Sexual and Reproductive Health Rights for incarcerated women in SierraLeone
By Cohort 5 of the Advocacy for Reproductive Justice in Africa short course
Sexual and Reproductive Health Rights in Sierra Leone continue to be a challenge especially for women. In 2019, the country launched the National Population Policy which aimed to improve the quality of life for all Sierra Leoneans. The new policy aimed to address the population dynamic and provide an effective response to the needs and aspirations of the expanding youth population and enhancing the reproductive health and rights for all Sierra Leoneans at every stage of their life.
In particular, the policy outlined key measures to address critical population management and development issues. These issues included addressing reproductive health and rights; reducing adolescent pregnancy; building women’ s empowerment; achieving education for all; and reducing mortality rates, which all align directly with UNFPA’ s mandate.
The 1994 Programme of Action of the International Conference on Population and Development (ICPD) considered that reproductive rights are human rights and these embrace certain human rights that already form part of national laws in Sierra Leone. These rights include: the basic right of all couples and individuals to decide freely and responsibly the number, timing and spacing of their children.
By 2019, it was 25 years since the launch of the ICPD and there were still challenges in terms of recognizing sexual rights, in addition to reproductive rights, ensuring universal access to contraceptives and comprehensive education for the citizens.
The National Population Policy outlined that promotion of these rights for all people should be the fundamental basis for Government and community-supported policies and programmes in the area of reproductive health, including family planning and maternal health. Strengthening legislation in maternal health is cited as a key instrument to reduce maternal mortality and would have a positive impact on maternal and child health, by moving beyond policy towards legislation to save women and children’ s lives.
These rights are expected to apply for all and this includes women in prison. However that is not the case. Women in Sierra Leone find themselves in prison for various reasons which incude poverty, prior experiences of abuse, mental health, education among others. The result of women interactions with the criminal justice system and continued stay in prison is physical and mental health, stigma, family connections and abandonment and economic impact. This article will highlight a few of these issues and how they affect the sexual and reproductive health rights of women offering recommendations on the way forward.
On the physical and mental health of women in prison, continued pre-trial detention poses an over-crowding challenge which directly affects women’ s hygiene especially during menstruation and pregnancy. This goes against Rule 10 and 11 of the United Nations Rules for the Treatment of Women Prisoners and Non-custodial Measures for Women Offenders (Bangkok Rules) which provides that women in prison are entitled to at least the same level of healthcare that is available to the general population and should receive gender-specific healthcare services.
While health is a problem for both men and women in prisons across the world, women’ s issues are not homogenous and thus their different health needs mostly go unnoticed as these prisons are designed by men and for men. Unlike men, women are more likely to suffer from various medical issues such as respiratory and infectious diseases and reproductive and sexually transmitted diseases including HIV. The correctional centres in Sierra Leone are not equipped to provide adequate treatment and do not offer healthcare services related to family planning, pregnancy, post-natal care among others. When these needs are not met, there are long term health effects while in and out of detention and these aspects of detention can impact the mental health of women differently.
Overcrowding affects the levels of hygiene and is linked to the spread of diseases, poor sanitation, privacy and safety. The correctional facilities in Freetown are severely overcrowded sometimes holding more than 60 women in a facility designed to hold 18. Due to lack of space, some women even have to share a bed. This situation is exacerbated by backlogs in the courts and strict bail conditions that lead to women in prison being held in pre-trial detention for long periods.
For correctional facilities outside the capital, water supply and sanitation are very poor and water is often scarce during the dry season. This poses a challenge to the hygiene and health and especially for women menstruating or pregnant. This goes against Rule 5 of the Bangkok Rules.
Medical services are lacking in the facilities and unless women are very sick when they enter prison, they are rarely screened for diseases except HIV and other STDs. Health care services for those who are in prison is the responsibility of the State. In Sierra Leone, ARVs for HIV and other essential drugs are supplied to correctional centres every month. For one to access specialized medications, they must be bought outside and many of the women cannot afford them and the result is that the officers sometimes buy this medication with their own funds. This then means that women receive the treatment when they are severely sick and for others, their illnesses are ignored together.
Prison authorities do not adequately provide for women’ s specific health services that directly affect their sexual and reproductive health includes gynecological care and cervical and breast cancer screenings. Local NGO’ s provide breast cancer screenings in some centres but no cervical cancer tests are administered to women in detention. In the capital Freetown, a doctor is on call and visits when deemed necessary while in the outskirts, the prisons only employ nurses who cannot provide the same level of expertise as doctors. In situations where a woman cannot be treated in prison, she is referred to a government hospital where treatment is not always free and many cannot afford the procedures.
For women who are pregnant, they are cared for by nurses in the correctional centres and taken to hospital for antenatal care when necessary. When they give birth, they are taken to a government hospital. However, there is inadequacy of necessary supplies needed for pre and post natal care and the correctional centre officers use their own money to care for the pregnant women. The concern is that the lack of adequate logistical support especially transport, endangers women’ s lives because often when a woman needs to give birth, there is no transportation system in place to take her to hospital. This endangers not only the mother but the child.
Mental health issues are both a cause and a consequence of imprisonment. Imprisoned women experience greater mental health issues compared to men and this is largely so due to unmet needs, in prison and the outside world. Mental health issues can be triggered by the poor prison conditions where women live in unclean environments far from their loved ones, eat poorly, receive inadequate healthcare and lack purposeful activity and privacy. Most women’ s mental health deteriorates once in prison and this leads to loneliness, depression and anxiety, trouble sleeping, aggressive thoughts and self harm or attempted suicide. This demonstrates the need for trauma informed mental health counselling in prison which is largely unavailable to women in correctional centres in Sierra Leone.
One cannot fail to mention the stigma that comes with being held in detention. The stigma is far worse for women than it is for men. Many women in prison in Sierra Leone once in, lose touch with their families and children. This causes pain and leads to increased mental health issues and dependency on drugs and substance abuse once released from custody. These women and their families are not the same ever again.
Some recommendations that are suggested for the problems highlighted above include:
> Incarceration should be used as a last result in line with international standards. There is need to develop alternatives to incarceration such as diversion policies given the harmful impact incarceration can have on women’ s health.
>There is need to provide bail and bond guidelines that factor in the non-homogenous challenges that women face for example, pregnant women and the social and economic realities of women, who do not need to be held in pre-trial detention.
>Provide for women’ s specific health services including gynecological, antenatal and post natal care and cervical and breast cancer screenings
>Increase the capacity of legal professionals around mental health and allocating resources for mental health services,
>Provide gender-sensitive and trauma informed training for judicial and law enforcement officers,
>Put in place gender-specific and trauma informed services such as mental health support and other services as well as strategies to prevent suicide and self harm.
>Conduct gender sensitive trials and adopt sentencing guidelines that consider issues
such as mental health conditions.
https://www.vancecenter.org/wp-content/uploads/2020/08/Final-Woman-wahala-na-prison-web-version-.pdf
https://www.civicus.org/index.php/media-resources/news/interviews/5974-sierra-leone-weare-dealing-with-a-relentless-campaign-by-anti-rights-groups
https://sierraleone.unfpa.org/en/news/new-national-population-policy-focuses-reproductivehealth-and-rights-womens-empowerment-an
