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Women's Health in Prison in the Northern Dimension Area

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Women's Health in Prison in the Northern Dimension Area Northern Dimension Partnership in Public Health and Social Well-being NDPHS Expert Group on Prison Health Thematic Report Women’s Health in Prison in the Northern Dimension Area NDPHS Series No. 3/2008 Northern Dimension Partnership in Public Health and Social Well-being (NDPHS) NDPHS thematic report: Women’s Health in Prison in the Northern Dimension Area The views reflected in this paper are those of the members of the NDPHS Expert Group on Prison Health who have developed it and should not, therefore, be interpreted otherwise. If specific country data are not available in this report, this is because the authors were either unable to obtain it or did not receive permission to publish this data. Editors: Ingrid Lycke Ellingsen, Elo Kocys and Maxi Nachtigall Pictures: Juerg Christandl, Amy Allock Maps: NDPHS, Nordic Council of Ministers This paper may be freely reproduced and reprinted, provided that the source is cited. It is also available on-line in the Papers’ section of the NDPHS Database at http://www.ndphs.org/?database,view,paper,19 View our website at www.ndphs.org and keep an eye on policy developments and explore the world of the NDPHS – a partnership committed to achieving tangible results! Further information: NDPHS Secretariat Strömsborg P.O. Box 2010 103 11 Stockholm, SWEDEN Phone (switchboard): +46 8 440 1920 Fax: +46 8 440 1944 E-mail: [email protected] The paper arises from the project “NDPHS Project Database” which has received funding from the European Union, in the framework of the Public Health Programme. The sole responsibility for that document lies with the NDPHS Expert Group on Prison Health. The Public Health Executive Agency is not responsible for any use that may be made of the information contained therein. 1 CONTENTS I. Executive Summary 1. INTRODUCTION……………………………………………………………………………….05 1.1 Women in Prison - a vulnerable group……………………………………....................08 1.2 Background…………………………………………………………………......................09 1.3 Gender Equality in Prison Health……………………………………….........................10 1.4 Report guidelines…………………………………………………………………………..10 1.5 Expected outcomes………………………………………………………........................12 2. LEGAL BACKGROUND.................................................................................................13 2.1 Legal background of health services in prisons……………………… …....................13 2.2 Regulations on women’s health in prison…………………………… …......................16 2.3 Regulations on work and education in prisons……………………… ….....................20 3. WOMEN’S HEALTH IN PRISON IN THE NORTHERN DIMENSION AREA…………………………………………………………………………………………….23 3.1 The prison health situation in the ND area………………….…………………………..23 3.2 Female prisoners in the ND area………………….……………………........................26 3.2.1 Age……………………………………………………………………............................28 3.2.2 Organization of medical service within penitentiaries in the ND area…………….…………..….…………………………………………….28 3.2.3 In practice within the ND area: General Health...…..……….……………….29 3.3 Main health problems encountered by women in ND area prisons ………………….30 3.3.1 HIV/AIDS…………………………………………………………......................30 3.3.2 HIV positive pregnant women in prison.………………………………………33 3.3.3 In practice within the ND area..………………………………………………...34 3.4 Tuberculosis (TB)……………………………………………………………....................36 3.4.1 In Practice within the ND area: TBC/ HIV...……………………....................38 4. PREGNANT WOMEN AND MOTHERS IN PRISON…………………………....................40 4.1 Pregnant women in custody………………………………………………......................41 4.1.1 Women in prison who are accompanied by their children ……………………...42 4.1.2 In practice within the ND area...……………………..………………....................44 4.2 Women with children outside the prison – social well-being and prevention measures……………………………………………………………………......................47 4.2.1 In practice within the ND area..………………………………………………...51 4.3 Criminal behaviour of youths………..…………………………………..........................52 2 5. SOCIAL REHABILITATION AND PRE-RELEASE TRAINING……………......................55 5.1 Background…………..………………………………………………………....................55 5.2 In practice within the ND area: Estonia – a case study...…………….........................59 5.2.1 Individual Sentence Plan……………………………………….......................59 5.2.2 Employment……………………………………………………………………...59 5.2.3 Education in prison……………………………………………………………...60 5.2.4 Rehabilitation Programmes…………………………………….......................61 5.2.5 Preparation for release…………………………………………......................62 5.2.6 Anger management………………………………………………....................63 5.3 VINN (WINNING) a good practice in social rehabilitation from Norway……………..65 5.4 NGO’s involvement………………………………………………………………………...66 5.4.1 In practice within the ND area..…………………………….…………………..67 5.5 Alternative measures to prisons for non-violent offences:……………………………..70 5.5.1 In practice within the ND the area...…………………………………………...71 6. RECOMMENDATIONS…………………………………………………………......................73 Appendix I List of references………………………………………………………......................76 Appendix II Questionnaire……………………………………………………………....................86 Appendix III Index of Tables and Maps…………………………………………………………….89 3 I. EXECUTIVE SUMMARY In the countries of the Northern Dimension (ND) area, the penal system presents a section of the society where major health problems are concentrated. For those who have to spend a shorter or longer time, or even a life-time, in prison, aspects of prevention and treatment for many complicated health problems become as crucial as the provision of rehabilitation and reintegration programmes for inmates, which are intended to help them ease back in society after their release. The spread of communicable diseases occurs predominantly between persons from marginalised groups who that live under harsh socio-economic circumstances, and consequently, many of which enter the penal system. There are also obvious connections between social disparities, mental health problems, drug use, infectious diseases, crime and imprisonment. Thus, it is necessary to extend the scope of joint work concerning penal systems in the Northern Dimension area to cover not only communicable diseases but also prevention and the better treatment of psychiatric disorders, the treatment and rehabilitation of drug addicts, improved custodial conditions for inmates, training for prison staff and strengthened co-operation between the prison system and the civil and social services in general. Female prisoners, and among them, women who are pregnant or caring for small children, constitute an extremely vulnerable group within the prison population. Therefore, this Thematic Report will focus especially on challenges faced by this group. Taking the health issues of women in prison into account, this Thematic Report developed by the Northern Dimension Partnership in Public Health and Social Well-being (NDPHS) Expert Group on Prison Health (PH EG) will examine how women’s health in prison is organized and whether health care and social well-being in prison is being adequately adjusted to women’s needs. It seeks to give recommendations to implement gender equality in the field of prison, including in the approach and assessment of prison health services. 4 CHAPTER 1 INTRODUCTION Photo by Juerg Christandl “It is a fundamental human right of everyone, including prisoners to the enjoyment of the highest attainable standard of physical and mental health. The state has a particular responsibility towards prisoners, as their loss of liberty means that the primary responsibility for their health then falls on the prison administration. Not only do prison authorities have a responsibility to provide medical care, they must also establish conditions which promote the well-being of prisoners and staff. Prisoners should not leave prison in a worse condition than when they entered.” (OHCHR 2006) In the countries of the Northern Dimension (ND) area, as in all other countries, the penal system presents a section of the society where major health problems are concentrated. “The obvious purpose of a prison sentence is to punish the offender and to prevent her/ him from re- offending” (NDPHS Working Plan 2007-2008). However many former prisoners return to committing crimes after being released, creating a vicious circle of punishment and re-offence. For those who have to spend a shorter or longer time, or even a lifetime, in prison, aspects of prevention and treatment for many complicated health problems become as crucial as the provision of rehabilitation and reintegration programmes for inmates, which are intended to help them ease back into society after their release. The spread of communicable diseases occurs predominantly between persons from marginalised groups who live under harsh socio-economic circumstances, and consequently, many of which enter the penal system. There are also obvious connections between social disparities, mental health problems, drug use, infectious diseases, crime and imprisonment. Thus, it is necessary to extend the scope of joint work concerning penal systems in the Northern Dimension area to cover not only communicable diseases but also the prevention and better treatment of psychiatric disorders, the treatment and rehabilitation of drug addicts, improved custodial conditions for inmates, the training of prison staff, as well as the strengthened co-operation between the prison system and the civil and social services. “With an ever increasing inmate population,
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