Gynecology

Women in Prison and their Health Problems

Over the past 20 years, there has been a greater than fivefold increase in the number of women incarcerated in the United States, with the preponderance in state facilities. A number of health profession organizations and human rights groups have been calling attention to the inadequate health [Page 386]care provided in our prisons and jails. The ratio of incarcerated, HIV-infected women to men is 3:1, in large part a result of their intravenous drug use, sexual abuse, prostitution, and sexual encounters with men of high-risk behavior profiles. For many of the same reasons the female inmate population is high risk for HIV infection, they are also high risk for other sexually transmitted diseases and gynecologic complications, such as cervical cancer.

Lawsuits

One way in which women have successfully lobbied for an improvement in the quality of obstetric and gynecologic health care within the correctional setting has been through the use of class action lawsuits. At the forefront of this effort is attorney Ellen Berry, who has worked on behalf of women prisoners for 24 years in the California state and federal prisons and several large California county jails. In 1985, Berry filed Harris v. McCarthy, on behalf of pregnant women prisoners at the California Institution for Women in response to a range of serious allegations concerning pregnancy care, including a very high rate of miscarriage and fetal demise, birth complications, and untreated medical emergencies. At that time, there was no obstetrician-gynecologist to serve the 1,500 inmates. The settlement agreement in this case required the hiring of an obstetrician-gynecologist and the creation of a Pregnancy Related Health Care Team of an obstetrician-gynecologist, nurse practitioner, registered nurse, and social worker to evaluate and handle each pregnancy case based on the then current American College of Obstetricians and Gynecologists (ACOG) standards. Subsequent cases, including Jones v. Dyer (1986) on behalf of pregnant women in the Alameda County Jail and Yeager v. Smith (1987) on behalf of pregnant and postpartum women at the Kern County Jail, were successfully settled, again relying on ACOG guidelines of care.

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