Releasing Prisoners, Redeeming Communities. Anthony C. Thompson

federal sentence for conspiracy. In the cases she describes, LeBlanc helps us see that these young women were often only marginally involved in the actual drug trade.¹⁵ Too often, these women were trapped in abusive relationships in which their criminal activity occurred in the context of a relationship where they had little or no control. These women often had become involved in a relationship with an abusive partner and would experience considerable difficulty escaping that situation. For psychological and often economic reasons, the woman did not see an alternative and simply stayed in the abusive relationship despite the danger. If the abusive partner happened to sell drugs, for example, it was likely that the woman would have been aware of this activity, which technically made her a knowing coconspirator. However, the gap between having knowledge of illegal activity and having control over the choice to engage in this conduct is typically quite wide. Still, if the government charged her partner with drug conspiracy, she often faced charges as a coconspirator. Her knowledge of his illegal activity would often be enough for prosecutors to charge her, for a jury to convict her, and for a judge to sentence her to a mandatory prison term.¹⁶ One particular example of this that received considerable attention was the case of Kemba Smith. Before being pardoned by President Clinton, Kemba Smith was sentenced to twenty-four years in prison as a first-time offender.¹⁷ The prosecution conceded that Ms. Smith never handled, used, or sold drugs, but she was still subjected to full prosecution simply because of her relationship with an alleged drug dealer.¹⁸ Thus, growing numbers of women ended up in prisons across the country. African American women were incarcerated in numbers disproportionate to their representation in the population.¹⁹

      Much like their male counterparts, women often entered prison with a range of needs. However, the programs, facilities, and services available to women prisoners in this country’s dual prison system were inferior in number and quality to those offered to men. Complicating matters, the needs of women prisoners were, in many ways, unique to women. Unfortunately, prison facilities typically had not been designed with women in mind. Thus, programming in these facilities did not pay particular attention to health or mental health issues as they might affect women, did not specifically seek to address the cluster of legal and emotional issues related to the custody of minor children, and did not focus on helping these women develop or sharpen skills that they might need to become gainfully employed upon release.

      Even those features of prisons intended to address the perceived different needs of women ultimately had significant negative consequences. For example, women still tend to be placed in prisons located in rural settings, which are thought to be less harsh and psychically jarring for women than the concrete walls of an urban prison or jail. But placement in remote areas often means that women are housed at considerable distances from their families and friends. Particularly for women of color, whose families most often need to rely on public transportation, these remote locations present insurmountable distances. The lack of proximity increases the difficulty of maintaining ties and often leads to greater social dislocation. Women’s prisons also tend to be smaller in size and population. While in theory smaller prisons may signal greater safety, they also tend to receive less funding and less attention because so few people are housed there. Thus, women tend to have access to a more limited range of programs than are often available to men in larger prison settings.

      Further complicating this picture is the lack of attention being paid to the reentry needs of women now being released in record numbers. Policy makers have begun to consider the steps that government should address during the massive release of ex-offenders. But they still have not seriously considered differences for women in their planning. At a minimum, prison officials and reentry planners should consider health issues that women prisoners present as they attempt to gain a better understanding of their needs.

       B. Developing a More Complete Picture of Women’s Unique Health Issues

      Medical research has only recently focused on women’s health issues as an area of study distinct from men’s medical concerns. So perhaps it is not so surprising that prison and reentry policy makers have barely begun to recognize, let alone meet, the unique health needs of female prisoners and the formerly incarcerated in communities. Given the overwhelming numbers of women with serious health problems in custody, prison and reentry planners can no longer afford to ignore their needs. In fact, the numbers are startling. For example, women in prison are now more likely than men to be infected with HIV: 3.4 percent of female inmates are HIV positive compared to 2.1 percent of male inmates.²⁰ The HIV infection rates among females are predominantly related to injecting drugs, crack use, and prostitution for drugs, which should give prison planners a starting point for counseling. Along with higher rates of HIV infection, women are at greater risk for sexually transmitted diseases that can have long-term implications for their overall health. Many women in prison also suffer from tuberculosis and various strains of hepatitis.

      Apart from these chronic illnesses, women often have other health needs that go unattended as well. The Kaiser Family Foundation published information from its comprehensive 2001 Women’s Health Survey.²¹ In that important study, disparities in access to health care and the ability to receive treatment and services for women of color were detailed.²² One conclusion drawn from this literature suggests that if the physical problems women face as they are admitted to prison are not addressed while they are there, the problems are compounded when they are released into poor, urban communities.

      According to the Women’s Health Data Book,²³ nonfinancial factors —including the availability of needed health services in communities, transportation, child care, and the lack of culturally specific services—all combine with other factors to deprive low-income women of adequate health services. Lack of education, single-parent status, and access to—as well as utilization of—preventive health care services also play a significant role in the provision of health services to women of color.²⁴ In addition to physical health problems, a number of studies suggest that women in custody also have higher rates of depression and other mental health problems.²⁵ Often these mental health issues have not been diagnosed or treated. Women of color in custody are often victims of sexual and physical abuse. According to the United States Department of Justice, more than 50 percent of women in jail report that they have been the victims of physical or sexual abuse in the past, compared with 10 percent of men.²⁶ Without intervention, these women are likely to return to their abusive relationships upon release.

      Health problems can have a ripple effect in reentry planning and implementation. For women leaving prison with health problems, managing to engage in the behavior expected of a parolee may be difficult. They may experience difficulty keeping parole appointments. Quite obviously, health and mental health problems that remain unaddressed can interfere with anyone’s ability to obtain and maintain a job. When we add physical and mental health issues to the often overwhelming stress associated with regaining custody of children that they may have lost as a result of incarceration, the picture for women is even more troubling. It is this combination of health needs and the pressures of parental roles that weighs most heavily on the women ex-offenders and often guides their choices upon release—a factor too often ignored in examinations of the problems posed by reentry.

       C. The Challenge of Motherhood behind Bars

      Perhaps the most significant factor distinguishing women from their male counterparts relates to responsibility for their children. The average woman in prison had physical custody of a child before her incarceration. In the United States, approximately 2.1 percent of all children under the age of eighteen have parents in state or federal prison.²⁷ This means that 1.5 million children are affected by the lack of any coherent reentry policy. The majority of mothers currently incarcerated were the sole caretakers for their children prior to incarceration. Generally, when a father goes to prison the mother keeps the family intact. However, a number of studies show that when a mother enters prison, the father often does not remain involved in the caretaking of the children. One study of state prisoners in the late 1980s found that 67.5 percent of the women had minor children as compared with only 54.4 percent of males.²⁸ In 1986, “76% of women prisoners were mothers and nine out of ten of them had children younger than eighteen.”²⁹ While “some children live with a relative during their mother’s incarceration, many enter