Introduction: The Chief Medical Officer for England's 2025 annual report provides a timely and comprehensive examination of the health of people in prison, on probation, and within the secure NHS estate in England, with welcome and necessary attention to the specific needs of women and families. Although women represent a small proportion of those in custody or under probation supervision, their health and social needs are disproportionately complex, often shaped by high rates of trauma, poor mental health, substance use, and experiences of abuse. Purpose: This commentary reflects on the report's findings in relation to experiences of ongoing research evaluating health and wellbeing outcomes for justice-impacted women. Findings: There are considerable challenges to engaging women on probation in research; workforce shortages, service restructuring, and well-intentioned gatekeeping constrain participation and illuminate wider systemic pressures within probation services. These barriers echo the health access challenges faced by women themselves, underscoring the need for better-resourced, justice-informed pathways. Conclusions: Aligning policy ambitions with operational realities, and resourcing collaborative research at ground level, are essential to reducing health inequalities among women under HMPPS supervision.

BACKGROUND:At the end of 2024 over 3,500 women were living in prison in England, many of whom have experienced prior trauma and domestic abuse and are more likely than men in prison to self-harm. Compared to women living in the community, they also have higher levels of social care needs, yet little research has been conducted to explore social care provision for this population. METHODS:We conducted surveys of healthcare managers and governors in eleven women's prisons in England and their corresponding nine local authorities (LAs), to establish how they addressed their responsibilities for women with social care needs eight years on from the 2014 Care Act. Numerical and pre-coded data were analysed in Microsoft Excel using simple descriptive methods (e.g., frequencies, percentages). Descriptive qualitative analysis was used on free-text data. FINDINGS:The LA survey was completed by 9/9 LA staff; the prison governor survey by 8 staff (representing 10/11 prisons); and the healthcare manager survey by 7/11 staff. Considerable variation was found between establishments in Care Act assessment rates (1% to 36%). Some prisons relied on prison officers or peer supporters who had not received adequate training/supervision to identify social care needs, although all respondents agreed that social care provision had improved since the Care Act. There was less agreement regarding arrangements for transferring assessments between LAs on release. Qualitative analysis provided insight into this and other problems, including identifying women with social care needs; transferring information; gaining access into the prison; and resolving disputes/disagreements between LAs. Several proactive initiatives to improve identification/provision, and promote wellbeing, were described (e.g., regular drop-ins; scoping the use of telecare; linking with external agencies (e.g., neurodiversity and sensory services); an enablement/reablement pathway; and advocacy). CONCLUSION:This paper is the first to explore social care provision for women in prison in relation to the 2014 Care Act. Although provision has grown and improved since the implementation of the Act, it is patchy and often suboptimal or "gets forgotten". Potential ways forward include standardised, flexible screening processes; gender-specific adaptation of screening/assessment tools; and social care training and supervision for officers and peer supporters.

"Women who are incarcerated often fall through the cracks in terms of health care that meets their unique health and social needs. In correctional systems largely designed with men in mind, and with health outcomes worse than both men in prison and women in the general community, it is a population that needs particular attention. This is why research on the health of women who are incarcerated is so important." - Jessica Gaber, Guest Editor of the Special Collection Research on the Health of Women who are Incarcerated: The Scope of the Field and Why It Matters While women who are incarcerated make up a smaller proportion of the overall incarcerated population than men, their incarceration rate is increasing at a faster rate globally. Because this proportion of women who are incarcerated is smaller, women are in systems and individual institutions that are largely designed with men in mind. There are unique considerations needed for the health and wellbeing of women in carceral settings, affected by a range of sources including health and social outcomes that women encounter, biological outcomes that people assigned female at birth may encounter, and other health-related issues specific to people who are incarcerated in carceral settings for women. This talk, which accompanies the Special Collection on the Health of Women Who Are Incarcerated, will review the status of the research being done in this field, and why it matters. Health of Women who are Incarcerated: The Scope of the Field and Why It Matters How can we ensure the ethical conduct of health research in detention settings? This talk looks at how soon-to-be-published international guidelines on the conduct of ethical health research in prisons and other detention settings were developed and highlights some key aspects of the guidelines. Health conditions among women in prisons Despite rapidly rising incarceration rates, the health needs of women in custody are overlooked. We conducted a global systematic review to summarise the current evidence on the health of women in prisons around the world.

[This corrects the article DOI: 10.1371/journal.pone.0329131.].

Introduction Each year, approximately 17 000 children will have a mother who is imprisoned in England and Wales. The impact of maternal vs paternal imprisonment is very different; the negative health consequences on children are likely to be much greater if a mother is imprisoned. The number of children affected by non-custodial justice involvement is likely to be far greater given the higher number of women under probation supervision. However, no official statistics or estimates are collected for this population. The purpose of the CHAMPION (children whose mothers are involved in the criminal justice system in Dorset & Hampshire, UK – developing health and social care outcome indicators) study is to develop a better understanding of the evidence of the impact of maternal contact with the CJS (Criminal Justice System) on children and to establish a set of core outcome indicators for monitoring and evaluating affected children’s health and well-being.Methods and analysis (i) A scoping review of the health impacts of maternal vs paternal imprisonment, (ii) qualitative focus groups and interviews with adults whose mother was imprisoned when they were children and children of mothers who have either been or currently are in prison or have received community order sentences. Qualitative interviews with a range of professionals working with these children, (iii) an outcomes workshop with justice-involved mothers and professionals working with the children and families of justice-involved mothers, and adult children who experienced maternal imprisonment.Ethics and dissemination Ethical approval from the University of Southampton’s Faculty of Medicine Review Panel (Ref: 76946) and His Majesty’s Prisons and Probation Service (HMPPS) National Research Committee (Ref: 2023-135). Publishing in peer-reviewed journals, presenting at research conferences, round table events and community-based workshops. The study’s peer researchers and lived experience leaders will enable the dissemination of findings beyond academic audiences and policy makers to third sector CJS organisations and individuals with lived experience.

The number of older women imprisoned is increasing around the world, leading to an increased demand on health and social care services within prisons. Imprisoned women are considered older by age 50 as they experience a disproportionate burden of cancer and disease. Access to prison cancer screening programmes in prison should mirror access in the community; however, this is not always the case. The purpose of this scoping review is to systematically review the literature relating to enablers and barriers of cancer screening programmes in imprisoned older women. We performed a scoping review using the Arksey and O’Malley framework. Twelve studies were identified. Locations of studies varied across high-income countries. Enablers and barriers were identified within operational, personal, and accessibility categories. To improve mortality relating to cancer diagnosis it is vital that older imprisoned women are supported to access cancer screening. It was identified that older imprisoned women have different needs to other prison populations, and the barriers and enablers identified relate to staffing, communication, peer support, and processes to improve the experience of the older prison population. There is limited research in this area, and older women are a minority in a marginalized prison population. More research is needed to ensure the appropriate and effective development of cancer screening services.

Background People living in prison (PLP) are at increased risk of vaccine-preventable diseases due to overcrowding, high turnover, and limited healthcare access. Vaccination is a cost-effective preventive intervention, yet coverage in prisons remains inconsistent and frequently absent from national immunisation strategies. Objective To develop evidence-based guidance to strengthen vaccination services in prisons, ensuring equity, continuity of care, and alignment with international public health standards. Methods The EU-funded RISE-Vac project employed a multistage approach, including two systematic reviews, a cross-country survey in 20 European states, stakeholder interviews, and focus groups. Evidence from these sources was triangulated within a dedicated database and synthesised into five domain-specific working documents, structured by public health objective, target population and modality of vaccine offer. Draft guidance was validated through a structured consensus process with a multidisciplinary expert panel (n = 27) and refined through two rounds of remote revisions. Results Key facilitators identified include integration of vaccination within prison health services, staff training, peer-led approaches, clear governance and financing, and interoperable health information systems. An incremental model of service delivery was proposed, ranging from a minimum package aligned with community standards to an expanded offer addressing the heightened health needs of PLP. This model encompasses catch-up and seasonal vaccination, cancer-preventing vaccines, and tailored interventions for specific risk groups, with continuity of care post-release as a central component. Conclusions Strengthening prison vaccination requires an incremental, person-centred model that integrates vaccination into routine prison healthcare, is supported by trained staff, peer-led initiatives, dedicated governance, and interoperable health information systems, and that addresses five priority domains, from catch-up and cancer-preventing vaccination to continuity of care after release. Embedding this model within national immunisation strategies can prevent outbreaks, reduce health inequities, and protect both PLP and the wider community.

BACKGROUND:Bacterial sexually transmitted infections (STIs) are common among people in prison, a population identified by WHO as a key group to addressing the burden of sexually transmitted and blood-borne infections worldwide. To inform elimination efforts, we aimed to estimate the global prevalence of bacterial STIs (chlamydia, gonorrhoea, and syphilis) in prisons and other closed settings. METHODS:We conducted a systematic review and meta-analysis by searching online databases (MEDLINE, Embase, Global Health, PsycInfo, CINAHL, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, Global Index Medicus, the Conference Proceedings Citation Index-Science, and the Conference Proceedings Citation Index-Social Sciences & Humanities) and reference lists for studies published from Jan 1, 2000, to Aug 5, 2025. We included peer-reviewed publications (scientific articles, conference abstracts, and technical reports) that reported on the prevalence of current chlamydia, current gonorrhoea, or current or previous syphilis infections, confirmed by validated diagnostic assays, among incarcerated populations (adolescents aged 10-19 years and/or adults aged >19 years). Two reviewers (GB and BH) independently assessed studies, extracted data, and evaluated the quality of studies using an adapted version of the Joanna Briggs Institute critical appraisal tool for prevalence studies. Pooled prevalence estimates for each bacterial STI were derived with use of generalised linear mixed-effects models, stratified by age group and, within each age group, by sex. Heterogeneity was quantified based on the I2 statistic and χ2 test. This systematic review and meta-analysis was registered with PROSPERO, CRD42023443370. FINDINGS:The search generated 5237 records, of which 212, corresponding to 206 unique studies, met the eligibility criteria and were included. Of the 206 studies, 137 included adults only (n=425 215), 53 included adolescents only (n=342 762), and 16 included both (n=675 119). 190 (92·2%) studies were conducted in high-income or upper-middle-income countries. Across the 206 studies, data were available for 1 443 096 individuals (483 438 [33·5%] females, 901 188 [62·4%] males, and 58 470 [4·1%] sex not reported). The mean age was 33·6 years (SD 9·7) for adults and 15·6 years (1·1) for adolescents. Among female adults, the pooled prevalence of current chlamydia was 6·5% (95% CI 5·1-8·3; I2=97·0%, p<0·0001; 15 582 crude infections in 166 767 females; 38 studies), the pooled prevalence of current gonorrhoea was 1·5% (0·8-2·7; I2=97·2%, p<0·0001; 4424 crude infections in 167 953 females; 32 studies), and the pooled prevalence of current or previous syphilis was 5·9% (4·1-8·3; I2=98·6%, p<0·0001; 5143 crude infections in 103 641 females; 59 studies). Among male adults, the corresponding estimates were 4·7% (3·7-6·0; I2=94·4%, p<0·0001; 7101 crude infections in 128 380 males; 33 studies), 0·4% (0·2-1·1; I2=98·4%, p<0·0001; 591 crude infections in 330 418 males; 23 studies), and 3·7% (2·8-5·0; I2=99·4%, p<0·0001; 10 404 crude infections in 522 133 males; 61 studies), respectively. Among female adolescents, the pooled prevalence of current chlamydia was 16·8% (14·0-20·0; I2=96·7%, p<0·0001; 31 206 crude infections in 221 350 females; 38 studies), the pooled prevalence of current gonorrhoea was 6·0% (4·5-7·9; I2=89·3%, p<0·0001; 2053 crude infections in 39 949 females; 22 studies), and the pooled prevalence of current or previous syphilis was 1·9% (0·1-26·4; I2=76·0%, p=0·0058; nine crude infections in 449 females; four studies). Among male adolescents, the corresponding estimates were 7·4% (6·3-8·8; I2=97·0%, p<0·0001; 15 122 crude infections in 231 606 males; 29 studies), 2·0% (1·4-2·7; I2=94·5%, p<0·0001; 1393 crude infections in 75 697 males; 17 studies), and 1·9% (0·5-6·5; I2=24·7%, p=0·26; 11 crude infections in 596 males; three studies), respectively. The overall quality of studies was moderate (118 [57·3%] of 206 studies) or high (88 [42·7%] studies). INTERPRETATION:The high prevalence of bacterial STIs in incarcerated populations, particularly among adolescents and females, highlights substantial public health gaps in bacterial STI prevention and treatment. Offering opt-out bacterial STI testing to all people in prison should be considered to accelerate elimination efforts. FUNDING:None.

Imprisonment aggravates incarcerated women's menstrual and reproductive health due to stress, overcrowding, and poor access to care. This study, based on interviews with 42 Filipino incarcerated women, found three main themes: increased menstrual discomfort, limited control over menstrual health, and coping with deprivation. Prison restricts women from their usual relief practices, like warm showers or pain medication, intensifying their discomfort. These findings highlight the unique menstrual health challenges faced by incarcerated women and underscore the urgent need for prison reforms to address their specific health needs and improve their well-being.

Despite rapidly rising incarceration rates, the health needs of women in custody are overlooked. This Review aims to summarise the current evidence on the health of women in prisons around the world. In this systematic review, we searched peer-reviewed and grey literature databases for quantitative studies published between Jan 1, 2003, and Jan 29, 2025. Our population of interest was people detained in carceral spaces designated for women as part of the criminal-legal system worldwide. We included studies that reported the prevalence of health conditions (based on the Global Burden of Disease Study, or in the International Classification of Disease 11th revision) among women in custody. We assessed risk of bias using the JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data. We identified 18 008 unique records, 247 studies (including more than 452 261 women) were included for analysis. Nearly all studies had a high risk of bias in at least one domain. Communicable diseases and mental health conditions were the most frequently described topics. Prevalence of many conditions varied widely between studies and across geographical regions. We identified gaps in the literature, particularly around non-communicable conditions and in the geographical representation of data. Globally, women in custody experience a high burden of health conditions but there are substantial gaps in current evidence and a need for improved data collection and reporting. Additionally, limitations found in some studies included the exclusion of people with complex health-care needs and the use of measures such as self-reporting, which depend on previous access to health care, and it is likely that the true burden of health conditions among incarcerated women is even greater. The findings of this Review call the correctional, health, and research communities to act to reduce the health inequities faced by women in prison.

The global prison population is rising, with over 11.5 million people in prison on any given day. Very little is known about hearing impairment in prison populations, despite prisons being a sound-centric closed environment. This study, a scoping review, aims to map and describe what is known about the situation and experiences of detained people with hearing impairment. This study is a global scoping review. A comprehensive search confined to the English language was conducted on Web of Science, Scopus and PsycINFO with no date restriction. The final data set of 28 records was charted and analysed thematically. Four themes were interpretation deficits in the criminal justice process; detachment, inability to communicate and isolation in the prison soundscape; prison staff communication challenges and discriminatory views; and hearing health in prison. The review is intended to inform the formulation of auditory disability-inclusive criminal justice strategies and practices to support those with hearing impairment when navigating the system.

Background:The increasing size of the ageing English prison population means that non-communicable diseases such as cancer are being more commonly diagnosed in this setting. Little research has so far considered the incidence of cancer in the English prison population, the treatment patients receive when they are diagnosed in a prison setting, their care costs and outcomes or their experiences of care compared with those of people diagnosed in the general population. This is the first mixed-methods study that has been designed to investigate these issues in order to inform recommendations for cancer practice, policy and research in English prisons. Methods:We compared cancer diagnoses made in prison between 1998 and 2017 with those made in the general population using a cohort comparison. We then used a cohort comparison approach to patients' treatment, survival, care experiences and costs of care between 2012 and 2017. We also conducted qualitative interviews with 24 patients diagnosed or treated in prison, and 6 custodial staff, 16 prison health professionals and 9 cancer professionals. Findings were presented to senior prison and cancer stakeholders at a Policy Lab event to agree priority recommendations. Results:By 2017 cancer incidence in prison had increased from lower levels than in the general population to similar levels. Men in prison developed similar cancers to men outside, while women in prison were more likely than women outside to be diagnosed with preinvasive cervical cancer. In the comparative cohort study patients diagnosed in prison were less likely to undergo curative treatment, particularly surgery, and had a small but significantly increased risk of death. They also had fewer but slightly longer emergency hospital admissions, lower outpatient costs and fewer planned inpatient stays. While secondary care costs were lower for patients in prison, when security escorts costs were added, emergency care and total costs were higher. Control and choice, communication, and care and custody emerged as key issues from the qualitative interviews. People in prison followed a similar diagnostic pathway to those in the general population but experienced barriers arising from lower health literacy, a complex process for booking general practitioner appointments, communication issues between prison staff, surgical, radiotherapy and oncology clinicians and a lack of involvement of their family and friends in their care. These issues were reflected in patient experience survey results routinely collected as part of the annual National Cancer Patient Experience Survey. The four priorities developed and agreed at the Policy Lab event were giving clinical teams a better understanding of the prison system, co-ordinating and promoting national cancer screening programmes, developing 'health champions' in prison and raising health literacy and awareness of cancer symptoms among people in prison. Limitations:We could not identify patients who had been diagnosed with cancer before entering prison. Conclusion:Healthcare practices and policies both within prisons and between prisons and NHS hospitals need to be improved in a range of ways if the cancer care received by people in prison is to match that received by the general population. Future work:Evaluating new policy priorities. Funding:This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 16/52/53) and is published in full in Health and Social Care Delivery Research; Vol. 13, No. 3. See the NIHR Funding and Awards website for further award information.

BACKGROUND:Rates of imprisonment for both women and men are high in England and Wales yet no official records report the number of people in prisons who are parents. Reports suggested 54% of people in prison have children under the age of 18 years which is estimated to affect 312,000 children annually. Research has examined the impact of parental imprisonment on their children, but little is known about the health and wellbeing outcomes for children who experience maternal versus paternal imprisonment. The Prison Reform Trust reported only 9% of children live with their father at the time of their mother's incarceration, whilst 75% of children live with their mother at their father's incarceration. The aim of this scoping review was to review the published evidence about the health impacts of maternal versus paternal imprisonment to enable a better understanding of the differential impacts on affected children and to identify where gaps in the evidence remain. METHODS:The Arksey and O'Malley methodology for scoping review was used to address how do the physical, mental and behavioural health, along with healthcare service use differ between children who experience their mother being imprisoned, compared to those who experience their father being imprisoned. Databases searched included Medline, Embase, CINAHL, Cochrane, PyschINFO, Web of Science, Delphis and IBBS. The search yielded 9,773 results, which after screening and removal of duplicates, resulted in 20 papers being included. RESULTS:All included papers compared data relating to outcomes for children who had experienced maternal or paternal imprisonment to children with no parental imprisonment, and three compared maternal to paternal imprisonment. Eighteen used populations in the United States of America and of these, thirteen used data from two studies. Having experienced either parent being in prison results in considerable impacts on the health of children, as well as their support networks and the stigma they encounter. The findings comprised of four main categories of health: physical health, mental health, behavioural health and healthcare service use. DISCUSSION:This review highlighted how atomised the study designs and study populations were in addition to the varied findings about the impact of maternal and paternal imprisonment on children. The sparsity of literature resulted in challenges addressing the original study question about how health and wellbeing outcomes differ for children experiencing maternal versus paternal imprisonment and no clear conclusions can be drawn. CONCLUSION:There is limited understanding about the impact of maternal or paternal imprisonment on their children's health and behaviour, despite the substantial implications their imprisonment has and the stigma. It is important to consider that the absence of clear significant findings, does not negate the great health needs for this cohort. Further research is vital to ensure this population is identified, recognised and supported appropriately.

Introduction COPE investigated the prevalence, patterns and determinants of prisoner self-harm during the COVID-19 pandemic, compared with pre-pandemic. The project used the natural experiment of the pandemic to understand effects of prison environments on self-harm.Methods COPE was a mixed-methods study involving all prisons within England and Wales. Participants included 80 437 prisoners identified from routine data sources, 71 (ex)prisoners consulted and 89 staff interviewed (average experience: 18.5 years). The main outcome measure was the rate of self-harm incidents reported. Secondary measures included qualitative assessments of prisoner and staff experiences related to self-harm during the pandemic. Qualitative outcomes were derived from thematic grouping of inmate consultation responses and framework analysis of staff responses. The exposure was the pandemic period from March 2020 to December 2021.Results There were gender differences in prisoner self-harm rates during the pandemic. In women’s prisons, the pandemic was associated with a 7% overall increase in self-harm (95% CI 2% to 13%) and a 43% increase in self-harm requiring hospitalisation (11% to 83%). Conversely, men’s prisons saw an 8% self-harm decrease (6% to 11%) and a 21% decrease in self-harm hospitalisation. Policy interventions, for example, in-cell telephones and additional phone credit were linked to reduced self-harm in men’s prisons. Introducing video visits was associated with an increase in self-harm in women’s and men’s prisons. Qualitative analysis revealed a complex interplay of factors influencing these outcomes, including tension between the risk of mental health deterioration because of greater isolation and the perceived safety benefits of a restricted regime.Conclusions The pandemic, and policy changes, were associated with changes in prisoner self-harm. Distinct patterns emerged between genders underscoring the need for gender-specific prison policies, especially during crisis management. Furthermore, the complex relationship between policy implementation and self-harm highlighted the importance of tailoring prison environments to effectively address the population’s diverse needs.

Non-Communicable Diseases (NCDs) continue to increase globally, including where recorded among prison populations. Pakistan, like many low- and middle-income countries is facing significant health system challenges. Little is known about NCDs in its prison population. A scoping review mapped and described what is known about factors impacting on NCDs in the prison population of Pakistan. Objective: To describe factors impacting Non-Communicable Diseases (NCDs) in the prison population of Pakistan and to inform policy and improve prison conditions, nutrition, and healthcare for effective NCD management and care. Methods: A comprehensive search was conducted on Web of Science, PubMed and EMBASE, restricted to publications from 2000 to 2023. Eight studies fulfilled the eligibility criteria. Records were independently screened, charted and content analysis was undertaken. Results: Six themes were generated; Nutritional and dietary provisions, Physical activity and body mass index; Substance use and dependence; Hypertension and diabetes; Access to medical care and Mental health. Prior and detention related risk and lifestyle factors underpin the chronic ill health of people living in prison. These include prior history of smoking and alcohol use, and situational aspects of prison conditions causing environmental stress, malnutrition and sedentarism. Where reported, hypertension, obesity and depression were high among people in prison. Conclusions: Prisons are fundamental to the domestic NCD response. Prisons in Pakistan require dedicated resourcing to improve basic conditions, nutrition and healthcare allocations for all people living in prisons. The review highlights the need for prison-based NCD screening, diagnosis, treatment and care in Pakistan, in close alliance with specialist care in hospitals. Further health research is warranted to examine the effectiveness of NCD policies and practices in place in contemporary prison systems in Pakistan.

Abstract Enhancing vaccination literacy is pivotal in addressing hesitancy, especially among incarcerated populations who may lack regular access to health information, thus ensuring health equity. Supported by the European Union, the RISE-Vac project endeavours to bolster vaccine literacy, accessibility, and uptake within European prisons. To discern vaccination knowledge gaps and preferences for information dissemination, consultations were conducted with incarcerated individuals in the United Kingdom (via the Prisoner Policy Network), France, and Moldova. A total of 344 responses were garnered: 224 from the UK, 70 from France, and 50 from Moldova. In addition a focus group was conducted in the UK. The key themes that emerged were common across the 3 participating countries: views of vaccination, prior knowledge about vaccines, areas of appetite for learning, availability of reliable information, and preferred mechanism for information sharing. Participants were particularly interested in learning about the effectiveness, side effects, and manufacturing of vaccines. Their invaluable input informed the creation of educational materials, notably a brochure slated for pilot testing in European prisons and a video clip. Notably, individuals with lived prison experience were actively engaged at every phase of this initiative, ensuring its relevance and efficacy.