Behind Bars, Beyond Care: The Bioethics of Healthcare for Incarcerated Women

Writer: Niharika Ojha

Editor: Kimberly Arinton

“A prison sentence takes away a person’s liberty; it should not also take away their health and their right to health,” - Dr Bente Mikkelsen, director of the Division of Noncommunicable Diseases and Promoting Health through the Life-course at WHO EURO.

In the United States, women are the fastest-growing incarcerated population. Yet while conversations about prison reform often focus on sentencing and reentry, one issue remains disturbingly overlooked: the healthcare of incarcerated women. Behind bars, women face unique and pressing health needs – — from reproductive and menstrual care to mental health and chronic disease management. Too often, those needs are neglected, raising profound questions of justice, autonomy, and human dignity.

Bioethics prompts us to consider how values such as justice, autonomy, beneficence, and nonmaleficence apply in healthcare. In the context of prisons, the ethical tension becomes especially clear: incarceration restricts freedom – —freedom of movement, choice, and bodily autonomy – —but it should not strip away a person’s fundamental right to healthcare. A just incarceration system would recognize that while individuals lose certain liberties, they should not lose access to timely, preventive, and humane medical care.

For incarcerated women, neglect often begins with the basics, such as inconsistent access to menstrual hygiene products (Ziazadeh, D). Pregnant women sometimes give birth while shackled, a practice condemned by medical associations but still reported in multiple states (Yearwood, L. T.). Preventive screenings for breast or cervical cancer are limited, and mental health services are scarce despite many incarcerated women being survivors of trauma, abuse, and addiction.

The principle of justice demands that healthcare resources be distributed fairly. But women in prison – disproportionately from poor and minority backgrounds – face a system stacked against them long before they enter a cell. Once incarcerated, these inequities deepen. A woman serving time for a nonviolent offense may find herself unable to access the same standard of prenatal care that she would receive outside. This raises a critical question: if society takes responsibility for someone’s freedom, doesn’t it also bear responsibility for their health?

Healthcare in prison also challenges the principle of autonomy. Can a woman truly consent to treatment if her choices are constrained by her environment? History reminds us of troubling abuses, from coerced sterilizations in prisons to the lack of informed consent around mental health treatment. Even today, many incarcerated women lack meaningful access to contraception or reproductive choice. Ethical care requires not just offering treatment, but ensuring that women can make informed, voluntary decisions about their bodies.

“Do no harm” is a cornerstone of medicine, yet harm often comes from neglect. Untreated infections, ignored mental health crises, or delayed obstetric care can have lifelong consequences. At the same time, providing adequate care has the potential to break cycles of suffering. Beneficence in this context means designing prison healthcare to reduce harm, promote health, and treat incarcerated women not as problems to be managed, but as patients deserving of compassion.

Perhaps the most profound ethical principle at stake is dignity. International standards, like the United Nations Bangkok Rules, emphasize the importance of addressing incarcerated women’s specific healthcare needs. Yet in the U.S., the prison system often prioritizes punishment over healthcare. Denying adequate care effectively signals that once a woman is incarcerated, her dignity is forfeited. But healthcare is not a privilege –— it is a right, one that persists regardless of legal status.

The neglect of incarcerated women’s healthcare is not just a logistical failure; it is a moral one. Prisons were designed to restrict liberty, not humanity. If bioethics calls us to uphold standards of justice, autonomy, beneficence, and dignity, then ignoring the unique healthcare needs of incarcerated women violates them all.

Healthcare behind bars should not be an afterthought. It should be a reflection of our values –— that even when liberty is lost, humanity should not be.

References:

1. World Health Organization Europe. (2019, November 21). Ignoring prison health can come at a cost for public health. Health Policy Watch. https://healthpolicy-watch.news/ignoring-prison-health-can-come-at-a-cost-for-public-health/ 

2. Yearwood, L. T. (2020, January 24). Pregnant and shackled: Why inmates are still giving birth cuffed and bound. The Guardian. https://www.theguardian.com/us-news/2020/jan/24/shackled-pregnant-women-prisoners-birth

3. Ziazadeh, D. (2019, May 30). Inadequate health care: A significant problem affecting incarcerated women. University of Michigan School of Public Health. https://sph.umich.edu/pursuit/2019posts/inadequate-healthcare-a-significant-problem-affecting-incarcerated-women.html