The scope of the problem: The health of incarcerated women in BC

ABSTRACT: About 10% of the prison population in British Columbia is wo­men; the annual number of provincial admissions for women may be as high as 3700. Consistent with the rest of Canada, Aboriginal people are overrepresented in the criminal justice system. There is a greater prevalence of bloodborne infections in incarcerated women. Women in prison tend to be of childbearing age, and the problem of separation from their children is inadequately dealt with in our current system. Continuity of health care delivery as women revolve from the community to prison and back to the com­munity is essential for improved health outcomes. Incarcerated women share their ideas regarding their health goals and recidivism.


Women in prison face a number of challenges not faced by their male counterparts, including lack of gender-specific health services and traumatic separation from their children.


In 2009 37 057[1] individuals were admitted to the correctional system in BC, of whom approximately 10% were female. Women in BC are incarcerated in either the federal or the provincial correctional system. 

Women in the federal system (Correctional Service Canada) have re­ceived a sentence of 2 years or longer. Women may serve their sentences in custody, on parole in the community, or a combination of both. The Fraser Valley Institution (FVI) in Abbotsford houses all federally sentenced women in BC. On any one day, 57 women will be housed at FVI and 39% of them will have a sentence of no longer than 40 months.[2]

Women in the provincial system include those remanded to custody (awaiting trial) and those sentenced to less than 2 years. Women may serve a custodial sentence, a community sentence, or a combination of both. Those who serve a custodial sentence will be housed in one of two facilities in BC: the Alouette Correctional Centre for Women in Maple Ridge or the Prince George Regional Correctional Centre. Because of increasing incarceration rates, projections indicate the provincial correctional system will eventually need 189 additional staff members to oversee approximately 300 new cells.[3

On any one day, the provincial correctional system houses 2800 individuals, of whom 10% are women.[4] However, because of short prison stays and high recidivism rates, the annual number of provincial admissions for women may be as high as 3700. Re­cidivism rates for women with short prison stays in BC are difficult to define, determine, and interpret. The so-called revolving door scenario contributes to the problem of unmet health care needs for women, both outside and inside of prison. 

Demographic characteristics and health status of incarcerated women
Throughout the world incarcerated women tend to be younger than the general population; they tend to be of childbearing age and to be poorly educated. In addition, women who are imprisoned have usually experienced physical and sexual abuse.[5]

Aboriginal peoples are overrepresented at all levels of the Canadian criminal justice system and account for approximately 20% of offenders serving a sentence in custody across Canada,[6] even though only 3% of Canadians are Aboriginal.[7] In BC ap­proximately 40% of women in the provincial system and 25% in the federal system are Aboriginal.[7] Incar­cerated adult Aboriginal people are generally younger, have less formal education, and are more likely to be unemployed than are incarcerated non-Aboriginal people.[8]

The guiding principles of the 2003 World Health Organization (WHO) Moscow declaration states that “Prisoners shall have access to the health services available in the country without discrimination on the grounds of their legal situation.”[9] The WHO Kyiv statement identifies women in prison and their children as a population with particular health needs that require gender-sensitive approaches.[10] Incarcerated women are a minority and are therefore often housed in prisons that were designed for men and are located at a great distance from their families and communities.

Consistent with world literature findings on the health of incarcerated women,[11] many health conditions are more prevalent among incarcerated women in BC than in the general population. Because the majority of women with provincial sentences are incarcerated for crimes associated with sub­stance abuse,[4] there is a greater prevalence of bloodborne infections such as HIV and hepatitis C among incarcerated women.[11] Prevalence estimates for psychiatric illness are as high as 80% for female offenders.[12

A disproportionate number of marginalized women with HIV are incarcerated[13] and these women face many challenges when accessing care. These challenges include physical isolation, issues of confidentiality/stigma, organizational constraints, and limited access to harm-reduction and other therapies. In addition, many wo­men face interruptions in their therapy when they are released because of the time needed to make new connections in the community for HIV care.[14

Women in prison globally experience greater mental and physical illness than men in prison, and than the general population.[15-18] The higher prevalence of mental health problems is frequently a result of abuse and victimization. Psychiatric diagnoses can include posttraumatic stress disorder, depression, anxiety, and phobias.[19-24] Women in prison also report massive weight gain during their imprisonment, which has been attributed to the metabolic changes of drug withdrawal, high-carbohydrate prison diets, methadone maintenance, prison canteen options limited to high-calorie snacks, boredom, and inactivity.[25-34

Separation of women from children
In Canada 85 000 prison admissions involve women every year, with ad­missions for remand and other reasons being double that number. Based on these figures, an estimated 20 000 Canadian children are separated from their mothers because of incarceration every year, and that number rises as penal populations increase year after year.[35] It is now recognized internationally that children need to maintain parental relationships with their incarcerated mothers.[36] Indeed, a 1990 Task Force for Federally Sentenced Women recommended an expansion of infant and mother health initiatives in Canadian correctional facilities. 

Previous research has demonstrated that the relationship between a mother and her child is a positive predictor of a woman’s successful transition into the community following incarceration.[37,38] Women who experience traumatic sep­arations from their children are significantly more likely to be re-incarcerated.[39]

Some women are separated from their children before their incarceration because their children are apprehended by child welfare authorities. In most cases this is because of concerns about maternal substance abuse. For these mothers and children, incarceration then prolongs or intensifies the separation. In other cases, the in­carceration itself precipitates the separation of mother and child. Moreover, because there is only one major provincial women’s prison in BC (and in most other Canadian provinces), women may be incarcerated far from home. Poverty and limited social re­sources exacerbate the effects of geographic dislocation, as the high cost of travel and long-distance telephone calls further separates female inmates from their children. 

Housing is a basic determinant of health.[40-43] Homelessness and unstable housing (living in shelters and temporary accommodation) negatively influence health and well-being[44,45] by increasing the risk of contracting tuberculosis and HIV,[46,47] contri­buting to higher rates of mental illness and substance abuse, and increasing mortality.[47-49

Historically, homeless populations were predominantly white, male, and single.[50] However, recent studies report more housing instability among women, and indicate this is associated with substance abuse and depression,[51,52] mortality among young women,[53] and positive HIV status.[54] In BC, an estimated 30% of people with substance abuse, mental illness, or both (SAMI) live in unstable housing.[55

Homelessness and incarceration appear to increase the risk of each other, and both seem to be mediated by mental illness and substance abuse, and disadvantaged sociodemographic status.[56] A recent report on BC provincial corrections states that 76% of female and 53% of male inmates were found to have SAMI; additionally, 37% of women and 21% of men were found to have a non-drug-related concurrent mental illness.[12

Need for throughcare 
Internationally, it is recognized that “throughcare”—the continuity of health care services as an offender moves from the community to the correction­al facility and then back out into the community—is essential for im­prov­ed health outcomes. The WHO and leading medical journals recommend that countries align their prison health care services with the public health and primary care services provided for their general population.[11,57-59] Accordingly, several jurisdictions (Nor­way, Uni­ted Kingdom, France, and New South Wales in Australia) have transferred the provision of health care for their incarcerated populations from the Ministry of Justice to the Ministry of Health.[58

In Canada, health care for people who are sentenced to 2 years or more (federal sentences), are delivered by Correctional Service Canada Health Services,[60] a stand-alone entity operating under the auspices of Correctional Service Canada. In BC, health care for people in provincial correctional centres has been contracted out to private health care providers since 2004. In Nova Scotia, health care for provincial correctional institutions was transferred to the jurisdiction of the Capital District Health Authority in 2001. 

Research into health and recidivism
During the summer of 2005, in pre­paration for a research project about enhancing the health and social well-being of women in custody, the following open-ended question was asked during in-depth one-on-one interviews with 16 incarcerated wo­men, and in group interviews with 16 correctional officers: “Tell us what you think are the major health concerns for women in prison that the prison participatory health research project should address?” Twenty-one themes emerged from an analysis of these interviews. 

In October 2005, a full-day face-to-face meeting with 120 incarcerated women, 10 correctional services staff (correctional officers and contracted health and allied staff), and 5 academic researchers was held to discuss the summer findings. During this meeting, the 21 themes were grouped under five headings: 

•    Addictions and mental health.
•    HIV, hepatitis, and other infections. 
•    Health care in prison. 
•    Life-skills and re-entry into society.
•    Children, family, and relationships. (Figure 1)[61

During the October meeting, participants also agreed on five shared values, namely, to ensure transparency of all information, to break the code of silence, to respect diversity (“listen and be heard”), to build on strengths, and to involve all who wish to participate in the research process. These values became guiding principles for developing all research processes. When a participatory health research project began inside a BC provincial correctional centre for women in October 2005, these values ensured an equitable partnership approach for the creation of the research team, with community members (incarcerated women and prison staff), organizational representatives (prison managerial staff), and academic researchers sharing their experiences and expertise, and all contributing to all aspects of the research.[62-64]

Subsequently, nine health goals emerged from the five health categor­ies (Figure 2).[65] These were identified by incarcerated women as essential for their successful reintegration into society following their release from prison, and reflect the women’s desire for health not only while in prison but also in the community after release from prison.

During the participatory health research project, incarcerated women designed and implemented a cross-sectional survey with both closed and open-ended questions. Data from the survey illuminate the role played by homelessness and unmet housing needs.[66] Eighty-three women complet­ed the survey (72% response rate). Of 71 respondents who were previously incarcerated, 56% stated that homelessness contributed to their return to crime, 63% reported difficulty finding housing upon previous release, and 34% desired relocation to another city upon release.

Those with five or more previous incarcerations were more likely to report difficulties finding housing (OR 6.51, 95% CI: 1.53-27.71), and less likely to report a desire for relocation (OR 0.18, 95% CI: 0.04-0.86). Although 83% of res­pondents said they preferred housing exclusively for ex-prisoners, there was no “one sort fits all” type of accommodation requested. 

Most women saw financial restrictions as the main barrier to finding housing upon release, as illustrated by the following responses: 

“  Rents too high, lack of references. Released with five bucks and no­where but the street. How are you supposed to live with that?”
“  It’s hard to get a place when you’re released with nothing. Not having housing prior to coming to jail or any family to go to upon release. You get out and [have] no one to share [costs] with.”
“ Social assistance gave me a hard time when applying for rent.”

Women also reported that the lack of basic needs associated with homelessness led them to crime in order to survive.

“ Gotta do what you gotta do to survive. Need $ for place to sleep and food. Turn to crime to survive.”
“  If I only had a place to sleep I would not have to commit so much crime… I had nothing and no money and no house and no food or drugs. I do crime to eat, support my [drug] habit, [have] place to rest.” 
“   Every time I have been released I have always started out on the street. Being left on the street it’s easy to fall back into the street life. No place [to live] means back on drugs and do crime to support it—it’s a vicious cycle.”

In addition, women described home­lessness as a barrier to employment, which in turn contributed to their return to crime:

“ I was on the street again. I had to make money by selling dope because if you don’t have a [home] address no one will hire you.”
“ Without a place to live it’s hard to sleep and without sleep it’s hard to get work.”
“ I had nowhere to live so I was not able to gain employment, therefore I stole someone’s money to survive.”

From 2008 until 2011, another community-based participatory health research project[67] followed over 400 incarcerated women for up to 18 months after their release from pro­vincial correctional centres in BC. The project aimed to determine which of the barriers that wo­men face as they seek to achieve their nine health goals also contribute to their high recidivism rates. Preliminary analysis of this data supports the hypothesis that incarcerated women’s recidivism rates are directly related to their unmet health and social needs. 

Summary
Women in both the provincial and federal correction systems in BC tend to be younger than the general population and poorly educated. Many are also mothers. Bloodborne infections such as HIV and hepatitis C are more prevalent among incarcerated women than incarcerated men, as is mental illness; in addition, women commonly have a psychiatric diagnosis, posttraumatic stress disorder, and a history of abuse and victimization. Incarcerated women in BC identified nine health goals as essential for their successful reintegration into society following their release from prison, including the provision of safe housing and improved relationships with their families.

Acknowledgments
We are grateful to all the women in prison who initiated and participated in the participatory health research program, and who worked together to improve health for themselves and their peers. We acknowledge funding provided by the Vancouver Foundation for the participatory research prison health project. We acknowledge the permission to reprint figures from Global Health Promotion (Figure 1) and the International Journal of Prisoner Health (Figure 2).

Competing interests
None declared


References

1.    Statistics Canada. Adult correctional services, average counts of offenders, by province, territory, and federal programs. Accessed 17 October 2012. www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/legal31a-eng.htm.
2.    Correctional Service Canada. Institutional profiles. Accessed 17 October 2012. www.csc-scc.gc.ca/text/facilit/institutprofiles/fraservalley-eng.shtml.
3.    Ministry of Public Safety and Solicitor General. New 20-cell addition to Prince George jail complete [news release]. Accessed 17 October 2012. www2.news.gov.bc.ca/news_releases_2009-2013/2010PSSG0051-001061.htm.
4.    Ministry of Public Safety and Solicitor General. A profile of B.C. corrections: Protect communities, reduce reoffending. Victoria: Corrections Branch; 2010. p. 54. Accessed 17 October 2012. www.lumby.ca/doc/bccorrections2010.pdf.
5.    van den Bergh BJ, Gatherer A, Fraser A, et al. Imprisonment and women’s health: Concerns about gender sensitivity, human rights and public health. Bull World Health Organ 2011;89:689-694
6.    Kong R, Beattie K. Collecting data on Aboriginal people in the criminal justice system: Methods and challenges. Ottawa: Statistics Canada; 2005. Catalogue no. 85-564-XIE. Accessed 17 October 2012. www.statcan.gc.ca/bsolc/olc-cel/olc-cel?catno=85-564-XIE&lang=eng#formatdisp.
7.    Kong R, AuCoin K. Female offenders in Canada. In: Juristat: Canadian Centre for Justice Statistics. Ottawa: Statistics Canada: 2008. p. 23. Catalogue no. 85-002-XIE, Vol. 28, no. 1. Accessed 17 October 2012. http://publications.gc.ca/collections/collection_2008/statcan/85-002-X/85-002-XIE2008001.pdf.
8.    La Prairie C. Aboriginal over-representation in the criminal justice system: A tale of nine cities. Can J Criminol 2002;44:181. 
9.    World Health Organization Europe. Moscow declaration on prison health as part of public health. Accessed 17 October 2012. www.euro.who.int/en/what-we-do/health-topics/health-determinants/prisons-and-health/publications/moscow-declaration-on-prison-health-as-part-of-public-health.
10.    World Health Organization Europe. Wo­men’s health in prison: Correcting gender inequity in prison health. Copenhagen: WHO/United Nations Office on Drugs and Crime; 2009. p. 56. Acces­sed 17 October 2012. www.unodc.org/documents/commissions/CND-Session51/Declaration_Kyiv_Women_60s_health_in_Prison.pdf.
11.    Fazel S, Baillargeon J. The health of prisoners. Lancet. 2011;377(9769):956-965
12.    Somers JM, Cartar L, Russo J. Corrections, health and human services: Evidence-based planning and evaluation. Burnaby: Centre for Applied Research in Mental Health and Addiction, SFU; 2008 p. 56. Accessed 17 October 2012.  www.carmha.ca/publications/documents/Corrections-Health-HumanServices-EBPE.pdf
13.    National Minority AIDS Council. Women and HIV/AIDS in prisons and jails. Acces­sed 17 October 2012. http://nmac.org/wp-content/uploads/2012/08/women-and-hiv-aids-in-prisons-and-jail.pdf.     
14.    Springer S, Altice F. Managing HIV/AIDS in correctional settings. Curr HIV/AIDS Rep 2005;2:165-170
15.    Plugge E, Fitzpatrick R. Assessing the health of women in prison: A study from the United Kingdom. Health Care Wo­men Int 2005;26:62-68
16.    Gunter TD. Incarcerated women and depression: A primer for the primary care provider. J Am Med Womens Assoc 2004;59:107-112
17.    Mooney M, Hannon F, Barry M, et al. Perceived quality of life and mental health status of Irish female prisoners. Ir Med J 2002;95:241
18.    Young M, Waters B, Falconer T, et al. Opportunities for health promotion in the Queensland women’s prison system. Aust N Z J Public Health 2005;29:324-327
19.    Messina N, Grella C. Childhood trauma and women’s health outcomes in a California prison population. Am J Public Health 2006;96:1842-1848
20.    Fogel CI. Hard time: The stressful nature of incarceration for women. Issues Ment Health Nurs 1993;14:367-377
21.    Zlotnick C. Posttraumatic stress disorder (PTSD), PTSD comorbidity, and childhood abuse among incarcerated women. J Nerv Ment Dis 1997;185:761
22.    Bastick M. A commentary on the standard minimum rules for the treatment of prisoners. Geneva: Quaker United Nations Office; 2005. 
23.    Covington SS. Women and the criminal justice system. Women’s Health Issues. 2007;17:180-182. 
24.    Møller L, Stöver H, Jürgens R, et al. Health in prisons: A WHO guide to the essentials in prison health. 2007. Ac­cessed 20 October 2012. www.euro.who.int/en/what-we-publish/abstracts/health-in-prisons.-a-who-guide-to-the-essentials-in-prison-health
25.    Nolan LJ, Scagnelli LM. Preference for sweet foods and higher body mass index in patients being treated in long-term methadone maintenance. Subst Use Misuse 2007;42:1555-1566
26.    Meiklejohn C, Sanders K, Butler S. Physical health care in medium secure services. Nurs Stand 2003;17:33-37
27.    London ED, Simon SL, Berman SM, et al. Mood disturbances and regional cerebral metabolic abnormalities in recently abstinent methamphetamine abusers. Arch Gen Psychiatry 2004;61:73
28.    Mohs M, Watson R, Leonard-Green T, et al. Nutritional effects of marijuana, heroin, cocaine, and nicotine. J Am Diet Assoc 1990;90:1261
29.    Shaw N, Rutherdale M, Kenny J. Eating more and enjoying it less: U.S. prison diets for women. Women Health 1985;10:39
30.    Gesch CB, Hammond SM, Hampson SE, et al. Influence of supplementary vitamins, minerals and essential fatty acids on the antisocial behaviour of young adult prisoners. Randomised, placebo-controlled trial. Br J Psychiatry 2002;181:22-28
31.    Cropsey K, Eldridge G, Weaver M, et al. Smoking cessation intervention for fe­male prisoners: Addressing an urgent public health need. Am J Public Health. 2008;98:1894
32.    Peterson M, Johnstone BM. The Atwood Hall Health Promotion Program, Federal Medical Center, Lexington, KY: Effects on drug-involved federal offenders. J Subst Abuse Treat 1995;12:43-48
33.    Cashin A, Potter E, Butler T. The relationship between exercise and hopelessness in prison. J Psychiatr Ment Health Nurs 2008;15:66-71
34.    Khavjou OA, Clarke J, Hofeldt RM, et al. A captive audience: Bringing the WISEWOMAN program to South Dakota prisoners. Womens Health Issues. 2007;17:193-201
35.    Cunningham AH, Baker LL. Waiting for mommy: Giving a voice to the hidden victims of imprisonment. London, ON: Centre for Children and Families in the Justice Systems; 2003. 
36.    Bayes S. A snowball’s chance: Children of offenders and Canadian social policy. Elizabeth Fry Society of Greater Vancouver; 2005. 
37.    Broidy L, Cauffman E. Understanding the female offender. Rockville MD: National Criminal Justice Reference Service; 2006. Accessed 19 October 2012. www.ncjrs.gov/pdffiles1/nij/grants/216615.pdf.
38.    Benda BB. Gender differences in life-course theory of recidivism: A survival analysis. Int J Offender Therapy Criminol 2005;49:325
39.    Messina N, Burdon W, Hagopian G, et al. Predictors of prison-based treatment outcomes: A comparison of men and women participants. Am J Drug Alcohol Abuse 2006;32:27-28
40.    World Health Organization. Ottawa charter for health promotion. First Internation­al Conference on Health Promotion, Otta­wa 21 November 1986. Accessed 19 Oct­ober 2012. www.who.int/healthpromotion/conferences/previous/ottawa/en/.
41.    Shapcott M. Housing. In: Raphael D (ed). Social determinants of health: Canadian perspectives. Toronto: Canadian Scholars’ Press; 2004. 
42.    Link BG, Susser E, Stueve A, et al. Lifetime and five-year prevalence of homelessness in the United States. Am J Public Health 1994;84:1907-1912
43.    Lester H, Wright N, Heath I, et al. Developments in the provision of primary health care for homeless people. Br J Gen Pract 2002;52:91
44.    Susser E, Valencia E, Conover S. Prevalence of HIV infection among psychiatric patients in a New York City men’s shelter. Am J Public Health 1993;83:568-570
45.    Gelberg L, Linn LS. Assessing the physical health of homeless adults. JAMA 1989;262:1973
46.    Wallace R, Wallace D. The coming crisis of public health in the suburbs. Milbank Q 1993;543-564
47.    Corneil TA, Kuyper LM, Shoveller J, et al. Unstable housing, associated risk behaviour, and increased risk for HIV infection among injection drug users. Health Place 2006;12:79-85
48.    Riley ED, Wu AW, Perry S, et al. Depression and drug use impact health status among marginally housed HIV-infected individuals. AIDS Patient Care STDs 2003;17:401-406
49.    Teesson M, Hodder T, Buhrich N. Alcohol and other drug use disorders among homeless people in Australia. Subst Use Misuse 2003;38:463-474
50.    Susser E, Moore R, Link B. Risk factors for homelessness. Epidemiol Rev 1993;15:546-556
51.    Calsyn RJ, Morse G. Homeless men and women: Commonalities and a service gender gap. Am J Community Psychol 1990;18:597-608
52.    Davey-Rothwell MA, German D, Latkin CA. Residential transience and depression: Does the relationship exist for men and women? J Urban Health 2008;85:707-716
53.    Cheung AM, Hwang SW. Risk of death among homeless women: A cohort study and review of the literature. CMAJ 2004;170:1243-1247
54.    Riley ED, Gandhi M, Bradley et al. Poverty, unstable housing, and HIV infection among women living in the United States. Cur HIV/AIDS Rep 2007;4:181-186
55.    Patterson M, Somers J, McIntosh K, et al. Addictions. Housing and support for adults with severe addictions and/or mental illness in British Columbia. Burnaby: Centre for Applied Research in Mental Health and Addiction, SFU; 2008. 
56.    Greenberg G, Rosenheck R. Jail incarcer­ation, homelessness, and mental health: A national study. Psychiatr Serv 2008;59:170-177
57.    Gatherer A, Moller L, Hayton P. The World Health Organization European Health in Prisons Project after 10 years: Persistent barriers and achievements. Am J Public Health 2005;95:1696
58.    Hayton P, Boyington J. Prisons and health reforms in England and Wales. Am J Public Health 2006;96:1730-1733
59.    Restum ZG. Public health implications of substandard correctional health care. Am J Public Health 2005;95:1689-1691
60.    Correctional Service Canada. CSC health services. Accessed 23 October 2012. www.csc-scc.gc.ca/text/hlth/index-eng.shtml.
61.    Martin RE, Murphy K, Chan R, et al. Primary health care: Applying the principles within a community-based participatory health research project that began in a Canadian women’s prison. Glob Health Promot 2009;16:43-53
62.    Israel BA, Eng E, Schulz AJ, et al. Methods in community-based participatory re­search for health. San Francisco: Jossey-Bass; 2005. 
63.    Israel BA, Schulz AJ, Parker EA, et al. Review of community-based research: Assessing partnership approaches to improve public health. Annual Rev Public Health 1998;19:173-202
64.    Agency for Healthcare Research and Quality. Creating partnerships, improving health: The role of community-based participatory research. Accessed 19 October. www.lnactiveaging.com/resources/cbprrole.pdf/at_download/file.
65.    Martin RE, Murphy K, Hanson D, et al. The development of participatory health research among incarcerated women in a Canadian prison. Int J Prison Health 2009;5:95-107. 
66.    Elwood Martin R, Hanson D, Hemmingway C, et al. Homelessness as viewed by incarcerated women: Participatory research. Int J Prisoner Health 2012;8:108-117.
67.    Martin RE, Murphy K, Korchinski M, et al. Doing time: A time for incarcerated women to develop a health action strategy. Presented at 39th NAPCRG Annual Meeting, 12–16 Nov­ember 2011.


Dr Elwood Martin is a clinical professor in the University of British Columbia Department of Family Practice and director of the Collaborating Centre for Prison Health and Education at UBC. Dr Buxton is an associate professor at the School of Population and Public Health at UBC. Ms Smith is the former coordinator of the Collaborating Centre for Prison Health and Education. Dr Hislop is an associate professor at the School of Population and Public Health at UBC and a retired epidemiologist at Cancer Control Research, BC Cancer Agency.

Ruth Elwood Martin, MD, FCFP, MPH, Jane A. Buxton, MBBS, MHSc, FRCPC, Megan Smith, BSc,, T. Gregory Hislop, MDCM. The scope of the problem: The health of incarcerated women in BC. BCMJ, Vol. 54, No. 10, December, 2012, Page(s) 502-508 - Clinical Articles.



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