In Finland, the health of female offenders has never before appropriately researched. Prison studies elsewhere show that female prisoners often have more health problems than male prisoners. Especially mental disorders, infectious diseases and illicit drug use are common among female inmates. The majority of prisoners are men and most prison studies have not taken gender differences into account. The aims of the present dissertation were as follows: to find out the prevalence of hepatitis and HIV infections and their risk factors among Finnish female prisoners; to assess the frequency and gender differences in childhood abuse and the connections between maltreatment in childhood and substance abuse and mental health; to study lifetime somatic diseases, the use of health care services and prescription medicines; to assess the work ability and employment history and need for treatment of female prisoners, and compare all the results to those of male prisoners.

This dissertation is part of a national prison health survey 2006. Data collection was between October 2005 and October 2007; the majority of the data was obtained in 2006. The material of the present study consisted of 101 females and 309 male prisoners for purposes of comparison.

The prevalence of hepatitis C virus (HCV) antibodies was 52%, hepatitis B surface antigen (HBsAg) 0%, hepatitis A virus (HAV) antibodies 38% and human immunodeficiency virus (HIV) antibodies 1% among women, 44%, 0.7%, 4% and 0.7% respectively among men. Among women, 71% of age group 16-24 had HCV. Among women, HCV was associated only with intravenous drug use (IDU) and syringe/needle sharing, whereas among men also with tattoos, cumulative years in prison and age. Both forms of childhood abuse studied were significantly more common among females than males (physical abuse 25% vs. 15% and sexual abuse 32% vs. 7%). Associations between childhood abuse and family integrity with substance abuse and mental health were different in males and females. The gender differences did not concur with those reported in studies on general populations. At least half of the women prisoners had selfreported somatic diseases in each of the various disease categories. A high proportion of women having somatic illnesses had been treated by a physician. Four out of five women regularly took some prescription medicine. Over 90% of the females reported lifetime hospital care and 70% lifetime use of psychiatric services. Regarding physical diseases and the use of health care services, the gender difference varied and was not so apparent in all disease groups. The females had used psychiatric and substance abuse services significantly more commonly than the males. Female recidivists had accidents/injuries significantly more commonly and were treated twice as often in psychiatric departments than first-time offenders. Among women, 78% were unemployed and only six percent were employed, whereas among men, the proportion of those employed was four times greater than for women. Of the women 42% were unable to work, of the men 11%. Substance abuse disorders were the most common reason for impaired work ability (over 70% in both genders). Among the women, other mental disorders were the second most common reason (39%) and somatic diseases caused impairment in 23%.

Crimes of violence were significantly more common among prisoners with limited working capacity. Need for treatment was found in 94% of the women and 90% of the men. In both genders, the majority of treatment needs were for mental disorders.

In conclusion, female prisoners have a high prevalence of HCV, which is in accordance with the high prevalence of IDU among Finnish prisoners. The risk factors for infections exhibit gender differences. There were also several gender differences between childhood adversities and substance abuse or lifetime mental disorders.

Childhood sexual abuse is well known to be more common among women than men, but among Finnish female prisoners physical abuse has also been a significantly more common experience. The frequent use of health care services by female prisoners is in accordance with their high morbidity related especially to substance abuse, mental health disorders, infections and injuries. Finnish female prisoners have serious problems with alcohol consumption and drugs and frequently other mental disorders, which impairs their work ability, employability and causes their need for treatment. It is important to ascertain the gender differences, and to take them into account in the planning of prison health services as well as other prison functions. The implementation of efficient prisoner treatment and rehabilitation programmes requires up-to-date information on prisoners’ health, need for treatment and ability to work. In future, there will be a need to regularly evaluate the changes in prisoners’ health and health-related factors, and account should be taken of the differences among minority groups such as females. Women have been a growing group of offenders and they will serve longer prison sentences.