SPECIAL FOCUS Healthcare for specific groups Women Women in prison have different and more acute healthcare needs than men. This is partly due to physiological differences, and partly because of their typical backgrounds, which can include drug use, physical or sexual abuse, sex work and unsafe sexual practices. Health conditions of women prisoners may have been untreated before admission, due to discriminatory practices that prevent women from accessing adequate healthcare in the community. Women prisoners have specific needs related to reproductive health issues, such as menstruation, pregnancy and menopause.20 In order to adequately respond to these, female-specific healthcare services need to be provided, including sexual and reproductive care and preventive healthcare such as pap smears and screening for breast and gynaecological cancer.21 Many prisons fail to deal properly even with women’s menstruation.22 ‘Period poverty’ continues to be an issue, with reports of It is estimated that around 75 per cent of women arriving in prison had some sort of drug-related problem at the time of arrest.24 The need for specialised treatment programmes for women substance abusers is recognised by the UN Rules for the Treatment of Women Prisoners and Non-custodial Measures for Women Offenders (the Bangkok Rules).25 A major concern is that prison systems often do not guarantee access to such treatment and discriminate against women when it comes to substance dependency treatment, or do not tailor programmes for women.26 In relation to the provision of opioid substitution therapy, a recent study found that women ‘generally have no access to these programmes while incarcerated’.27 The Bangkok Rules are clear that prison health authorities should provide or facilitate specialised treatment programmes for women substance abusers, taking into account prior victimisation, the special needs of pregnant women and women with children, as Case study from England substance misuse or sex work, as well as women who have chaotic lifestyles. The National Health Service (NHS) in England has launched a pilot programme in a women’s prison. The programme was set up to break the cycle of reoffending and to improve the mental and physical health of women in the prison. It is run and managed by healthcare teams in the prison, with a view to handing over responsibility for each case to probation services when the offender is released. There are strict criteria for prisoners to be admitted into the programme, and women must be in the last six months of their sentence. The programme accepts prisoners who are repeat offenders and prisoners who have experiences of domestic violence, 6 | menstrual products being used by prison staff as bargaining chips to exercise power over women.23 The programme offers participants 12 two-hour facilitated group sessions as well as one-to-one meetings on a range of health topics, including: • Sexual health and healthy relationships. • Well-being, including healthy diet and exercise. well as women’s diverse cultural backgrounds.28 Where relevant programmes do not exist in prison, there is an increased duty on authorities to facilitate access of prisoners to relevant programmes in the community.29 Studies have shown that women prisoners who participate in such programmes are more likely to be successfully rehabilitated.30 Women prisoners are a high-risk group for sexual and reproductive health diseases, including cancer and sexually transmitted infections, particularly due to their typical backgrounds – which often include drug use, sexual abuse and violence, sex work and unsafe sexual practices.31 Although women prisoners are more likely to contract HIV in prison than men, they have less access to preventive and treatment programmes than their male counterparts.32 Gender-specific treatment and care for HIV is required by Bangkok Rule 14, acknowledging that medical treatment for women with HIV should be different from treatment for men. Alarmingly high rates of mental health problems are reported amongst women prisoners, • How to register and access primary care. • How to register and access mental health well-being services. • Emotional self-care. The sessions include input from former women prisoners who talk about their experiences before and after release. The women are also offered individual follow-up sessions if necessary. Initial outcomes have been positive and NHS England plans to develop and evaluate the enhanced skills pilot, with the intention of embedding it into commissioned health services in prison in the near future. Penal Reform International and Thailand Institute of Justice | Global Prison Trends 2019