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Growing evidence indicates that women in prison are particularly vulnerable to many negative health outcomes, including cervical cancer. The Papanicolaou (Pap) test is an effective tool to screen for this disease. To determine what is and is not working with the Pap test and follow-up treatment, we performed qualitative interviews with women prisoners and key informants at a California state women's prison. Our assessment revealed that the process of administering Pap tests at this institution was not meeting the health care needs of the women interviewed.
Women reported having negative experiences during the test and with their health care providers. Additionally the prison's culture and infrastructure create obstacles that hinder prisoners from receiving quality care and providers from delivering that care. In response, women prisoners use selfand community advocacy to meet their health care needs and cope with these challenges. (Am J Public Health. 2005;95:1712-1717. doi:10.2105/AJPH.2005.063677)
WOMEN IN PRISON HAVE unique reproductive health needs stemming from a variety of health matters.1-4 Although specific data on the rates of cervical cancer among women in US prisons are not available, a confluence of factors place women in prison at high risk for this disease. First, compared with the general population, women in US prisons have high rates of substance abuse and mental health problems and a higher incidence of communicable diseases such as HIV, hepatitis C, and sexually transmitted infections.3,5-7 Second, many of these women had limited access to quality primary and preventive health care before they were incarcerated.2,6,7
Finally, the race and ethnicity of women prisoners are contributing risk factors for cervical cancer. Although African American and Latina women represent just over a third of the women in the general population of California, they comprise over half of all women in California state prisons.8,9 The incidence and mortality rates for cervical cancer in US women of color are higher than they are for White women.10 Within California, Latina women have the highest incidence of cervical cancer among all ethnicities, and African American women have disproportionately high mortality rates.11
Quality, effective public health practice requires that preventive health care be coupled with clinical treatment. The controlled environment of correctional facilities presents a unique opportunity to provide quality screening and preventive health care, as well as appropriate...