Regardless of facility type, female prisoners in Zambia have been exclusively under female guard since 2001. For the remaining seven facilities, female accommodation is makeshift. Of these 52 conventional facilities, 45 have a ‘built-for-purpose’ female wing. Of the 54 conventional facilities, one is female only, one is a juvenile facility, and the remainder have both a male and female wing. Zambia has 87 prisons in total of which 54 are considered ‘conventional’ holding facilities and the remainder termed ‘farm’ or open-air prisons. This study was designed to expand the evidence base in Zambia regarding women prisoners’ health and access to healthcare. While it is generally understood that environmental conditions are dire, for example, and that women’s psychological and physical health needs are likely to be being overlooked, evidence of how structural conditions interact with social and institutional factors in the facility to influence women prisoners’ behaviours or health service access in these settings is largely lacking. The ability of policy makers and programmers to develop sophisticated and sustainable interventions to address the complex needs of female prisoners remains constrained by lack of empiric data documenting epidemiological patterns and the institutional and social dynamics influencing female prisoners’ health and access to health care. Although growing concerns about HIV and TB epidemics in prison populations have also resulted in several recent studies demonstrating high rates of infectious diseases in sub-Saharan African prisons, none of these report fully gender-disaggregated data making them less useful for understanding women prisoners’ disease burden or healthcare needs. In South Africa several studies have documented aspects of women prisoners’ experience including the carceral space, the role of trauma and the implementation of health policies. In a mixed methods study in one Ghanaian prison, Sarpong et al reported women prisoners had poor access to quality healthcare, noting demographic characteristics, marital status, educational background and occupation influenced respondents’ perceptions of, and access to services. A few notable exceptions include a study from four Zambian prisons, which found women prisoners were underserved by general healthcare programs and heavily impacted by physical and sexual abuse. In sub-Saharan Africa, prisons research as a whole is lacking, and empirical research focussing on the experiences and issues of women prisoners is almost non-existent. Despite their small absolute numbers, women prisoners represent the fastest growing incarcerated population globally and have seen a 22 % increase in sub-Saharan African prisons since 2000

Marginalisation is due to a range of structural, relational and demographic factors compounded by weak advocacy for, or inclusion of women prisoners’ needs in domestic public policy debates.

Evidence from a number of (predominantly high-income) countries also highlights the fact that women prisoners tend to experience higher rates of physical and mental disease while incarcerated compared to their male counterparts. Although evidence remains thin in low-income settings, peer reviewed literature from high-income settings demonstrates that women prisoners experience higher rates of emotional, physical and sexual abuse compared with non-incarcerated women. In sub-Sahara, African women prisoners constitute between 1 and 4 % of the total prison population.

Bwana spoons oh oh globby