Research question
- What interventions are effective in promoting the physical and mental health of women in prison or post-release?
The evidence base underpinning interventions that are effective in supporting the health of people in prison and post-release is sparse. This despite the fact that the prison population has considerably worse health outcomes than the general population. This call for research focuses on women who are, or have been, in contact with the prison system – that is, women who are imprisoned and women who are post-release.
Women represent less than 4% of the total prison population. Women are often sentenced for non-violent, low-level offences, and are more likely to be sentenced for short periods of time compared with men who receive custodial sentences. Women in contact with the prison system are often among the most vulnerable in society and often have multiple and complex needs; these may relate to factors such as:
- traumatic histories of abuse and victimisation
- mental health difficulties
- neurodivergence
- substance misuse
- homelessness
These issues are highlighted in two recent reports, one report outlining the status and needs of women in the criminal justice system, and the other report focusing on reducing women’s imprisonment.
Prison can be viewed as an opportunity to deliver interventions that could have a positive impact on health outcomes – such as by facilitating smoking cessation, testing or screening for health conditions, or addressing alcohol and substance misuse. Conversely, aspects of the prison system may worsen existing health problems and increase health inequalities, for example by leading to reduced opportunities for physical activity, restricted dietary choice, or negative social interactions.
Compared with men in prison, women in prison are much more likely to be primary carers, and although research suggests around 60% of women in prison have children, data on how many women are the primary or sole carers of children is not routinely published. Pregnancy and motherhood represent a particular challenge in prison, and adverse pregnancy outcomes are more likely for women who are imprisoned. Challenges include meeting nutritional requirements for healthy pregnancy outcomes (for both mother and baby) and ensuring access to pregnancy-related and parental support. In general, improving the health of imprisoned women may provide the opportunity to break inter-generational cycles of poor health and adverse childhood experiences.
In addition to improving the physical and mental health of women in prison and post-release from prison, it is also important to reduce reoffending, for example by successfully reintegrating people back into the community. Although the population of women in contact with the prison system is small, women who reoffend have a higher average number of reoffences than do men who reoffend. Evidence suggests that interventions providing continuation of care from custodial settings into the community are more effective in reducing reoffending than interventions that are solely community-based or solely custodial setting-based.
The Public Health Research (PHR) Programme wishes to commission research on the effectiveness of interventions in promoting the physical and mental of women in prison or post-release. The programme are predominantly interested in interventions operating at a population or group level rather than at an individual level, and which should address health inequalities and the wider determinants of health. We recognise that interventions are likely to impact different (sub)populations in different ways and encourages researchers to explore such inequalities of impact in their study design.
Suggested areas of research
Suggested areas of research could include, but are not limited to, evaluation of:
- interventions that focus on mental ill-health among women in prison or post-release, including interventions aimed at reducing self-harm and substance and alcohol misuse
- trauma-informed and trauma-specific interventions
- interventions that seek to meet the needs of, and improve health outcomes for, women in prison who may be neurodivergent or have a learning disability
- interventions that focus on physical health among women in prison or post-release, including sexual and reproductive health and dental health
- interventions promoting access (increased access and equity of access) to physical activity and sport or exercise
- interventions impacting diet and food security of women in prison, for example:
- access to nutritious food
- cooking skills
- food budgeting
- interventions impacting maternal health (ante/peri/post-natal) for women and babies in prison or post-release – which might include a focus on:
- pre- and post-natal care, such as ante-natal or parenting exercise classes; interventions addressing lack of birthing choice (pregnancies in prison are deemed high risk)
- nutrition and food security during pregnancy and breastfeeding
- impact of compulsory removal of a baby or child after birth
- pregnancy not ending in live birth, including termination, miscarriage and stillbirth
- interventions addressing how women serving short sentences (as opposed to longer sentences) can engage with and benefit from health interventions in prison and in the community post-release
- non-accredited interventions in reducing reoffending and supporting desistance
- interventions targeting prison staff and key workers, for example through training
- peer or family support interventions to improve health outcomes in prison and post-release, such as building social capital and re-establishing support networks
- interventions that provide continuation of care spanning the prison setting and post-release
- interventions that address the multiple, interacting disadvantages that affect the most marginalised women in prisons and post-release.
Study designs
A range of study designs and outcome measures can be used. Researchers will need to clearly describe and justify their choice of health outcomes, target population group, as well as the rationale for their methodological approach. Researchers are encouraged to consider additional outcome measures including those relating to the broader determinants of health and health inequalities, which should be specified and justified. Researchers will also need to specify key outcomes and how these will be measured in the short, medium and long term.
Providing value to the economy and community
Understanding the value of public health interventions – whether outcomes justify their use of resources – is integral to the PHR Programme, where resources relating to different economic sectors and budgets are potentially relevant. The main outcomes for economic evaluation are expected to include health (including health-related quality of life) and the impact on health inequalities as a minimum, with consideration of broader outcomes welcomed. Different approaches to economic evaluation are encouraged as long as they assess the value and distributive impact of interventions. Applications that do not include an economic component should provide appropriate justification.
Researchers are strongly encouraged to ensure that service users, including people with lived experience from the target audience, are meaningfully involved in the design and planning of the intervention and/or as potential, suitably rewarded, members of the research team. Researchers should demonstrate the relevance of their proposed research to decision-makers and people with lived experiences and they might do this through involving them as costed/rewarded members of the research team. Researchers are encouraged to explain how they will share their findings with policy makers, public health officers, special interest groups, charities, community audiences and other relevant stakeholders. Researchers are expected to be aware of other studies in this area, development in practice, and ensure their proposed research is complementary.
Applicants are expected to be aware of research or recommendations appearing in the upcoming National Women’s Prison Health and Social Care Review (and other studies in this area), in order to ensure that their research is complementary and adds value.
Further information
To find out more on how to submit an application to the PHR Programme, please refer to the Stage 1 guidance notes and PHR supporting information.