Challenges and opportunities for gender-affirming healthcare for transgender women in prison

• Date: 13 March 2017
• DOI: https://doi.org/10.1108/IJPH-08-2016-0046
• Published date: 13 March 2017
• Pages: 32-40
• Author: Jae Sevelius,Valerie Jenness
• Subject Matter: Health & social care,Criminology & forensic psychology,Prisoner health,Sociology,Sociology of crime & law,Public policy & environmental management,Policing,Criminal justice

Challenges and opportunities for

gender-affirming healthcare for

transgender women in prison

Jae Sevelius and Valerie Jenness

Abstract

Purpose –The purpose of this paper is to briefly address three interrelated areas of concerns –victimization,

housing placement and healthcare provision –related to the health and welfare of transgender women in jails,

prisons and other types of detention facilities.

Design/methodology/approach –Drawing on a growing body of research on health risks for transgender

women who are detained in facilities in California and elsewhere, the authors provide recommendations for

policy and practice that constitutes gender-affirming healthcare for transgender women behind bars.

Findings –Policymakers, correctional leaders, and prison-based clinicians have a number of opportunities

to address the welfare of transgender women in jails, prisons and other types of detention facilities.

Originality/value –This policy brief offers concrete steps government officials can take to better meet their

professional and constitutional obligations, provide higher quality care for transgender women involved in the

criminal justice system, and effectuate positive changes in transgender women’s health and welfare both

inside and outside of carceral environments.

Keywords Health in prison, Correctional healthcare, Health policy, Human rights, Women prisoners,

Transgender

Paper type Viewpoint

Introduction

Transgender people challenge one of the most basic assumptions of incarceration:

segregation by sex , with sex (and corre sponding gender id entity) meaning m ale and female

(and only male and female). Transgender people problematize the taken-for-gran ted status of

sex-segregated d etention facilit ies as a routine poli cy commitment and operat ional practice

because their gend er identity and/or g ender expression d o not align with the se x they

were assigned at birth (see Box 1). Transgender people’s gender expression may or may not

align with their gender identity and often varies depending on their desire for and access to

transition-rel ated healthcare, s uch as hormones and s urgeries; this in tu rn, results in

challenges to long-standing classification systems in corrections. The binary system of

classification has created a multitude of complications when it comes to caring for transgender

people in contemporary correctional settings, including providing high-quality healthcare. In

this historical co ntext, transgend er people in some jur isdictions techni cally have legal

protection against discrimination, but they nonetheless confront significant threats to health

and welfare as detainees, jailers and prisoners.

Transgender individuals “are more likely than the general population to experience multiple forms

of violence across the life span”and “[t]hey are less likely to receive adequate medical and

criminal justice interventions when this victimization occurs”(Witten and Eyler, 1999, p. 464; see

also Lombardi et al., 2001). With this in mind, we focus empirical, analytic and policy attention on

transgender women who are subject to state control. Recognizing that transgender men also

comprise an important population of concern, we focus on transgender women because

Received 28 August 2016

Revised 7 December 2016

22 December 2016

Accepted 5 January 2017

The authors want to thank the

University of California Justice and

Health Consortium for inviting the

authors to write this policy brief.

This brief has benefitted from

feedback provided by members of

the Consortium, especially Brie

Williams, Megan Comfort and

Danielle Castro. The drafting of this

manuscript has been supported in

part by Award No. R34DA038541

(PI: Sevelius) from the National

Institute on Drug Abuse at the

National Institutes of Health.

Jae Sevelius is based at the

University of California,

San Francisco, San Francisco,

California, USA.

Valerie Jenness is based at the

University of California, Irvine,

Irvine, California, USA.

PAG E 32

j

INTERNATIONALJOURNAL OF PRISONER HEALTH

j

VOL. 13 NO. 1 2017, pp. 32-40, © Emerald Publishing Limited, ISSN 1744-9200 DOI 10.1108/IJPH-08-2016-0046