3.  Damage to health caused by imprisonment A recent international comparative study examined prison suicide rates in 24 higher income countries,14 including four of those featured in our ten country study – England & Wales, Netherlands, Australia and the United States of America (Fazel et al, 2017). This found no evidence to link high suicide rates with high incarceration rates. In fact, the reverse was indicated, with the Nordic countries and the Netherlands having some of the highest documented rates of prisoner suicide, yet the world’s lowest incarceration rates. By contrast, rates of prisoner suicide in America and Australia were considerably lower, despite these countries’ higher incarceration rates. Nor was the higher number of prisoner suicides a reflection of more suicide in the countries’ general populations. Instead, individual prisoner-level factors were considered the most likely explanation for high suicide rates. These factors include the fact that prisoners in countries with lower incarceration rates are statistically more likely to have committed serious violent crimes or have a mental illness, both of which are associated with increased suicide risk (see also Fazel et al, 2008). There is also evidence that recently released prisoners are at even greater risk of suicide than serving prisoners, particularly in the year after release (with this risk being higher still in the first four weeks) (Pratt et al, 2006 and Spittal et al, 2014). In a large-scale Swedish study, links were found between postrelease suicide and previous substance use disorder, relapse into drug use, and homelessness (Haglund et al, 2014). You have no reason to hope for a brighter future, you’re done, you’re oppressed, every ounce of you is taken. So many women commit suicide as soon as they’re released. Female ex-prisoner 1, Kenya 3.1.7 Vulnerable sub-groups of prisoners Being in prison carries greater health risks for some people as a result of their specific characteristics or vulnerabilities or because of the prison’s inability to meet their health needs. When conditions are overcrowded and prisons are under-resourced, the potential impact on their health may be even more serious. Reduced levels of staff monitoring and intervention together with raised levels of tension and violence may leave them more susceptible to abuse and they may find it more difficult to access treatment and support. Female prisoners Women in prison have frequently suffered physical, mental or sexual abuse and often have untreated health problems (Moloney et al, 2009). Rates of mental illness are higher in female prisoners than male (Binswanger et al, 2010). Women are likely to have histories of substance misuse and childcare issues and are at significantly higher risk of self-harm and suicide in prison (Corston, 2007). Many of the vulnerabilities documented in female prison populations mean that I’d been abused before, imprisonment does disproportionate and lasting harm, prompting calls for and prison reawakened greater community provision and for the abolition of female imprisonment my past feelings of fear. (for example Coles et al, 2018). I walked into the prison and felt just fear. Female prisoners constitute a minority of incarcerated populations:15 around 7 per cent in Brazil, 10 per cent in the United States, 8 per cent in Australia, Female ex-prisoner 2, 13 per cent in Thailand, 4 per cent in India, 3 per cent in African countries Kenya and 5 per cent in Western Europe (Walmsley, 2017). As most prison systems have been designed to accommodate male prisoners, they are rarely equipped to meet women’s specific needs. Health services for women in prison are sometimes minimal. Standards of prison healthcare often fall below those of women’s health services in the community (World Health Organization, 2011).  14 The data included suicides in pre-trial/remand detention as well as among sentenced populations: disaggregated prisoner suicide data were not available. 15 Albeit a rapidly growing minority: see section 4.2.1 below. The percentages shown here have been rounded to the nearest whole number. 11