New Study Finds Incarceration History Prevents Black Women from Accessing Healthcare

Formerly incarcerated Black women—most of whom are survivors—need trauma-informed, community-based approaches to healthcare to effectively address their needs and honor their experiences.

 

FOR IMMEDIATE RELEASE

November 29, 2023

NEW YORK— Today, the National Black Women’s Justice Institute released a groundbreaking study examining how formerly incarcerated Black women access healthcare services, the barriers they face in trying to access those services, their healthcare needs, and the impact of incarceration on their health.

More than 230,000 women are incarcerated in the United States. Black women are not only disproportionately incarcerated, but they also tend to experience worse health outcomes compared to white and Hispanic women. 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.

This study, Pathways to Wellness: Health Needs of Black Women After Incarceration, from the National Black Women’s Justice Institute investigated how race, gender, health, and incarceration 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. Very few studies explore the intersections of these categories and how they interact. Researchers at the National Black Women’s Justice Institute conducted in-depth interviews with 21 formerly incarcerated Black women across the state of California.

“Black women are not only disproportionately incarcerated, but they also tend to experience worse health outcomes compared to white and Hispanic women, primarily driven by systems of oppression. Yet, despite wanting and trying to access the healthcare they need, Black women face unnecessary barriers and receive little support in getting the care they need,” said Dr. Sydney McKinney, executive director of the National Black Women’s Justice Institute and report co-author. “I am thankful for the candor, vulnerability, and trust of the women who participated in this study. They courageously shared their stories with us and, in doing so, helped us shed light on the critical needs of formerly incarcerated Black women, who are often ignored. This study is an important step toward enhancing and increasing the availability of reentry services that advance the health, wellness, safety, and healing of formerly incarcerated Black women and girls.”

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.

Other key findings

• About 67% of women in the study reported a mental illness, substance use disorder, or both, which they directly connected both to traumatic experiences before incarceration and to the exacerbating effect of the carceral environment itself. Once released from incarceration, these women sought or are seeking mental health and medical care providers who they can trust, who are attentive, and who seek to understand their reentry journeys.
  

• More than 75% of the women in the study reported having a chronic health condition. Nearly 25% 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, such as hypertension, diabetes, and high cholesterol.
  

• 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.
  

• Limited pre-release planning hindered women’s ability to access healthcare after leaving confinement, despite health insurance coverage being strongly associated with reduced rearrest rates among women. 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.
  

• Inequities in access to quality health services, healthy food, and opportunities vary by geographic location. Therefore, the location where women were released or paroled played a role in their ability to access health care—from the quality and availability of healthcare providers to access to fresh food.
  

• 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.

“This report confirms the need for what women and trans people of all genders are fighting for with the Sister Warriors Freedom Charter—including the right to make our own medical care decisions and to access quality medical care, and the right to access cultural, holistic, and professional methods of healing from the trauma we’re exposed to before, during, and after system-involvement,” said Jessica Nowlan, President of Reimagine Freedom and advisor to the study. “This report clearly outlines the need for us to have to assert these rights. We’ve long known among ourselves that incarcerated and formerly incarcerated women’s health needs and desires are overlooked, but I’m grateful to see this issue investigated and highlighted with such dignity and respect.”

Women in the study detailed experiences of inadequate and neglectful care, which they described as resulting from racial and gender bias, stigma related to drug use and their conviction histories, and the perception that Black women don’t feel pain. These biases and stigmas resulted in treatment delays, a lack of follow-up, and misdiagnoses during confinement, which worsened health outcomes.

"This study is a step in the right direction for a long overdue empathetic response to the toll the criminal justice system has taken on Black lives, including Black women,” said Dr. Marilyn Jones, advisor to the study and executive director of Because Black Is Still Beautiful, which works to dismantle historic perceptions, practices, and policies that negatively affect criminal justice impacted Black women. “Black women with histories of incarceration face a trifecta of discrimination (gender, race, criminal record), which takes a toll on our physical and mental health. The process of incarceration adds another layer of oppression in the form of a lack of freedom of movement and speech.  All of these factors affect wellness. To some degree, prison and wellness are oxymorons just based upon the conditions for living in prison as an adult. An optimal solution would be to reduce the number of us incarcerated and launch a wellness campaign from the streets for the rest of us. In the meantime, we need more research like this study to inform what evidence-based healthcare and practices look like for Black women both inside and outside of bondage; neither is fair. We need more research that seeks to see what we value, and that values us. This is scarce in the criminal justice literature. I feel blessed to witness the narrative shifting." 

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 full report is available at https://bit.ly/PathwaysToWellnessStudy.

# # #

The National Black Women’s Justice Institute (NBWJI) conducts research, elevates Black women’s experiences, and educates the public about innovative, community-led solutions to address the criminalization of Black women and girls. NBWJI aims to dismantle the racist and patriarchal U.S. criminal-legal system and build, in its place, pathways to opportunity and healing. The National Black Women’s Justice Institute envisions a society that respects, values, and honors the humanity of Black women and girls, takes accountability for the harm it has inflicted, and recognizes that real justice is healing. For more information, visit www.nbwji.org.