environmental noise and other factors, (c) physical health conditions/pain, (d) nightmares and flashbacks, and (e) not taking sleep medication. DISCUSSION: Most participants reported poor sleep quality during incarceration. Poor sleep might exacerbate existing health conditions and contribute to the development of new health problems for incarcerated women. Furthermore, poor sleep quality may reduce a woman's ability to fully participate in beneficial prison programming. This investigation provides a first look at how women sleep in prison and offers recommendations for future research.

Factors contributing to poor physical health in incarcerated women.

Prisons have become the primary health care provider for some of the poorest and sickest women in the United States. By virtue of both biological sex and gender, incarcerated women have health needs different from those of their male counterparts. The purpose of this qualitative investigation was to understand better women's perceptions of how prison has affected their physical health. We conducted this investigation in a maximum-security women's prison in the United States using focus group methodology (12 focus groups, made up of 65 women). Women described several specific prison-based factors that affected their physical health: limited and complicated access to care; nutritional concerns; limited physical activity; and smoking in prison. We discuss these findings in relation to the gender-based health issues facing incarcerated women.

The impact of incarceration on women's mental health: responses from women in a maximum-security prison.

Many women enter prison with significant mental health conditions. Without appropriate intervention during incarceration, there is the potential for these conditions to worsen during confinement. As a result, women, most of whom will eventually be released from prison, might return to their families and communities with even more complex mental health needs. We examined women's perceptions of how incarceration had affected their mental health. Our study approach included descriptive surveys and focus groups with women in prison. Our analysis revealed that women's mental health might worsen, might improve, or might remain the same as a result of incarceration. Women's accounts also provide evidence to support the need for all women's correctional institutions to adopt a trauma-informed approach to care of this vulnerable population.

Grief interrupted: the experience of loss among incarcerated women.

Incarcerated women face a number of stressors apart from the actual incarceration. Nearly half of all women in prison experience the death of a loved one during their incarceration. Our purpose for this study was to explore the experience of grief and loss among incarcerated women using a phenomenological method. Our study approach followed van Manen's method of phenomenology and Munhall's description of existential lifeworlds. Our analysis revealed four existential lifeworlds: temporality: frozen in time; spatiality: no place, no space to grieve; corporeality: buried emotions; and relationality: never alone, yet feeling so lonely. The findings generated from this study can help mental health providers as well as correctional professionals develop policies and programs that facilitate the grief process of incarcerated women within the confines of imprisonment.

Childhood sexual abuse, teenage pregnancy, and partnering with adult men: exploring the relationship.

Although the mechanism by which early victimization, specifically sexual abuse, increases the risk of adolescent pregnancy is unclear, a relationship between previous victimization and adolescent pregnancy has been demonstrated. While partnering with an older man may initially offer the means necessary to escape a neglectful or violent family of origin, this protection be accompanied by an imbalance of power and control. Both adolescent mothers partnered with adult men and adolescent mothers partnered with male peers reported sexual abuse perpetrated by family members, family friends, strangers, and peers. Policies developed to protect young people from victimization, including mandatory reporting and statutory rape laws, should be evaluated for their consistent application to all children, regardless of age, race, gender, or pregnancy status.

Teenage mothers and breastfeeding: does paternal age make a difference?

This descriptive investigation explores the impact of paternal age on a teenage mother's decision regarding infant-feeding method during the postpartum hospital stay. Eighty-six teenagers who delivered a live birth were asked the age of the fathers of their babies and what, if any, influence the fathers had on infant feeding. Although the fathers of the babies frequently voiced an opinion regarding infant feeding, teenage mothers partnered with older men were less likely to breastfeed during the postpartum hospital stay than were teenagers partnered with male peers. Implications for future research and clinical nursing practice are presented.

Domestic violence and trauma care in teenage pregnancy: does paternal age make a difference?

OBJECTIVE: To determine whether teenagers partnered with adult men were more likely to report domestic violence and trauma-related care during pregnancy than teenagers partnered with male peers. DESIGN: Nonexperimental, descriptive comparative design. SETTING: Postpartum unit in a large, urban teaching hospital. PARTICIPANTS: English-speaking teenagers who recently delivered a live infant. METHODS: Semistructured interviews lasting from 30 minutes to 2 hours. INSTRUMENTS: The Abuse Assessment Screen, the Danger Assessment Scale. MAIN OUTCOME MEASURES: Domestic violence and trauma-related care during pregnancy. RESULTS: Teenagers with adult partners were not more likely to report domestic violence or seek trauma-related care during pregnancy than teenagers with peer-age partners. CONCLUSION: Researchers, policy makers, and health care providers should continue to address violence occurring among pregnant teenagers by identifying subgroups who may be at increased risk of abuse.

Relationships between incarcerated women. Moving beyond stereotypes.

1. Described as one of the "pains of imprisonment," separation may be particularly difficult for women in prison because most functioned in multiple relational roles, including mother, wife, girlfriend, daughter, sister, and friend, before incarceration. 2. In the absence of consistent contact with family, friends, and other loved ones outside prison, incarcerated women may seek to develop connections with other inmates as a way to adapt to life in prison. 3. Positive adaptation may allow incarcerated women to take advantage of educational/vocational, parenting, and drug treatment programs offered in prison, thus facilitating their adaptation after release.