Health Needs of Black Women After Incarceration
In the United States, Black women have long experienced disparities in health and healthcare that continue to persist today. Black women not only generally have shorter life expectancies, higher maternal mortality rates, and higher prevalence of health conditions such as heart disease, stroke, obesity, diabetes, anemia, and stress compared to non-Hispanic white and Latinx women, but they are also disproportionately incarcerated.
Incarceration has been shown to be a social determinant of health and an underlying cause of the persistent inequities in overall health, reproductive health, and mental health outcomes experienced by formerly incarcerated Black women.
Despite the important nexus of race, gender, health, and incarceration, few studies explore how they interact to shape the reentry experiences of formerly incarcerated women and their health, especially the experiences of Black women who are disproportionately represented within this population.
Our new report, Pathways to Wellness: Health Needs of Black Women After Incarceration, seeks to fill this gap in research by examining the often marginalized experiences of formerly incarcerated Black women. We interviewed 21 formerly incarcerated Black women in California about their healthcare needs, how they access healthcare services, and the barriers they face in trying to access care.
Throughout this study, women reported that stigma about their incarceration history or past history of drug use prevented them from seeking help for pain and discomfort. Decisions that the women in the study made to “push through” pain and not “complain” illustrate how the behaviors and coping strategies of the “Strong Black Woman” stereotype and incarceration history interact to directly impact whether and how Black women access healthcare after release.
Read some of our key report findings below:
Summary of Findings
Incarceration negatively impacts health and exacerbates already existing health needs of Black women.
Many Black women enter incarceration with existing trauma and health and mental health issues. Incarceration does little to address these issues, and often, it compounds the problems. The impact of this is that when women leave incarceration, their health is often worse than when they entered.
Treatment delays and lack of follow-up: Formerly incarcerated Black women reported that when they were incarcerated, they experienced long waiting periods to be seen by healthcare providers, ranging from weeks to months. Even when women did see a healthcare provider and received a diagnosis, lack of follow-up by providers meant that women’s health conditions worsened.
Dismissal of claims or not taking claims seriously: When Black women were finally able to see a healthcare provider, they reported that many of those providers did not take their health concerns seriously or dismissed them entirely.
Misdiagnoses: Several Black women in the study shared personal stories and witness accounts of improper medical care from providers’ misdiagnoses, which ranged from benign issues like being given an inaccurate eyeglass prescription to fatal consequences.
High cost of healthcare in confinement: The high cost of copays for people who are incarcerated significantly limits people’s ability to access care while in confinement. In California people in prison earn, on average, $0.08 to $0.95 per hour for their work. For someone earning $0.08 an hour, a $5 copayment requires more than 7 days of work. A minimum wage worker in California would have to pay more than $600 for a single doctor’s visit if they were charged at the same rate of incarcerated people.
High-priority health concerns included reproductive health needs, mental health needs & maintaining sobriety, obesity & weight gain, and certain chronic conditions.
The critical health concerns of Black women, once released from incarceration, broadly focused on being more proactive about addressing and improving their physical health, including the importance of eating healthy and getting more exercise.
Reproductive health: One-third of Black women in the study reported reproductive health issues during confinement, including pelvic pain, symptomatic uterine fibroids, and heavy menstrual bleeding.
Mental health needs and maintaining sobriety: About two-thirds of women in the study reported a mental illness, substance use disorder, or both, which they directly connected to traumatic experiences before incarceration and the exacerbating effect of the carceral environment itself.
Obesity and weight gain: More than half of the women in the study said that weight gain was among their high-priority health concerns, both during incarceration and after release. Weight gain during incarceration is a problem that disproportionately affects women in prison compared to men, especially those with comorbid diseases.
Chronic health conditions: More than 75% of the women in the study reported having a chronic condition. The top health concerns that women prioritized included chronic conditions such as hypertension, diabetes, and high cholesterol. Nearly a quarter of the women in the study were at least 50 years old at the time of their latest release from confinement, and because of their age, they were especially concerned about chronic conditions.
Accessing healthcare after incarceration is difficult.
The Black women in this study want to take preventative measures to address and improve their health and wellness. However, accessing healthcare after incarceration remains challenging for formerly incarcerated Black women.
Distrust of the healthcare system: For some formerly incarcerated Black women, the treatment they received from healthcare providers in confinement—including inadequate and “one-size-fits-all” treatment, dismissal of claims, lack of follow-up, and misdiagnoses—engendered deep distrust in the healthcare system once released and prevented women from seeking help later to meet their health and wellness needs.
Complexity of insurance systems: Although health insurance coverage is strongly associated with reduced rearrest rates among women, there is limited education and pre-release planning to facilitate women’s ability to access healthcare after leaving confinement. Formerly incarcerated Black women with Medi-Cal (California’s Medicaid program) experienced limited health coverage, especially relative to private insurance. For many formerly incarcerated Black women in the study, there was an overwhelming consensus that there is a need for updated, accurate, and accessible information as it pertains to navigating the healthcare system.
Geographic location affected Black women’s access to health care: Inequities in access to quality health services, healthy food, and opportunities vary by geographic location. Therefore, the location where women were released or paroled to played a role in their ability to access health care—from the quality and availability of healthcare providers to access to fresh food.
Women develop their own strategies to address health needs after incarceration.
In spite of women’s distrust of healthcare providers due to negative past experiences and the challenges of navigating the complexity of various insurance systems, many of the women in this study developed their own strategies to access healthcare that supported their own health and wellness goals.
Connect with supportive organizations: Black women reported that community-based organizations—such as A New Way of Life, the Transitions Clinic Network, and Root and Rebound—were gateways to healthcare and mental health services.
Self-advocacy as self-care: Many of the formerly incarcerated women in this study reported that self-care and self-love were critical strategies in accessing the type of care that they needed to support their own health and w ellness goals. Selfcare included advocating for themselves in various healthcare settings, going to church for supportive community and fellowship, setting boundaries in relationships, developing positive coping skills, and practicing kindness with themselves.
Advocate for others: Giving back and paying it forward to other system-impacted people through advocacy and direct services was a central theme in participants’ healing. More than half of the formerly incarcerated Black women in the study work or volunteer in direct services and/or advocacy roles that leverage their lived experience to help others, such as working with people who are homeless, in recovery, and survivors of domestic violence.
Desires for health and wellness
Most women in the study said that, for them to be holistically healthy and well, they needed access to wraparound support services, including peer support, safe affordable housing, accessible information, and diverse, competent, and compassionate providers.
What’s next?
The study’s findings indicate the need for stakeholders who interact with incarcerated and formerly incarcerated Black women—whether based in a carceral facility or in the community—to listen to Black women when they express their pain and concerns, reject pathologizing, address implicit bias, and see Black women with incarceration experience as the full human beings they are.
The desires of the women in the study for peer support and help navigating healthcare systems indicate promise for community health worker roles to support Black women, especially those with chronic health conditions, in navigating the healthcare system to ensure they can access the treatment and medication they need to be well and thrive.
Earlier this year, we issued new policy recommendations to address the specific challenges that Black women face and their needs when they return to their communities from incarceration, including their health needs. Explore our policy report.