Sexual and Reproductive Health Outcomes among Incarcerated Women in Canada: A Scoping Review

Abortion and contraception within prison health care: a qualitative study

BACKGROUND

Although abortion was completely decriminalized in Canada 36 years ago, barriers to pregnancy prevention and termination persist across the country, such as travel and information gaps. Research demonstrates incarcerated people face barriers to family planning care, yet there is no systematic data collection of sexual and reproductive health experiences and outcomes among incarcerated people in Canada. The aim of this study was to explore family planning care experiences among women and gender diverse people who have experienced incarceration in Canada.

METHODS

We conducted a qualitative community-based research study using focus groups for data collection and reflexive thematic analysis to generate key themes. Our study team included members with lived experience of incarceration. We conducted recruitment in partnership with community organizations. We asked about accessing abortion and contraception while incarcerated and on release.

RESULTS

We conducted six focus groups with 35 recently incarcerated participants. Five themes emerged: (1) Competing health needs; (2) Institutional barriers to care; (3) Mistreatment and unethical care; (4) Health knowledge gaps; and (5) Challenges to care-seeking in community.

CONCLUSION

People in prison experience concurrent unmet health needs that crowd out sexual and reproductive health. Prison procedures and perceived unethical professional behaviours impinge care-seeking. Information about abortion and contraception is not readily available in prison. Barriers to care persist upon release. Family planning professionals may improve care for people who experience incarceration by recognizing concurrent mental health needs; anticipating impact of prior negative experiences on care-seeking; challenging limitations to health education in prison; and addressing post-release challenges for patients.

Communicating sexual health to the incarcerated population: information dissemination in a US sample of inmate handbooks

Incarcerated individuals frequently enter prison with a history of high-risk lifestyle behaviours likely to contribute to the transmission of infectious disease. Prisons offer a unique setting in which to advance health equity to an underserved population by disseminating information and education. Sexual health education has the potential to mitigate negative health consequences in the incarcerated population and improve sexual health practices upon community re-entry, benefiting both incarcerated individuals and communities. Limited empirical research examines sexual health information and education in US correctional facilities. Handbooks, given to all people upon incarceration, have the potential to provide vital information and education to promote safe sexual practice and prevent disease transmission. This work, guided by 22 critical sexual health education recommendations from the US Centers for Disease Control and Prevention, examines the presence (or absence) of recommended sexual health information and guidance in prison handbooks. Handbooks (n = 74) from 49 of 50 US states were qualitatively analysed with results revealing limited information, education or guidance about sexual health/safe sexual practice during incarceration or afterwards. Utilising handbooks for comprehensive sexual education could be a critical step towards reaching members of an already at-risk underserved population.

Development and psychometric evaluation of the sexual and reproductive health needs of incarcerated women scale: a methodological study

BACKGROUND

This study aimed to develop and validate a comprehensive tool designed to assess the sexual and reproductive health (SRH) needs of incarcerated women.

METHODS

A methodological study was conducted from January to March 2023 in two female prisons in Tehran and Hamedan, Iran. The participant pool consisted of women who had been incarcerated for a minimum of 6 months and were aged between 15 and 49 years. The instrument development involved two phases. Phase I involved a literature review and interviews with incarcerated women to understand their SRH needs. Phase II assessed psychometric properties to establish the scale's validity and reliability.

RESULTS

The SRH Needs of Incarcerated Women (SRH-NIW) scale was refined, comprising 37 items across six domains: pregnancy and childbirth services, parenting services, family planning and sexual health services, personal and medical care services, screening services and infection control services. Exploratory factor analysis explained 66.15% of variance. The Content Validity Ratio and Content Validity Index were 0.8 and 0.94, respectively, indicating high content validity. Average Variance Extracted values ranged from 0.592 to 0.698. The whole scale showed a Cronbach's alpha of 0.823, and the Intra-class Correlation Coefficient was 0.879.

CONCLUSION

The SRH-NIW scale is a valid and reliable tool for assessing the SRH needs of incarcerated women. It can enhance healthcare services and interventions for incarcerated women, potentially leading to policy improvements within the prison system.

A qualitative exploration of the psychological needs of women survivors of rape in Iran

BACKGROUND

Rape is one of the principal forms of sexual violence leading to numerous psychological consequences for women. Providing effective psychological services to women survivors of rape requires identifying and considering their real needs. This study aimed to explore the psychological needs of women survivors of rape.

METHODS

In this exploratory-descriptive qualitative study, the participants consisted of 19 women survivors of rape and 20 people with experience in providing services to survivors of rape, selected via purposive sampling method in Isfahan, Iran. In-depth individual semi-structured interviews and field notes were used to collect data, which were then analyzed using the conventional content analysis method.

RESULTS

Based on the analysis of the interviews, the psychological needs of women survivors of rape were classified into three main categories: facing psychological problems, attention to emotional reactions, and the need to accept and adapt to reality.

CONCLUSIONS

The results revealed that women survivors of rape have different psychological needs. Thus, to meet these needs, supportive and psychological interventions can be considered at both individual and environmental levels. Also, eliminating gender stereotypes affecting the occurrence of rape in the dimensions of Iranian culture can lead to the liberation of the society from the culture of rape.

Community-based models of health care for women, trans and nonbinary people released from prisons: An international scoping review with implications for Canada

AIMS AND OBJECTIVES

To illustrate the scope of different types of transitional, community-based health interventions for formerly incarcerated women, trans and nonbinary people, the eligibility criteria for these interventions, and associated health outcomes.

BACKGROUND

Meeting the health needs of formerly incarcerated people in community, rather than through the criminal justice system, may prevent further experiences of criminalization. Research is needed to understand what community-based health interventions have been implemented internationally to inform the design of an intervention in Canada.

DESIGN

Scoping review using the Joanna Briggs Institute scoping review methodology.

METHODS

In consultation with a medical research librarian, key databases and journals were searched for English language articles, from any country, with no specified date range. Three authors independently screened titles and abstracts to identify articles for full-text review. The study adheres to PRISMA-EQUATOR guidelines.

RESULTS

Thirty-six studies met the present criteria and were reviewed in full text. Method, setting, participants, sample, relevant outcomes and relevant findings were extracted from each study for synthesis. Included studies had varied methods and were published from 1999 to 2020. Thirty-one studies were based in the United States, one in Puerto Rico and two each in Canada and the United Kingdom. The most common health issue focus was human immunodeficiency virus and/or hepatitis c virus. The most common outcome was uptake of offered services, such as a transitional clinic.

CONCLUSIONS

Gaps in the research pertain to a lack of attention to clinical outcomes and patient experience, and a lack of consideration of sexual and reproductive health concerns. Women were the minority population in all studies that included both men and women; transgender participants were mentioned in only four of thirty-six studies. The specific needs of women, trans and nonbinary people must be taken into consideration.

RELEVANCE TO CLINICAL PRACTICE

Nurses must be conscious of the elevated health risks associated with exposure to correctional institutions and the risks associated with the period of transition.

PATIENT OR PUBLIC CONTRIBUTION

A member of the research team brings lived experience expertise with respect to the criminal justice system.

General and reproductive healthcare experiences of formerly incarcerated women in the United States: a qualitative study

PURPOSE

The US prison population has recently reached an all-time high, with women representing the fastest growing subpopulation. Correctional health-care system in the USA remains fragmented and nonuniform in practice, particularly in women's health care, with poor transitions between incarceration and release. This study aims to examine the qualitative health-care experiences of women while incarcerated and their transition into the community health-care setting. Additionally, this study also examined the experiences of a subset of women who were pregnant while incarcerated.

DESIGN/METHODOLOGY/APPROACH

After obtaining institutional review board approval, adult, English-speaking women with a history of incarceration within the past 10 years were interviewed using a semi-structured interview tool. Interview transcripts were analyzed using inductive content analysis.

FINDINGS

The authors completed 21 full interviews and identified six themes that were both the most significant and most novel: "feeling stigmatized and insignificant," "care as punishment," "delay in care," "exceptions to the rule," "fragmentation of care" and "obstetric trauma and resilience."

ORIGINALITY/VALUE

Women face numerous barriers and hardships when accessing basic and reproductive health-care services while incarcerated. This hardship is particularly challenging for women with substance use disorders. The authors were able to describe for the first time, partially through their own words, novel challenges described by women interacting with incarceration health care. Community providers should understand these barriers and challenges so as to effectively reengage women in care upon release and improve the health-care status of this historically marginalized group.

Effect of a board game on imprisoned women's knowledge about sexually transmitted infections: a quasi-experimental study

INTRODUCTION

Board games can be used as a playful educational practice in the teaching and learning process, as they constitute an educational technology that can be a source of health knowledge and an aid in decision-making. The objective of this research was to assess the effect of a board game on imprisoned women's knowledge about STIs.

METHODS

A quasi-experimental study was conducted in 2022 with 64 imprisoned women who were students at a school located in a prison unit from the city of Recife, state of Pernambuco, Brazil. A 32-item instrument was used to assess knowledge about sexually transmitted infections before, immediately after the intervention and at 15 days. The intervention consisted in applying the Previna board game in a classroom. All the analyses were performed in the Stata software, version 16.0, with a 5% significance level.

RESULTS

The knowledge mean in the pre-test was 23.62 (± 3.23) points, whereas it rose to 27.93 (± 2,28) in the immediate post-test, dropping to 27.34 (± 2.37) (p < 0.001) in post-test 2, which was performed 15 days after the intervention. There was a statistically significant difference in the means obtained between the pre-test and the immediate post-test (p < 0.001), with a difference of 4.241 points, as well as between the pre-test and post-test 2 (p < 0.001), a difference of 3.846 spots.

CONCLUSIONS

The Previna board game significantly increased its players' knowledge about STIs, and such increase in knowledge remained significant during the follow-up period.

"They look at you like you're contaminated": how HIV-related stigma shapes access to care for incarcerated women living with HIV in a Canadian setting

OBJECTIVES

Given the gender disparities in HIV outcomes for women living with HIV (WLWH) who experience incarceration, and the impact of HIV-related stigma on HIV care, this qualitative study investigated how HIV-related stigma within prison settings shapes HIV care for WLWH.

METHODS

Drawing from SHAWNA (Sexual Health and HIV/AIDS: Women's Longitudinal Needs Assessment), a community-based research project with cisgender and transgender WLWH in Metro Vancouver, peer and community interviewers conducted 19 qualitative interviews (May 2017-February 2018) with recently incarcerated WLWH focused on factors that shape incarceration trajectories. Drawing on socio-ecological frameworks and using participatory analysis, this analysis sought to characterize how HIV-related stigma shapes experiences and access to care for incarcerated WLWH.

RESULTS

Participants' responses focused predominately on experiences in provincial correctional facilities and the ways through which HIV-related stigma within correctional settings was linked to access to HIV care. Experiences of HIV-related stigma within prisons led to isolation and discrimination for WLWH which was reinforced through institutional processes, compromised privacy, and uncertainty about confidentiality. Experiences of HIV-related stigma informed decisions for some participants to withhold HIV status from healthcare staff, compromising access to HIV treatment during incarceration.

CONCLUSION

Amid ongoing efforts to improve healthcare delivery within Canadian correctional facilities, these findings have important implications for the provision of HIV care for incarcerated WLWH. Culturally safe, trauma-informed programming focused on reducing HIV-related stigma, improved communication regarding medical privacy, and interventions to change processes that compromise privacy is critical to improve healthcare access in correctional facilities.