Health promoting prisons – An impossibility for women prisoners in Africa?

Abstract

The health needs of women in sub-Saharan African prisons are both neglected and poorly understood. Outside South Africa, little research exists on African prison health; what is available tends to be gender-blind and concerned with disease prevention rather than with health promotion. While Vetten (2008) has raised this concern previously, a comprehensive overview of women's health and health promotion in African jails is clearly absent. Available evidence shows that the conditions in African prisons are harmful to health, justifying a need for a health promoting prisons agenda rooted in the needs of sub-Saharan Africa. Women prisoners have significant mental and physical health needs, and international conventions on health care are not being respected globally. The health promoting prison concept has considerable attention in the Global North, with a commitment to equivalence of health care, gender sensitivity and to prisoners' social as well as health needs. This article provides an opportunity for critical reflection on women's health in prison, shows the lack of research in this area, questions the suitability of the health promoting prisons' agenda for sub-Saharan Africa, draws on our limited experience of the women's prison in Lusaka, Zambia, and produces recommendations to tackle women's health and wellbeing needs within the criminal justice systems of sub-Saharan Africa.

Contemporary women prisoners health experiences, unique prison health care needs and health care outcomes in sub Saharan Africa: a scoping review of extant literature.

“…Studies conducted in Zimbabwe, Malawi, Nigeria, Central African Republic, Benin, South Africa, Zambia, Ghana, and Cameroon described physical conditions for women in prisons as inhumane, filthy, overcrowded, poorly ventilated, and with inadequate hygiene and sanitation [ 6 , 16 , 21 , 33 – 45 ]. The African Union Special Rapporteur on Prisons, Conditions of Detention in Africa also observed similar poor conditions in seven SSA countries including Namibia, Uganda, Mozambique, Malawi; Cameroon, Ethiopia and South Africa [ 46 – 52 ].…”

“…Women prisoners constitute a minority of the prison population, and their special health needs relating to gender sensitivity, reproductive health, their children and particularly the treatment of infectious diseases are often neglected [ 2 ], unmet by prison health services and compromised by the dominant ‘male’ prison environment [ 3 , 4 ]. Generally, women have more specific health needs and conditions than male prisoners [ 5 , 6 ]. They subsequently incur a greater draw on health provisions in prison based health services compared to males [ 1 ].…”

“…Research activity on prison health is historically of low priority in the region. The gathering of strategic prison health information is generally restricted to infectious diseases such as HIV/TB, and primarily focused on incarcerated males, and with little direct consultation with women prisoners [ 6 , 18 , 22 – 25 ]. We aimed to address the need for a comprehensive overview on women prisoners’ health in the SSA region, by undertaking a comprehensive and systematic mapping exercise to establish what is currently known about women prisoner’s health, their health care experiences and their unique prison health care needs when incarcerated in SSA.Stan.…”

Promoting health and well-being in prisons: an analysis of one year’s prison inspection reports

“…WHO's strategic oversight has been a salient factor in ensuring that prison health is on the public health agenda of various nations (Gatherer, Møller, & Hayton, 2005). The majority of concerted effort has been undertaken in the European WHO region, with less political appetite for addressing the health of people in prison in other regions, such as North America (Woodall, 2018) and Africa (Dixey, Nyambe, Foster, Woodall, & Baybutt, 2015). While the intention of WHO is laudable, there have been critics who argue that the strategic philosophy of addressing prison health and actual implementation 'on the ground' is at considerable odds which has resulted in an uncoordinated global response (Woodall, 2016).…”

“…In other countries there has been far less activityin Norway and in Ireland, for instance, there are no dedicated policies for health promotion in prison (Macnamara & Mannix-Mcnamara, 2014;Santora, Arild Espnes, & Lillefjell, 2014) and in several Eastern European regions there is no resource for health promotion in prison (Macdonald, Rabiee, & Weilandt, 2013). In extreme cases, some countries in sub-Saharan Africa are reported to run prisons that are unjust, unhealthy, and sites of human rights abuses (Dixey et al, 2015). These differences often relate to resource allocation and, in some instances, ideological views on who is deserving or not in regard to health intervention.…”