By Cynthia Golembeski, Carolyn Sufrin, Brie Williams, Precious Bedell, Sherry Glied, Ingrid Binswanger, Donna Hylton, Tyler Winkelman, and Jaimie Meyer
Health and economic inequities exacerbated by the COVID-19 pandemic disproportionately harm women, and particularly women of color, involved in the criminal legal system.
Structural racism, sexism, poverty, substandard healthcare in jails and prisons, and the health effects of incarceration worsen women’s health. The pandemic only compounds these effects. Often overlooked or less visible, incarcerated women are at significantly increased risk of acquiring infectious illness, including COVID-19.
Alternatives to incarceration, and care continuity for chronic health conditions, including substance-use and psychiatric disorders, which disproportionately affect women, are necessary within the current pandemic and beyond.
Over 1,000,000 women are in prisons and jails, or on parole or probation. The number of women in prison has increased by 800% since 1980, which is twice the men’s growth rate.
Rates of COVID-19 cases have escalated at an accelerated rate in jails and prisons, where residents’ COVID-19 death rate is three times higher and the positive test rate is 5.5 times higher than the general population.
Across the U.S., over 1,275 prisoners have died and over 235,000 prisoners and correctional officers have been infected within prisons and jails, which constitute COVID hotspots. In Florida’s Lowell Correctional Institution, more than 1,000 incarcerated women and nearly 75 staff have tested positive for COVID-19. The Oklahoma Department of Corrections has reported 780 women testing positive for COVID-19 inside the minimum security Eddie Warrior Correctional Center, which has a maximum capacity of less than 1,000.
The COVID-19 pandemic, which calls for social distancing, sheltering in place, and quarantine, has laid bare the vast inequities within our public health system, including in prisons and jails. The Center for Disease Control and Prevention (CDC) guidance on managing COVID-19 within correctional facilities coalesce with medical experts’ coordinated action guidelines for evidence-based emergency discharge planning priorities.
A recent survey of U.S. voters found overwhelming bipartisan support for reducing COVID-19 related risks through criminal justice reform, including jail and prison population reductions; early release, particularly for those most vulnerable to contracting COVID-19, and minimized jail admissions.
Prisons and jails have taken steps to reduce their populations during the pandemic: jail populations throughout the U.S. decreased by 25% between March and June 2020, and prisons experienced a 8% population decrease.
But COVID-19 policies within jails and prisons vary in standardization, salience, and implementation regarding: early release; reducing admissions; contact limitations during parole and probation; waiving medical copayments; and lowering video and phone costs.
Women in prisons and jails have particularly high rates of mental and physical health conditions and socio-economic challenges in comparison to incarcerated men and women in the community. Additionally, the proportion of aging women in prison is growing faster than men, and associated with increased needs, costs, comorbidity burden, physical and cognitive disabilities, and vulnerability to COVID-19. Understanding and addressing the health challenges of people involved in the criminal legal system is critical to achieving the triple aim of improving patient experience of care, improving population health, and reducing the per capita cost of care within and across communities.
Limiting critical rights, benefits, and opportunities during times of increased need conflicts with goals of advancing successful reentry, rehabilitation, and public safety, particularly for women, who are disproportionately impacted.
More than 10,000 individuals are released from federal and state prisons and 200,000 churns through jails weekly, with over 66% rearrested within three years. Nearly 95% of people incarcerated will return to communities and face reentry challenges as part of restoring relationships, healthcare, housing, and financial security. Many women return to under-resourced neighborhoods amidst prevalent poverty, violence, and substance use.
The effects of the criminal legal system on individuals, families and communities remain long after time served. For instance, people convicted of felony and misdemeanor violations face over 44,000 restrictions, barriers, and bans limiting access to health care, public benefits, housing, education, employment, and family, domestic, and judicial rights. Experiencing incarceration and the stigma of a criminal record is challenging. Women often shoulder greater financial burdens and family responsibilities than men.
Cross-agency collaboration, which incorporates psychological and emotional components that women need to heal and recover, can facilitate and sustain integrative continuity of care models that address structural racism, poverty and trauma histories, and mental and physical health conditions. Community-based clinics providing transitional care, including primary care and case management, as well as peer patient navigators, improve reentry for women.
Decarceration, drug policy reform, and alternatives to incarceration are necessary criminal legal system reform efforts that may improve health outcomes further upstream and aid women in addressing underlying challenges while maintaining and strengthening positive ties to families and communities. From a systems perspective, it is less costly and disruptive to avoid incarceration altogether and deliver continuous care in the community for chronic health conditions, including substance use and psychiatric disorders.
The current COVID-19 crisis intensifies the needs of those being released from prison and jail, and those that remain inside. Alternatives to incarceration, decarceration, strong social safety nets, reentry support, and limiting criminal conviction-related penalties regarding employment, education, housing, and public benefits are critical for safer, healthier transitions from prisons and jails to communities.
For more, read the authors’ related academic article: Golembeski, C.A., Sufrin, C.B., Williams, B., Bedell, P.S., Glied, S.A., Binswanger, I.A., Hylton, D., Winkelman, T.N. and Meyer, J.P., 2020. Improving Health Equity for Women Involved in the Criminal Legal System. Women’s Health Issues 30(5): 313-319.