14 Feb 07

The health of female prisoners who are drug users tends to improve during their time in prison, an Oxford University study has found.

Three-quarters of the 505 female prisoners studied by researchers from the Department of Public Health had used illegal drugs in the six months before imprisonment. These women saw their health improve in prison, which the researchers assume is both because of the reduced availability of drugs and because their lifestyle in prison was healthier than their life outside. 'Regular meals, consistent shelter and protection from violence by a partner or street violence were all things which many of these women were not getting in the outside world,' said Dr Emma Plugge, lead researcher. 'In interviews, women described the way in which acquiring drugs and maintaining their addiction had taken precedence in their lives to the detriment of almost everything else, including their health. Many were underweight and many had problems sleeping. These women led such chaotic lives outside prison that prison life was a respite. Their health improved as a result.'

At the end of April 2006 there were almost 77,000 people in prison in England and Wales. Women make up a small (but increasing) proportion of this population - less than six per cent - but have specific health needs which differ from those of male prisoners, such as gynaecological problems and pregnancy. The team studied 505 female prisoners, conducting questionnaires and interviews immediately on arrival in prison, after one month, and after three months (by which time the study population had fallen to 112 women).

For the study population taken as a whole, some health behaviours improved over three months in prison and others did not. The proportion of smokers remained the same but the amount smoked decreased; alcohol consumption and drug use decreased; and women were more likely to taking antidepressants or medication for high blood pressure. However, there was no improvement in exercise and diet, and no statistically significant change in rates of self harm.

'The most striking finding was just how poor the women's health was on arrival,' said Dr Plugge. Before coming into prison, 85 per cent of the study population smoked; 42 per cent drank alcohol in excess of the recommended amount; 75 per cent had used illegal drugs in the previous six months; 27 per cent had at some point been paid for sex; and 16 per cent had self harmed in the previous month. Just 13 per cent met government recommendations on exercise and diet. Eighty-three per cent reported a longstanding illness, and 73 per cent were taking some form of prescribed medication. Poor mental health, mainly depression and anxiety, was common.

The researchers noted that were it not for certain health issues - such as drugs or mental illness - many women may not have ended up in prison in the first place. 'It became clear that for many, prior health status was directly linked to offending,' said Dr Plugge. 'There was theft to finance chronic addiction, and offences directly linked to mental health problems.'

In interviews, some criticism of the health regime in prison emerged, with women citing poor hygiene, poor diet, few opportunities to exercise, and sometimes difficult relationships with custodial staff.

'There is a challenge to improve healthcare in prison and address some of the issues raised by the interviews with women - and this is already being tackled by the NHS working in partnership with the Prison Service,' said Dr Plugge. 'However, the bigger, yet largely unrecognised, challenge is addressing these women's health issues in the community, both before and after prison.'