By Marcella Alsan and Crystal Yang

The U.S. has one of the highest incarceration rates in the world, with over seven million admissions to jails each year. Incarcerated individuals are the only group in the U.S. that have a constitutional right to receiving "reasonably adequate" health care. Yet, there is little oversight and funding for health care in jails, where illness and mortality are rampant. In this study, we randomize the offer of health care accreditation to 44 jails across the U.S. Surveys of staff indicate that accreditation improves coordination between health and custody staff. We also find that accreditation improves quality standards and reduces mortality among the incarcerated, which is three times higher among control facilities than official estimates suggest. These health gains are realized alongside suggestive reductions in six-month recidivism, such that accreditation is highly cost effective.

NBER Working Paper 33357

Cambridge, MA: National Bureau of Economic Research, 2025. 54p.

By The LOUISIANA LEGISLATIVE AUDITOR

We evaluated the treatment of women incarcerated in Louisiana’s state and local correctional facilities. We conducted this audit in response to House Concurrent Resolution 104 of the 2023 Regular Session, 1 which requested that the legislative auditor audit whether state and local correctional facilities are following state law regarding the treatment of pregnant incarcerated females, and the general healthcare and treatment of all incarcerated females. According to a report issued by the National Conference for State Legislatures (NCSL) in 2022,2 even though there are still more men than women involved in our nation’s justice systems, the rate of growth of the women’s population has vastly increased, and between 1980 and 2019 the number of incarcerated women (in both jails and prisons) increased by more than 700%. According to this report, state and local government systems and facilities are predominately designed to handle men. Louisiana’s Incarcerated Female Population. Incarcerated females in Louisiana are housed in both state and local correctional facilities. The Department of Public Safety and Corrections (DPS&C), Division of Correction Services (DOC) oversees the custody and care of females (state offenders) serving a prison sentence for a felony conviction. DOC oversees one female correctional facility— Louisiana Correctional Institute for Women (LCIW). Out of the 64 parishes, 47 have local correctional facilities (local jails) that house females who are pre-trial or are serving sentences for non-felony convictions and usually a term of less than one year. In addition, some local jails house state offenders on behalf of DOC for a daily per diem of $26.39 per state offender. As of July 2024, there were 3,519 incarcerated females, with 1,582 being state offenders under DOC’s supervision. The purpose of this audit was to evaluate the treatment and care of incarcerated females in Louisiana. As of July 2024, 3,519 women were incarcerated in Louisiana. Of this number, 1,582 were state offenders under the supervision of the Department of Public Safety and Corrections (DPS&C), Division of Correction Services (DOC). The remaining 1,937 were local offenders housed in local jails. DOC oversees the state’s only correctional facility for females – the Louisiana Correctional Institute for Women (LCIW). LCIW’s capacity currently is 450. As a result, 1,132 female state offenders are housed in local jails on behalf of DOC at a cost of $26.39 per day per individual. Overall, we found that local jails lack sufficient procedures to comply with state laws related to the treatment of incarcerated women in Louisiana. Additionally, while LCIW generally provides sufficient access to basic medical and educational services for incarcerated women, similar access in local jails varies. We also found that incarcerated men in local jails receive more developmental opportunities than women. Specifically, we found that none of Louisiana’s local jails, which house 87.2% of incarcerated women in Louisiana, have sufficient, written procedures encompassing all requirements in state law regarding female incarceration. In addition, although prohibited in state law, at least three jails indicated leg irons were used on pregnant or birthing women housed in their facilities. Local jails also did not always sufficiently document the use of restraints for pregnant women and did not always advise pregnant women in writing of their rights related to the use of restraints. We found as well that Louisiana’s local jails do not sufficiently address the healthcare needs of incarcerated women during and following pregnancy or provide preventive health screenings to all women. We also found that local jails could better protect the dignity of incarcerated women by ensuring sufficient access to hygiene supplies and activities such as showering, as well as increased privacy during different states of undress. According to the U.S. Department of Justice, educational and vocational programming, recreational time, and visitation during incarceration can improve reentry outcomes. However, we found that access to these opportunities varies across correctional facilities, with female offenders often having less access than male offenders. In addition, LCIW is working to complete the construction of a new facility designed to house approximately 950 female state offenders, which is double its current capacity. LCIW expects that the new facility will be operational by late summer of 2025. The report contains our findings and recommendations. I hope this report will benefit you in your legislative decision-making process.

Baton Rouge, LA: LOUISIANA LEGISLATIVE AUDITOR, 2025. 47p.

By Evelyn F. McCoy, Azhar Gulaid

This study aimed to understand the state of reproductive health care access and quality in a jail in California after early stages of the implementation of Assembly Bill 732 (A.B. 732). A.B. 732 was passed in September 2020 with the goal of increasing reproductive health care access and quality for incarcerated people and pregnant incarcerated people in state prisons and county jails.

WHY THIS MATTERS

People in jail—especially women, nonbinary people, and transgender people—have specific and significant reproductive health needs. Most people in jail are in their peak reproductive years, have histories of physical and/or sexual violence, and enter jail with more significant reproductive health care needs than the general population. Incarcerated people are more likely than the general population to have STIs, human immunodeficiency virus, and viral hepatitis, as well as higher rates of cervical and breast cancer and irregular menstrual cycles. Unsanitary conditions in jail, coupled with limited access to reproductive health care, can worsen health outcomes for people in jail. Despite this, reproductive health and health care for incarcerated people, as well as policies implemented to improve these areas, are understudied and overlooked.

WHAT WE FOUND

Study participants experience significant delays between requesting services and delivery of services, and have even experienced nonresponsiveness after multiple medical requests.Study participants face significant challenges in the delivery and quality of care, including having medical staff who are inexperienced with basic medical procedures such as blood draws, having inconveniently timed procedures, and getting little to no follow-up or information after procedures.Study participants noted that they have experienced dismissiveness from medical staff, have needed to exaggerate requests as emergencies to receive care, and have even experienced mistreatment and punishment from staff.Most study participants shared that they have never received general information about reproductive health care or services and do not know what is available to them.Half of study participants shared that they do not feel comfortable or safe receiving services from jail medical staff. Discomfort comes from private medical information being discussed in jail common spaces and officers being present at medical appointments, including procedures that require undressing.Nearly a third of study participants have experienced bias or pressure from staff about reproductive decisions.Our study also identified findings in the following areas, as detailed in the report:preventive caremenstruation supportcontraceptive care and abortionpregnancy and postpartum carereentry preparation and parenting classes

HOW WE DID IT

We conducted semi-structured, individual, in-person interviews with 34 incarcerated people in a women’s jail in California to learn about their experiences accessing and receiving reproductive health care since A.B. 732 was passed.Washington, DC: Urban Institute, 2024. 83p.