Women In Prison: Issues and Challenges Confronting U.S. Correctional
Systems (Letter Report, 12/28/1999, GAO/GGD-00-22).

Pursuant to a congressional request, GAO provided information on the
management of female inmate populations.

GAO noted that: (1) in 1980, GAO reported to Congress that U.S.
correctional systems had not been aggressive in providing programs and
services to female inmates due to their relatively small numbers and
because many officials felt that female inmates did not need the same
type of training and vocational skills as male inmates; (2) since 1980,
the number of women in prison has increased over 500 percent--to about
84,000 at calendar year-end 1998; (3) with the general rise in the
number of female inmates, there has been increasing awareness that
female inmates have some needs that are different from those of male
inmates, such as child-related responsibilities and gender-specific
health care; and (4) while progress has been made, GAO's work and other
studies indicate that U.S. correctional systems still face challenges in
addressing the unique needs of female inmates.

--------------------------- Indexing Terms -----------------------------

 REPORTNUM:  GGD-00-22
     TITLE:  Women In Prison: Issues and Challenges Confronting U.S.
	     Correctional Systems
      DATE:  12/28/1999
   SUBJECT:  Correctional facilities
	     Women
	     Population statistics
	     Prisoners
	     Statistical data
	     Children
	     Education or training
	     Health care services
IDENTIFIER:  California
	     Texas

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United States General Accounting Office
GAO

Report to the Honorable

Eleanor Holmes Norton

House of Representatives

December 1999

GAO/GGD-00-22

WOMEN IN PRISON
Issues and Challenges Confronting U.S.

Correctional Systems

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Contents
Page 101GAO/GGD-00-22 Managing Female Inmate Populations
Letter                                                                      1
                                                                             
Appendix I                                                                 14
Objectives, Scope, and
Methodology
                           Objectives                                      14
                           Overview of Our Scope and Methodology           14
                                                                             
Appendix II                                                                18
Growth in Female Inmate
Population
                                                                             
Appendix III                                                               22
Female Inmate
Characteristics
                           Characteristics of Female Inmates in            22
                           1991 and 1997
                           Trends in Characteristics of Female             26
                           Inmates in State Prisons
                                                                             
Appendix IV                                                                35
Correctional Facilities
                           Federal Prisons for Women                       35
                           California Prisons for Women                    39
                           Texas Prisons for Women                         42
                                                                             
Appendix V                                                                 45
Correctional Policies,
Classification Systems,
and Education/Job-
Training Programs
                           Correctional Policies Addressing                45
                           Female-Specific Needs
                           Classification Systems for Female               48
                           Offenders
                           Education and Job-Training Programs             50
                           Lawsuit on Conditions of Confinement            53
                           for BOP Female Inmates
                                                                             
Appendix VI                                                                55
Parenting Issues
                           Mother-Child Visitations                        55
                           Mother-Infant/Child Residential                 58
                           Programs
                           Parent Education Programs                       61
                                                                             
Appendix VII                                                               64
Female-Specific Health
Care
                           Female-Specific Health Care in U.S.             64
                           Correctional Systems
                           Policies and Procedures in                      65
                           Jurisdictions Studied
                           Reviews of Female-Specific Health Care          66
                                                                             
Appendix VIII                                                              72
Substance Abuse
Treatment, Mental
Illness, and HIV
Infection
                           Substance Abuse Treatment                       72
                           Mental Illness                                  78
                           HIV Infection                                   79
                                                                             
Appendix IX                                                                81
Comments From the Bureau
of Prisons
                                                                             
Appendix X                                                                 84
GAO Contacts and Staff
Acknowledgments
                                                                             
Tables                     Table II.1:  Number of Female Inmates           19
                           Under the Jurisdiction of Federal and
                           State Correctional Authorities
                           (Calendar Year-ends 1980, 1990, and
                           1998)
                           Table III.1:  Age, Race/Hispanic                23
                           Origin, Education, and Prearrest
                           Employment of Female Inmates in
                           Federal and State Prisons, 1991 and
                           1997
                           Table III.2:  Most Serious Offenses of          24
                           Female Inmates in Federal and State
                           Prisons, 1991 and 1997
                           Table III.3:  Prior History of Drug             25
                           Use and Physical or Sexual Abuse of
                           Female Inmates in Federal and State
                           Prisons, 1991 and 1997
                           Table III.4:  Marital Status, Minor             26
                           Children, and Living Arrangements of
                           Minor Children of Female Inmates in
                           Federal and State Prisons (1991 and
                           1997)
                           Table III.5:  Characteristics of                28
                           Female Inmates in State Prisons
                           (1979, 1986, 1991, and 1997)
                           Table III.6: Most Serious Offense of            29
                           State Prison Female Inmates (1979,
                           1991, and 1997)
                           Table III.7:  Maximum Length of                 30
                           Sentences (Median and Mean) of Female
                           Inmates in State Prisons (1979, 1986,
                           1991, and 1997)
                           Table III.8:  Marital Status and                31
                           Number of Children of Female Inmates
                           in State Prisons (1979, 1986, and
                           1991)
                           Table III.9:  Living Arrangements of            32
                           Minor Children of Female Inmates in
                           State Prisons (1986, 1991, and 1997)
                           Table III.10: Drug Use History of               32
                           State Prison Female Inmates (1986,
                           1991, and 1997)
                           Table III.11: Alcohol or Drug Use by            33
                           State Prison Female Inmates (1986,
                           1991, and 1997)
                           Table III.12: Prior Physical or Sexual          34
                           Abuse of State Prison Female Inmates
                           (1986, 1991, and 1997)
                           Table IV.1: Populations and Rated               37
                           Capacities for BOP Female Facilities
                           (as of August 6, 1999)
                           Table IV.2:  Distance Between Prison            38
                           and Release Residences for Federal
                           Prison Inmates (as of October 1999)
                           Table IV.3: Populations and Design              41
                           Capacities of California Female
                           Facilities (as of October 3, 1999)
                           Table VI.1:  Female Inmates in State            56
                           Prisons Visited by Minor Children,
                           1997
                           Table VIII.1:  Drug Treatment of                73
                           Federal and State Female Inmates
                           Since Admission to Prison, by Levels
                           of Drug Use, 1991 and 1997
                           Table VIII.2:  Drug- or Alcohol-                74
                           Involved Federal and State Prison
                           Inmates Participating in Treatment or
                           Other Substance Abuse Programs, 1997
                           Table VIII.3: Limitations to Providing          75
                           Substance Abuse Treatment to Federal
                           and State Prison Inmates, 1996
                           Table VIII.4: Residential Substance             77
                           Abuse Treatment for Female Inmates in
                           California Prisons (as of October
                           1999)
                           Table VIII.5:  Female and Male Inmates          79
                           in State Prisons Infected with HIV
                           (at calendar year-end, 1991 to 1996)
                                                                             
Figures                    Figure 1:  Number of Female Inmates in           3
                           Federal and State Prisons, 1980 to
                           1998.
                           Figure IV.1:  U.S. Map Showing                  36
                           Location of BOP's Women-Only Prisons
                           Figure IV.2:  California State Map              40
                           Showing Location of California
                           Prisons for Women
                           Figure IV.3:  Texas State Map Showing           43
                           Location of Texas Facilities for
                           Women
                                                                             

Abbreviations

BJS       Bureau of Justice Statistics
BOP       Bureau of Prisons

B-280204

Page 6GAO/GGD-00-22 Managing Female Inmate Populat
ions
     B-280204

December 28, 1999

The Honorable Eleanor Holmes Norton
House of Representatives
 
 Dear Ms. Norton:

     As you requested, this report discusses
issues important or unique to managing female
inmate populations.1 More specifically, it
provides information on the following questions
about women in prison:

ï¿½    What are the trends in the number of female
inmates and the growth of this population?
ï¿½    What do statistics or trends show about
female inmate characteristics, including age,
race/Hispanic origin, most serious offense, drug
use, prior physical or sexual abuse, and number of
minor children?
ï¿½    What are the trends in the number of
correctional facilities for female inmates? How
near are female inmates housed to their families
or community ties?
ï¿½    To what extent do correctional policies,
classification2 systems, and education/job-
training programs consider the needs of female
inmates?
ï¿½    What types of parenting programs are provided
to female inmates (i.e., visitation, mother-
infant/child residential programs, and parent
education programs)?
ï¿½    What types of reviews are performed to assess
female-specific health care (e.g., gynecological
care), particularly regarding access to care and
quality of care?
ï¿½    To what extent are substance abuse treatment
services provided to female inmates?  What are the
rates of mental illness among female inmates?
And, what are the rates of human immunodeficiency
virus (HIV) infection among female inmates?

As agreed with your office, this report generally
focuses on the nation's three largest correctional
systems for female offenders-the federal Bureau of
Prisons (BOP), the California Department of
Corrections, and the Texas Department of Criminal
Justice. However, for some issues or questions,
this report also presents information obtained
from previously issued national studies on women
in prison. At calendar year-end 1998, the three
correctional systems collectively held over one-
third of the nation's female inmates. We
interviewed officials from the relevant federal
and state agencies and nongovernmental
organizations and reviewed documentation they
provided us. In addition, we visited at least two
women's prisons in each of the three jurisdictions
we studied, wherein we toured the facilities and
interviewed correctional officials. Our work did
not include interviewing female inmates. In some
instances, we compared trend or characteristics
data on female inmates with data on male inmates.
Because this report provides an overview of the
major issues related to women in prison, it may
not include all of the programs and initiatives
under way to address such issues.

     We performed our work from May 1998 to
October 1999 in accordance with generally accepted
government auditing standards. Appendix I contains
additional information on our scope and
methodology.

Results in Brief
In 1980, we reported to Congress that U.S.
correctional systems had not been aggressive in
providing programs and services to female inmates
due to their relatively small numbers and because
many officials felt that female inmates did not
need the same type of training and vocational
skills as male inmates.3 Since 1980, the number of
women in prison has increased over 500 percent-to
about 84,400 at calendar year-end 1998. With the
general rise in the number of female inmates,
there has been increasing awareness that female
inmates have some needs that are different from
those of male inmates, such as child-related
responsibilities and gender-specific health care.
While progress has been made, our work and other
studies indicate that U.S. correctional systems
still face challenges in addressing the unique
needs of female inmates.

     Detailed answers to the questions presented
above are included in appendixes II through VIII
and summary answers are as follows:

ï¿½    Growth in female inmate population: Since
1980, the number of female inmates under the
jurisdiction of federal and state correctional
authorities increased more than 500 percent-from
about 13,400 in 1980 to about 84,400 at calendar
year-end 1998, with the preponderance in state
facilities. As figure 1 shows, the increase has
been steady during this period. In fact, the
number of female inmates in federal and state
prisons increased each year since 1980. The growth
in both the female and male inmate prison
populations since 1980 can be traced in part to
changes in sentencing laws that are intended to
get tough on crime, particularly on drug offenders
(e.g., mandatory minimum sentences and repeat
offender provisions).

Figure 1:  Number of Female Inmates in Federal and
State Prisons, 1980 to 1998.

Source: GAO analysis of Bureau of Justice
Statistics data.

While far smaller in total than the total male
inmate population, the female inmate population is
growing at a faster rate. For example, from 1990
to calendar year-end 1998, the annual rate of
growth for the female inmate population averaged
8.5 percent, versus an average annual increase of
6.6 percent for male inmates. Also, from 1990 to
1997 (the most recently available data),
imprisonment rates for both female and male
inmates showed similar but widespread disparities
by race and Hispanic origin. For example, in 1997,
black females were more than twice as likely as
Hispanic females and eight times more likely than
white females to be in prison. (See app. II.)

ï¿½    Female inmate characteristics: According to
Bureau of Justice Statistics (BJS) surveys of
federal and state prison inmates,4 in 1997, the
typical female inmate was over age 30 and a member
of a racial or ethnic minority. Before entering
prison, a large percentage of female inmates had
abused drugs and had experienced physical or
sexual abuse. For example, in 1997, almost three-
fourths of female inmates in state prisons said
they used drugs regularly at some time in the
past, and slightly over one-half reported a prior
history of physical or sexual abuse. Also, in
1997, a large majority of female inmates in
federal and state prisons were unmarried, and
almost two-thirds had at least one minor child
(under age 18). The total number of minor children
whose mothers were in federal and state prisons
increased from about 61,000 in 1991 to about
110,000 in 1997. After the mother entered prison,
the vast majority of minor children lived with
their grandparent, other relative/friend, or
father. (See app. III.)

ï¿½    Correctional facilities and proximity to
community ties: To accommodate the rapid growth in
the female inmate population, the three
jurisdictions we studied have opened several new
facilities for women. In 1980, BOP had five
prisons for women, and California and Texas had
two prisons for women. In 1998, BOP, California,
and Texas had 15, 5, and 14 facilities for women,
respectively, many of which were opened during the
1990s.5

At the time of our review, the female inmate
populations in federal prisons generally exceeded
their rated capacities (i.e., the number of
inmates that planners or architects intended for
the facility) by a higher percentage than that for
male inmates in federal prisons. In California,
the inmate populations in prisons for women
generally exceeded their design capacities by a
lower percentage than that for inmates in prisons
for men. In Texas, the inmate populations in all
women and men facilities were at or under design
capacities.

Officials in all three jurisdictions told us that
because of the location of facilities for women,
it is not possible to house all female offenders
close to their home of record. According to BOP,
the placement of female offenders presents unique
challenges since it would be prohibitively
expensive to establish facilities for small
numbers of women in every state (relatively close
to their families or community ties). BOP data
show that, in October 1999, about 30 percent of
female inmates in federal prisons-excluding those
with release residences in foreign countries,
Alaska, Hawaii, and U.S. territories and
possessions-were assigned to facilities more than
500 miles from their release residences, compared
with about 24 percent of male inmates in federal
prisons. (See app. IV.)
ï¿½    Correctional policies, classification
systems, and education/job-training programs: Of
the three jurisdictions, only BOP had a policy
that required programs and services to address and
consider the gender-specific needs of female
offenders. California and Texas policies focused
on standardization or equal treatment of female
and male offenders. However, all three
jurisdictions provided some level of female-
specific programs and services, such as parenting
programs.

BOP used distinct or separate classification
systems for female and male offenders to place
them into groups based on their security and
program needs. As a result, a greater percentage
of female than male offenders were assigned to
lower security-level facilities. California used
one classification system for both female and male
offenders, although female inmates of all security
levels were generally housed together. Texas also
used one classification system for both female and
male offenders, with a few minor housing
differences for females (e.g., medium custody
level female offenders may live in dormitories,
but medium custody level male offenders must live
in cells).

All three jurisdictions offered basic education
programs (e.g., General Educational Development
and English as a second language) and job training
at each facility. However, the number and type of
job-training programs varied significantly by
jurisdiction and facility. For example, the number
of job-training programs offered in California's
prisons for women ranged from 3 to 16. (See app.
V.)
ï¿½    Parenting programs: As previously mentioned,
in 1997, almost two-thirds of female inmates in
federal and state prisons had at least one minor
child, according to BJS surveys of prison inmates.
However, BJS data show that over one-half of
female inmates in state prisons were never visited
by their minor children. Visitation log sheets at
the facilities we visited also revealed that
mother-child visits were infrequent. For example,
log sheets at two federal prisons-each of which
housed about 1,000 female inmates-showed that
during an average week one facility received a
total of 12 minor child visitors, and the other
facility received a total of 44 minor child
visitors. According to federal and state
correctional officials in the three jurisdictions
we studied, travel distances and related travel
costs are the primary reasons for infrequent
visitation. Visitation policies and schedules in
the three jurisdictions were the same for female
and male inmates. Of the three jurisdictions,
California was unique in providing family or
overnight visitation, but few children
participated in the program.
Two of the three jurisdictions we studied (BOP and
California) have residential programs for inmate
mothers and their infants and/or children. BOP's
program allows female inmates to remain with their
infants up to 3 months after delivery, while
California allows inmate mothers and their
infants/children to remain together for up to 6
years. However, national survey information and
our work indicate that such programs exist only at
BOP and about 11 states. In other states, newborns
are removed from the inmate-mother's care during
or immediately following the hospital stay. The
three jurisdictions we studied provided female
inmates with parent education programs, although
each had waiting lists for participation. In two
of the three jurisdictions (California and Texas),
female inmates were generally offered more parent
education programs than male inmates. (See app
VI.)

ï¿½    Female-specific health care: Prior research
indicated that the vast majority of U.S.
correctional systems provided some level of health
care related to female-specific issues. For
example, of the 44 U.S. jurisdictions (BOP and 43
states) that responded to a 1999 national survey
of female inmate health care, 43 jurisdictions
(BOP and 42 states) said they provided
gynecological and obstetrical services during
1998.6 Also, according to BJS' 1997 survey of
state prison inmates, about 90 percent of female
inmates reported having a gynecological
examination after admission to prison. However,
prior research and lawsuits in several states
indicated that improvements in the delivery of
services may be needed. For example, one of the
three jurisdictions we studied (California) was
involved in a class-action lawsuit related to
health care at two women's prisons. An August 1997
settlement agreement provided for, among other
things, that California's policies be reviewed and
critiqued by certain specified experts in
correctional health care.

The three jurisdictions we studied use national
standards and have policies for providing health
care related to female-specific issues (e.g.,
gynecological care). Two of the jurisdictions (BOP
and Texas)-using small nongeneralizable
samples-either assessed or recently began to
assess female inmates' access to such care. None
of the three jurisdictions routinely assessed the
quality of health care related to female-specific
issues. However, each of the three jurisdictions
took actions in 1999 to improve their quality
assurance programs, which could lead to increased
monitoring and reviews of the quality of female-
specific health care. (See app. VII.)

ï¿½    Substance abuse treatment, mental health, and
HIV infection: As indicated above, many female
inmates have histories of involvement with
substance abuse. However, prior studies and our
work in selected jurisdictions indicate that
correctional systems may not be providing enough
substance abuse treatment programs for female
inmates. For example, according to BJS data,
although the percentage of female inmates in
federal and state prisons who acknowledged drug
use before incarceration increased from 1991 to
1997, the percentage of female inmates who
reported being treated for drug abuse since
admission to prison declined during this period.
Also, the three jurisdictions we studied had
waiting lists for substance abuse treatment. For
example, as of October 1999, about 600 female
inmates in BOP facilities were on the waiting list
for residential substance abuse treatment.

Female inmates have higher rates of mental illness
and HIV infection than male inmates. For example,
according to BJS' 1997 surveys of prison inmates,
about 13 percent of female inmates in federal
prisons and about 24 percent of female inmates in
state prisons reported a mental condition or an
overnight stay in a mental hospital or treatment
program, compared with 7 percent of male inmates
in federal prisons and about 16 percent of male
inmates in state prisons. Also, at calendar year-
end 1997, 3.5 percent of all female inmates in
state prisons were known to be HIV infected,
versus 2.2 percent of all male inmates in state
prisons. Overall, the percentage of female and
male inmates in state prisons who were known to be
HIV positive remained relatively constant from
1992 to 1997. (See app. VIII.)
Agency Comments
     We provided a draft of this report for review
and comment to the Department of Justice and BOP,
the California Department of Corrections, and the
Texas Department of Criminal Justice.

     On November 18, 1999, Justice's Audit Liaison
Office (Justice Management Division) orally
advised us that the draft had been reviewed by
senior Department of Justice management and the
Office of Justice Programs and these reviewers
generally had no specific comments on the
information presented in the draft. In its written
comments dated November 15, 1999, BOP concurred
with the draft report, with the following
exceptions and comments. (See app. IX)

     According to the Director of BOP, the draft
report statement that BOP does not routinely
evaluate the quality of care of female inmates is
inaccurate. To support this view, the Director
provided information on various national and
facility-specific programs and initiatives
intended to improve the quality of health care at
BOP facilities.

     We agree that BOP has various programs and
initiatives intended to improve the quality of
health care at BOP facilities. In fact, each
program and initiative noted in BOP's written
comments was mentioned in the draft report.
However, BOP did not routinely assess the quality
of health care related to female-specific issues
(e.g., gynecological care) under any of its
quality assurance programs or initiatives. For
example, in BOP's written comments, the Director
noted that a facility housing female inmates could
monitor, under its local quality assurance plan,
the number of Pap smears and mammographies
conducted, the methodology used in ordering and
performing such tests, and the successful
interpretation of test results. However, only one
of the three facilities housing female inmates
that we visited addressed female-specific issues
in its local plan. Moreover, the monitoring of
female-specific issues at the one facility
involved a quantification of outputs or services
provided and not an evaluation of the outcomes or
quality of care.

     Based on BOP's comments regarding quality
assurance reviews, we have modified this report
where appropriate to more clearly note that our
work focused on the extent to which BOP conducted
quality assurance reviews of health care related
to female-specific issues. We have also provided
additional information on BOP's various quality
assurance programs and initiatives.

     The Director of BOP also commented that BOP's
National Institute of Corrections works with many
state and local corrections agencies on problems
and issues concerning the effective management and
treatment of women offenders in community
corrections centers, jails, and prisons. Where
appropriate, we have recognized such assistance in
this report.

     During the period November 15 to 19, 1999,
the California Department of Corrections and the
Texas Department of Criminal Justice provided oral
technical comments and clarifications, which have
been incorporated in this report where
appropriate.

As arranged with your office, unless you publicly
announce the contents of this report earlier, we
plan no further distribution until 30 days after
the date of this report.  At that time, we will
send copies of this report to Representative Henry
Hyde, Chairman, and Representative John Conyers,
Ranking Minority Member, House Judiciary
Committee; and to Senator Orrin Hatch, Chairman,
and Senator Patrick Leahy, Ranking Minority
Member, Senate Judiciary Committee. We also are
sending copies of this report to The Honorable
Janet Reno, Attorney General; The Honorable
Kathleen Hawk Sawyer, Director, BOP; Mr. C.A.
"Cal" Terhune, Director, California Department of
Corrections; Mr. Wayne Scott, Executive Director,
Texas Department of Criminal Justice; and other
interested parties. Copies of this report also
will be made available to others upon request.

Please contact me on (202) 512-8777, or Danny
Burton or Eric Erdman on (214) 777-5600, if you or
your staff have any questions about this report.
Key contributors to this assignment are listed in
appendix X.

Sincerely yours,

Laurie E. Ekstrand
Director
Administration of Justice Issues
 
_______________________________
1Earlier this year, we reported on staff sexual
misconduct in women's prisons-Women In Prison:
Sexual Misconduct by Correctional Staff (GAO/GGD-
99-104, June 22, 1999).
2In the context of correctional systems, the term
"classification" refers to the systematic
subdivision of inmates into groups based on their
security and program needs.
3Women In Prison: Inequitable Treatment Requires
Action (GAO/GGD-81-6, Dec. 10, 1980).
4Periodically, about every 5 years, BJS conducts
nationally representative surveys of inmates in
federal and state correctional facilities. The two
most recent surveys were conducted in 1991 and
1997.
5In addition to BOP's 15 women-only prisons, BOP
had 10 administrative facilities that housed both
female and male inmates.
6Corrections Compendium, November 1999.

Appendix I
Objectives, Scope, and Methodology
Page 16GAO/GGD-00-22 Managing Female Inmate Popula
tions
Objectives
     In response to a request by Congresswoman
Eleanor Holmes Norton, this report presents
information on the following issues or questions
related to women in prison:

ï¿½    What are the trends in the number of female
inmates and the growth of this population?
ï¿½    What do statistics or trends show about
female inmate characteristics, including age,
race/Hispanic origin, most serious offense, drug
use, prior physical or sexual abuse, and number of
minor children?
ï¿½    What are the trends in the number of
correctional facilities for female inmates? How
near are female inmates housed to their families
or community ties?
ï¿½    To what extent do correctional policies,
classification1 systems, and education/job-
training programs consider the needs of female
inmates?
ï¿½    What types of parenting programs are provided
to female inmates (i.e., visitation, mother-
infant/child residential programs, and parent
education programs)?
ï¿½    What types of reviews are performed to assess
female-specific health care (e.g., gynecological
care), particularly regarding access to care and
quality of care?
ï¿½    To what extent are substance abuse treatment
services provided to female inmates?  What are the
rates of mental illness among female inmates?
And, what are the rates of human immunodeficiency
virus (HIV) infection among female inmates?

Overview of Our Scope and Methodology
Initially, in addressing these issues or
questions, we conducted a literature search to
identify relevant reports, studies, articles, and
other documents. In so doing, among other
resources, we contacted (1) the National Institute
of Justice, which is a component of the Department
of Justice's Office of Justice Programs and serves
as the department's research and development
agency and (2) the National Institute of
Corrections, a federal Bureau of Prisons (BOP)
component that operates an information
clearinghouse.

Generally, as agreed with the requester, the scope
of our work covered prisons in three
jurisdictions, that is, the federal correctional
system (BOP) and state systems in California and
Texas-the two states with the largest number of
female inmates. In each jurisdiction, we visited
at least two women's prisons:

ï¿½    BOP: We visited 3 of BOP's 15 women-only
prisons-Federal Prison Camp Byran (Texas), Federal
Correctional Institution Dublin (California), and
Federal Correctional Institution Danbury
(Connecticut). These three facilities are among
BOP's largest women's prisons. Two of the three
prisons (Bryan and Dublin) are located in the
states we studied. Further, we selected Danbury
partly because most District of Columbia female
felony offenders had been transferred to this
Connecticut facility.2
ï¿½    California Department of Corrections: We
visited the two largest of California's five
prisons for women-the Central California Women's
Facility and the Valley State Prison for
Women-both located in Chowchilla. Also, these
facilities reportedly are two of the largest
women's prisons in the world. Collectively, these
two prisons house about 7,000 women offenders,
over one-half of the state's female inmates.
ï¿½    Texas Department of Criminal Justice: We met
with the wardens of 6 of Texas' 14 facilities that
house female inmates (Gatesville, Hilltop, Hobby,
Mountain View, Murray, and Woodman). Five of the
six facilities are centrally located in the state
(in the Gatesville area) and house approximately
one-half of the state's female inmates. We toured
three of the six facilities (Gatesville, Murray,
and Woodman).

For some topics, such as (1) inmate populations,
(2) inmate characteristics, and (3) parenting
programs, we were able to obtain national or
multistate perspectives by drawing upon published
data or conducting limited telephonic surveys. We
also contacted various research, industry,
advocacy, and other organizations to obtain
information on issues related to women in prison.
These instances are noted in applicable appendixes
of this report and in the following sections,
which give specific details about the scope and
methodology for the respective issues or questions
we addressed.

Scope and Methodology of Our Work Regarding Female
Inmate Populations, Characteristics, and
Facilities
     To identify information on female inmate
populations and characteristics, we relied
primarily on national survey data from the
Department of Justice's Bureau of Justice
Statistics (BJS). BJS obtains year-end and midyear
counts of prisoners from BOP, the departments of
corrections in each of the 50 states, and the
District of Columbia. Also, about every 5 years,
BJS conducts nationally representative surveys of
inmates in federal and state correctional
facilities. BJS has conducted two surveys of
federal prison inmates. These two surveys were
based on projectable samples selected from federal
inmate populations, as of calendar year-end 1991
and 1997, respectively. In contrast to its two
surveys of federal prison inmates, BJS has
conducted five surveys of state prison inmates.
The five most recent BJS surveys were based on
projectable samples selected from state inmate
populations as of calendar year-ends 1974, 1979,
1986, 1991, and 1997, respectively. More details
about the BJS surveys are presented in appendixes
II and III.

To obtain information on facilities for female
inmates, we focused on BOP and state correctional
systems in California and Texas. In so doing, we
contacted applicable federal and state officials
to determine (1) the number, name, and location of
female facilities; (2) female inmate populations
compared with prison capacities; and (3) the
distances between women's prisons and release
residences and/or major metropolitan areas.

Scope and Methodology of Our Work Regarding
Correctional Policies, Classification Systems, and
Education/Job-Training Programs
Regarding correctional policies, classification
systems, and education/job-training programs, our
work focused primarily on the extent to which BOP,
California, and Texas policies and procedures are
standardized for female and male inmates or
recognize female-specific differences. Within
these jurisdictions, at a policy level, we
reviewed (1) laws and/or policies that recognize
gender-specific differences, (2) classification
policies used for purposes of security and custody
designations,3 and (3) policies related to equal
availability of education and job-training
programs. We did not assess compliance with
policies and procedures, evaluate outcomes, or
determine if female-specific needs were actually
being met.

Scope and Methodology of Our Work Regarding
Parenting Issues
     Regarding mother-child visitation at selected
BOP, California, and Texas facilities housing
female inmates, we (1) reviewed policies and
procedures to identify the types of visitation
programs offered, (2) obtained information and/or
statistics on the number of children involved in
visitation programs, and (3) interviewed
correctional officials to identify barriers or
obstacles to mother-child visitation.

     Regarding residential programs for inmate
mothers and their infants/children, we interviewed
experts on women in prison issues and reviewed
literature to identify correctional jurisdictions
with programs that allow female inmates to bond or
live with their infants or children for an
extended duration. We interviewed cognizant
officials and obtained documentation on various
aspects of the federal and state programs,
including program components, duration, and
eligibility requirements.

     Regarding parent education programs at
selected BOP, California, and Texas facilities, we
interviewed officials and reviewed documentation
on the types of programs/classes offered, their
duration, eligibility requirements, and waiting
lists.

Scope and Methodology of Our Work Regarding Health
Care Issues
To ascertain how selected gender-specific health
care needs are being met (e.g., gynecological
care), we interviewed cognizant BOP, California,
and Texas officials and reviewed policies and
procedures to identify standards for offering or
providing female-specific health care. We then
determined what systems or reviews the three
jurisdictions have implemented to assess
compliance with applicable standards (i.e., we
ascertained how the jurisdictions review access to
care and ensure quality of care).

Scope and Methodology of Our Work Regarding
Substance Abuse Treatment, Mental Illness, and HIV
Infection
Regarding substance abuse treatment, mental
illness, and HIV infection, we reviewed previously
issued national studies (i.e., studies conducted
by BJS, the National Center on Addiction and
Substance Abuse at Columbia University, the
National Institute of Justice, and us). Also, for
BOP, California, and Texas, we (1) identified
policies and procedures for providing substance
abuse treatment, (2) reviewed documents that
describe treatment programs (e.g., program
components and program durations), and (3)
obtained information and/or statistics on program
participation and waiting lists.

_______________________________
1In the context of correctional systems, the term
"classification" refers to the systematic
subdivision of inmates into groups based on their
security and program needs.
2The National Capital Revitalization and Self-
Government Improvement Act of 1997 (P.L. 105-33)
required the transition of female felony offenders
from the District of Columbia Department of
Corrections to BOP. In July 1999, we reported on
the status of the transition-Women in Prison:
Transition of District of Columbia Female Felons
to the Federal Bureau of Prisons (GAO/GGD-99-144R,
Jul. 21, 1999).
3Classification policies affect housing, access to
programs, location, levels of privilege, and
degree of deprivation of liberty.

Appendix II
Growth in Female Inmate Population
Page 19GAO/GGD-00-22 Managing Female Inmate Popula
tions
BJS, with the U.S. Bureau of the Census as its
collection agent, obtains year-end and midyear
counts of prisoners from BOP, the departments of
corrections in each of the 50 states, and the
District of Columbia. This appendix presents
information and statistics from various BJS prison
population reports.

According to BJS, table II.1 shows the following
statistics about the growth in the female inmate
population (calendar year-end data):

ï¿½    Since 1980, the number of female inmates
under the jurisdiction of federal and state
correctional authorities increased more than 500
percent-from about 13,400 in 1980 to about 84,400
in 1998, with the preponderance in state
facilities.
ï¿½    From 1990 to 1998, the female inmate
population almost doubled-from about 44,100 in
1990 to about 84,400 in 1998.
ï¿½    From 1990 to 1998, the annual rate of growth
for the female inmate population averaged 8.5
percent (versus an average annual increase of 6.6
percent for male inmates).
ï¿½    From 1990 to 1998, the female inmate
population grew at an annual rate of at least 10
percent in 18 states. North Dakota reported the
highest average annual increase in female inmates
(16.7 percent), while only the District of
Columbia reported fewer female inmates during this
period.1
ï¿½    In 1998, there were 57 sentenced female
inmates2 per 100,000 women in the United States
(compared with 885 sentenced male inmates per
100,000 men in the United States). In other words,
relative to the number of U.S. residents, 1 in
every 1,754 women and 1 in every 113 men were
sentenced prisoners under the jurisdiction of
federal or state authorities in 1998.
ï¿½    In 1998, over a third of all female inmates
were held in the three largest jurisdictions:
California (11,694), Texas (10,343), and the
federal system (9,186).
ï¿½    In 1998, the federal system and 26 states had
more than 1,000 female inmates (24 states and the
District of Columbia had less than 1,000 female
inmates).
ï¿½    In 1998, Oklahoma (with 122 sentenced female
inmates per 100,000 female state residents) and
Texas (with 102) had the highest female
incarceration rates. Maine and Vermont (both with
9 sentenced female inmates per 100,000 female
state residents) had the lowest incarceration
rates.

Table II.1:  Number of Female Inmates Under the
Jurisdiction of Federal and State Correctional
Authorities (Calendar Year-ends 1980, 1990, and
1998)
Jurisdiction    Number of female        Average annual  Incarceration rate,
                    inmates       percentage increase,                1998a
                                          1990 to 1998
               1980   1990   1998                                          
Federal       1,399  5,011  9,186                 7.9 %                    5
States        12,02  39,054 75,241                 8.5                    51
                  1
 U.S. total   13,42  44,065 84,427                 8.5                    57
                  0
                                                                           
State                                                                      
Alabama         265    955  1,525                 6.0                    64
Alaska           21    128    302                11.3                    54
Arizona         219    835  1,780                 9.9                    66
Arkansas        106    435    696                 6.1                    52
Californiab   1,316  6,502 11,694                 7.6                    67
Colorado         69    433  1,070                12.0                    53
Connecticut     206    683  1,357                 9.0                    43
Delaware         57    226    440                 8.7                    51
District of      70    606    478                -2.9                   173
Columbiab
Florida         839  2,664  3,526                 3.6                    45
Georgia         568  1,243  2,474                 9.0                    61
Hawaii           31    171    430                12.2                    60
Idaho            25    120    321                13.1                    52
Illinois        346  1,183  2,646                10.6                    43
Indianab        241    681  1,198                 7.3                    39
Iowa             93    212    491                11.1                    33
Kansas          113    284    523                 7.9                    39
Kentucky        125    479  1,046                10.3                    51
Louisiana       303    775  2,126                13.4                    94
Maine            21     44     63                 4.6                     9
Maryland        229    877  1,140                 3.3                    39
Massachusetts   106    582    750                 3.2                    13
b
Michiganb       634  1,688  2,052                 2.5                    41
Minnesota        65    159    288                 7.7                    12
Mississippi     117    448  1,213                13.3                    77
Missouri        236    777  1,880                11.7                    67
Montana          25     76    248                15.9                    56
Nebraska         56    145    254                 7.3                    28
Nevada          100    406    743                 7.8                    85
New Hampshire     5     44    116                12.9                    19
New Jersey      198  1,041  1,653                 6.0                    39
New Mexico       57    193    315                 6.3                    32
New York        613  2,691  3,631                 3.8                    38
North           616    945  1,932                 9.4                    35
Carolinab
North Dakota      2     20     69                16.7                    19
Ohio            632  1,947  2,912                 5.2                    50
Oklahoma        247  1,071  2,091                 8.7                   122
Oregon          100    362    523                 4.7                    29
Pennsylvania    272  1,006  1,517                 5.3                    24
Rhode Island     26    166    235                 4.4                    18
South           327  1,053  1,412                 3.7                    63
Carolina
South Dakota     18     77    202                12.8                    54
Tennessee       336    390    886                10.8                    31
Texasc        1,221  2,196 10,343                  NC                   102
Utah             27    125    270                10.1                    25
Vermont          16     36     45                 2.8                     9
Virginia        303    927  1,806                 8.7                    47
Washington      190    435  1,018                11.2                    35
West Virginia    30     76    211                13.6                    23
Wisconsin       154    348  1,169                  NC                    42
Wyomingb         29     88    131                 5.1                    55
States total  12,02  44,065 84,427                                          
                  1
Legend
NC = Not calculated because of changes in
reporting procedures.
aThe overall incarceration rates (i.e., U.S.
total, federal, and state total) represent the
number of female inmates with sentences of more
than 1 year per 100,000 female U.S. residents. The
individual state incarceration rates represent the
number of female inmates with sentences of more
than 1 year per 100,000 female state residents.
bGrowth from 1990 to 1998 may be slightly
overestimated due to a change in reporting
methods.
cExcludes an unknown number of female inmates in
1990 who were "paper ready" state inmates in local
jails.
Source: GAO summary of BJS data.

While far smaller in total than the male inmate
population, female inmates have become a larger
part of the total prison population. For example,
in 1998, women prisoners accounted for 6.5 percent
of all prisoners nationwide, up from 5.7 percent
in 1990 and 4.1 percent in 1980. Also, from 1990
to 1997 (the most recently available data), female
and male incarceration rates showed similar but
widespread racial and ethnic disparities. For
example, in 1997, black non-Hispanic females (with
an incarceration rate of 200 per 100,000) were
more than twice as likely as Hispanic females (87
per 100,000) and eight times more likely than
white non-Hispanic females (25 per 100,000) to be
in prison. These differences among white, black,
and Hispanic females were consistent across all
age groups.

The growth in the female inmate prison population
can be traced in part to changes in sentencing
laws that are intended to get tough on crime,
particularly on drug offenders (e.g., mandatory
minimum sentences and repeat offender provisions).
For example, during the 1990s, drug offenders
accounted for the largest source of total growth
among female inmates. More specifically, from 1990
to 1997 (the most recently available data), the
number of female inmates serving time for drug
offenses nearly doubled, while the number of male
inmates serving time for drug offenses increased
by 48 percent. The number of female and male
inmates serving time for violent offenses,
however, increased at about the same pace (up 68
percent for women and 64 percent for men).

_______________________________
1In January 1998, as part of the National Capital
Revitalization and Self-Government Improvement Act
of 1997 (P.L. 105-33), the District of Columbia
Department of Corrections began transferring its
female felony inmates to BOP.
2Sentenced inmates are those with sentences of
more than 1 year.

Appendix III
Female Inmate Characteristics
Page 25GAO/GGD-00-22 Managing Female Inmate Popula
tions
BJS has conducted two nationally representative
surveys of inmates in federal correctional
facilities (1991 and 1997). Also, about every 5
years since the mid-1970s, BJS has conducted
nationally representative surveys of inmates in
state correctional facilities. Inmates were
interviewed about their current offenses and
sentences, criminal histories, family and personal
backgrounds, and prior drug and alcohol use, among
other things.1 Using the survey results, BJS
developed nationally representative estimates of
the characteristics of federal and state prison
inmates.

The following presents selected characteristics of
federal and state female inmates during 1991 and
1997 and additional trend statistics for female
inmates in state prisons. For a given survey year,
the total number of inmates shown may vary from
table to table. These variances occur because, in
using the sample responses to develop estimates
for the entire inmate universe, BJS made
adjustments to compensate for response rates to
particular questions.

Characteristics of Female Inmates in 1991 and 1997
     For selected characteristics, the following
sections and tables summarize the results of BJS
surveys of federal and state female prison inmates
in 1991 and 1997:

ï¿½    Age, race/Hispanic origin, education, and
prearrest employment (table III.1);
ï¿½    Current/most serious offense (table III.2);
ï¿½    Prior history of drug use and physical or
sexual abuse (table III.3); and
ï¿½    Marital status, minor children, and living
arrangements of minor children (table III.4).

Age, Race/Hispanic Origin, Education, and
Prearrest Employment
     Table III.1 shows the following statistics
about the age, race/Hispanic origin, education,
and prearrest employment of female inmates:

ï¿½    The percentage of female inmates in federal
and state prisons age 35 and older increased from
1991 to 1997;
ï¿½    In 1997, the race or origin of female inmates
in federal prisons was fairly evenly distributed
among whites, blacks, and Hispanics (about 29, 35,
and 32 percent, respectively);
ï¿½    In 1991 and 1997, the largest race or origin
category in state prisons was blacks (about 46 to
48 percent);
ï¿½    In 1997, about 73 percent of female inmates
in federal prisons and about 36 percent of female
inmates in state prisons were high school
graduates or had some college or more; and
ï¿½    In 1997, about 63 percent of female inmates
in federal prisons and about 51 percent of female
inmates in state prisons were employed prior to
their arrest.

Table III.1:  Age, Race/Hispanic Origin,
Education, and Prearrest Employment of Female
Inmates in Federal and State Prisons, 1991 and
1997
Characteristic         Percent of     Percent of
                        federal          state
                     female inmates female inmates
                      1991    1997   1991    1997
Age:                                                    
24 or younger        11.3 %   8.6 %  16.4 %  11.5 %
25-34                40.2    35.3    50.4   43.4  
35-44                31.3    32.0    25.5   34.1  
45-54                12.2    18.2     6.1    9.0  
55 or older           5.0     5.8     1.7    1.9  
Race/Hispanic                                     
origin:
White non-Hispanic   29.0 %  29.1 %  36.2 %  33.2 %
Black non-Hispanic   38.6    34.5    46.0   47.7  
Hispanic             29.5    32.2    14.2   15.4  
Othera                2.9     4.2     3.6    3.7  
Education:b                                       
8th grade or less    12.0 %   8.4 %  16.0 %   8.4 %
Some high school     15.3    18.7    45.8   55.5  
High school          47.0    44.1    22.7   21.7  
graduate
Some college or      25.8    28.8    15.5   14.4  
more
Prearrest                                         
employment
Employed             63.3 %  63.4 %  46.7 %  50.7 %
Unemployed           36.7    36.6    53.3   49.3  
Number of female    4,222   6,422   38,796  66,242  
inmates
aIncludes Asians, Pacific Islanders, American
Indians, Alaska Natives, and other racial groups.
bBased on highest grade completed.
Source: GAO summary of BJS data.

Current/Most Serious Offenses
Table III.2 shows that, in 1997, about 72 percent
of female inmates in federal prisons and about 34
percent of female inmates in state prisons were
serving sentences for drug offenses.

Table III.2:  Most Serious Offenses of Female
Inmates in Federal and State Prisons, 1991 and
1997
Characteristic         Percent of     Percent of
                        federal          state
                     female inmates female inmates
                      1991    1997   1991    1997
Most serious                                      
offenses:
Violent offenses      7.7 %   6.7 %  32.2 %  28.2 %
Property offenses    16.5    12.2    28.7   26.6  
Drug offenses        65.5    71.7    32.8   34.4  
Public order          8.6     7.7     5.7   10.5  
offenses
Other offensesa       1.8     1.7     0.6    0.3  
Number of female    4,217   6,392   38,462  65,735  
inmates
Note: Detail may not add to 100 percent because of
rounding.
aIncludes blackmail, extortion, hit-and-run
driving with bodily injury, child abuse, criminal
endangerment.
Source: GAO summary of BJS data.

Prior History of Drug Use and Physical or Sexual
Abuse
Table III.3 shows the following statistics about
female inmates' prior history of drug use and
prior history of physical or sexual abuse:

ï¿½    From 1991 to 1997, an increasing percentage
of female inmates in federal and state prisons
acknowledged (1) regular drug use before
incarceration and (2) a prior history of physical
or sexual abuse before incarceration;
ï¿½    In 1997, about 37 percent of female inmates
in federal prisons and about 62 percent of female
inmates in state prisons acknowledged they had
used drugs in the month before their current
offense; and
ï¿½    In 1997, about 40 percent of female inmates
in federal prisons and about 57 percent of female
inmates in state prisons acknowledged they were
physically or sexually abused before
incarceration.

Table III.3:  Prior History of Drug Use and
Physical or Sexual Abuse of Female Inmates in
Federal and State Prisons, 1991 and 1997
Characteristic         Percent of     Percent of
                        federal          state
                     female inmates female inmates
                      1991    1997   1991    1997
Drug use:                                         
Ever used drugs      34.7 %  47.2 %  65.3 %  73.6 %
regularly before
incarcerationa
Used drugs in month  27.6    36.7    53.9   62.4  
before
current offense
Under drug           16.3    19.3    36.3   40.2  
influence at the
time
of current offense
Committed offense    10.3    12.3    23.9   29.0  
to get money
to buy drugs
Number of female    4,208   6,368   38,743  65,338  
inmates
Physical or sexual                                
abuse:
Ever physically or                                
sexually
abused before
incarceration?
Yes                  22.2 %  39.9 %  43.2 %  57.2 %
No                   77.8    60.1    56.8   42.8  
Number of female    4,083   6,347   38,109  65,425  
inmates
aRegular use is defined as once a week or more for
at least 1 month.
Source: GAO summary of BJS data.

Marital Status, Minor Children, and Living
Arrangements of Minor Children
     Table III.4 shows the following statistics
about female inmates' marital status, minor
children, and living arrangements of minor
children:

ï¿½    A large majority of female inmates were
unmarried (i.e., widowed, divorced, separated, or
never married) in 1991 and 1997;
ï¿½    About 60 percent of female inmates in federal
prisons and about two-thirds of female inmates in
state prisons had at least one child under age 18
in 1991 and 1997;
ï¿½    The total number of children under age 18
whose mothers were in federal or state prisons
increased from about 61,000 in 1991 to about
110,000 in 1997.2
ï¿½    The vast majority of minor children whose
mothers were in prison lived with their
grandparent, other relative/friend, or father in
1991 and 1997, with about one-half living with
their grandparent.

Table III.4:  Marital Status, Minor Children, and
Living Arrangements of Minor Children of Female
Inmates in Federal and State Prisons (1991 and
1997)
Characteristic         Percent of     Percent of
                        federal          state
                     female inmates female inmates
                      1991    1997    1991   1997
Marital status:                                   
Married              28.8 %  29.4 %  17.3 % 17.3 %
Widowed               5.7     6.0     5.9    5.8  
Divorced             22.5    21.1    19.1   19.9  
Separated            10.6    10.0    12.5    9.8  
Never married        32.3    33.6    45.1   47.1  
Have children under                               
age 18:
Yes                  61.4 %  59.1 %  66.6 % 65.8 %
No                   38.6    40.9    33.4   34.2  
Total number of     5,252   7,792   56,123   102,4  
children under age                            48
18
Living arrangements                               
of children under
age 18
Did child(ren)                                    
under 18 live with
mother before she
entered
prison?a
Yes                  87.4 %  84.0 %  71.7 % 64.3 %
No                   12.6    16.0    28.3   35.7  
After the mother                                  
entered prison,
with whom did minor
children
live?b
Father               25.8 %  31.6 %  25.4 % 27.7 %
Grandparent          48.0    45.5    50.6   52.7  
Other                32.4    37.6    24.4   28.5  
relative/friend
Agency/foster home    4.5     3.2    10.7    9.7  
Other/alone            NR      NR     6.0    8.7  
Legend
NR = Not reported in the BJS source document.
aPercents are based on inmates with children under
age 18.
bPercents add to more than 100 percent because
inmates with more than one child may have provided
multiple responses.
Source: GAO summary of BJS data.

Trends in Characteristics of Female Inmates in
State Prisons
As mentioned previously, while BJS has conducted
only two surveys of federal prison inmates (1991
and 1997), it has conducted five surveys of state
prison inmates (1974, 1979, 1986, 1991, and 1997).
To the extent comparable data were reported by
BJS, we used the results of the 1979, 1986, 1991,
and 1997 surveys to develop tables showing trends
in the characteristics of female inmates in state
prisons.3 Specifically, the tables summarize the
following characteristics:

ï¿½    Age, race/Hispanic origin, education, and
prearrest employment (table III.5);
ï¿½    Most serious offense (table III.6);
ï¿½    Maximum length of sentences by most serious
offense (table III.7);
ï¿½    Marital status and number of children (table
III.8);
ï¿½    Living arrangements of minor children (table
III.9);
ï¿½    Drug use history (table III.10);
ï¿½    Alcohol use history (table III.11); and
ï¿½    Prior physical or sexual abuse (table
III.12).

As indicated in some of the tables, BJS' 1979 and
1986 surveys did not report on as many
characteristics as did the 1991 and 1997 surveys.

Age, Race/Hispanic Origin, Education, and
Prearrest Employment
Table III.5 shows the following statistics about
the age, race/Hispanic origin, education, and
prearrest employment of female inmates in state
prisons:

ï¿½    The percentage of female inmates in state
prisons who were age 35 or older increased from
about 23 percent in 1979 to about 45 percent in
1997;
ï¿½    The percentage of female inmates in state
prisons of Hispanic origin doubled from about 8
percent in 1979 to about 15 percent in 1997;
ï¿½    From 1979 to 1997, the education levels of
female inmates in state prisons either remained
fairly constant or reflected no clear trends.
However, the percentage of female inmates with
little education (8th grade or less) decreased
from 16 percent in 1991 to about 8 percent in
1997.
ï¿½    The prearrest employment levels of female
inmates in state prisons were similar in 1979
(about 52 percent) and 1997 (about 51 percent).

Table III.5:  Characteristics of Female Inmates in
State Prisons (1979, 1986, 1991, and 1997)
Characteristic       Perc
                    ent
                    of
                    fema
                    le
                    inma
                    tes
                    at
                    year
                    end
                       1979    1986  1991     1997
Age:                                              
17 or younger          0.4 %   0.2 %  0.1 %    0.6 %
18-24                 31.2   22.3   16.3    10.9  
25-34                 45.8   50.5   50.4    43.4  
35-44                 15.1   19.6   25.5    34.1  
45-54                  5.5    5.5    6.1     9.0  
55 or older            2.0    1.8    1.7     1.9  
Median age              NR     29     31      33  
                            years   years   years
Race/Hispanic                                     
origin:
White non-Hispanic    36.6 %  39.7 % 36.2 %   33.2 %
Black non-Hispanic    53.2   46.0   46.0    47.7  
Hispanic               7.6   11.7   14.2    15.4  
Othera                 2.6    2.5    3.6     3.7  
Education:b                                       
8th grade or less     14.8 %  16.5 % 16.0 %    8.4 %
Some high school      46.3   49.7   45.8    55.5  
High school graduate  26.5   19.1   22.7    21.7  
Some college or more  12.4   14.8   15.5    14.4  
Prearrest                                         
employment:
Employed              51.7 %  47.1 % 46.7 %   50.7 %
Unemployed            48.3   52.9   53.3    49.3  
Number of female     11,080  19,812   38,79  66,242  
inmates                                6
Legend
NR = Not reported in the BJS source document.
aIncludes Asians, Pacific Islanders, American
Indians, Alaska Natives, and other racial groups.
bBased on highest grade completed.
Source: GAO summary of BJS data.

Most Serious Offenses
Table III.6 shows the following statistics about
the most serious offenses of female inmates in
state prisons:

ï¿½    The percentage of female inmates in state
prisons whose most serious offense was a drug
offense increased from about 11 percent in 1979 to
about 34 percent in 1997, with most of the
increase occurring from 1986 to 1991;
ï¿½    The percentage of female inmates in state
prisons whose most serious offense was a violent
offense decreased from about 49 percent in 1979 to
about 28 percent in 1997; and
ï¿½    The percentage of female inmates in state
prisons whose most serious offense was a property
offense decreased from about 37 percent in 1979 to
about 27 percent in 1997.

Table III.6: Most Serious Offense of State Prison
Female Inmates (1979, 1991, and 1997)
Most serious        Perce
offenses            nt of
                   femal
                   e
                   inmat
                   es at
                   year
                   end
                       1979    1986   1991    1997
Violent offenses:    48.9 %  40.7 %  32.2 %   28.2 %
Murdera              15.5    13.0    11.7     8.5 
Negligent             9.8     6.8     3.4     2.6 
manslaughter
Kidnaping             1.4     0.9     0.4     0.6 
Rape                  0.4     0.2     0.4     0.4 
Other sexual          0.3     0.9     1.3     0.9 
assault
Robbery              13.6    10.6     7.8     7.2 
Assault               7.6     7.1     6.2     6.8 
Other violentb,       0.4     1.2     1.1     1.3 
Property offenses    36.8 %  41.2 %  28.7 %   26.6 %
Drug offenses:       10.5 %  12.0 %  32.8 %   34.4 %
Possession            2.7     4.0    11.8    14.6 
Trafficking           7.1     7.3    19.8    18.5 
Other/unspecified     0.7     0.7     1.3     1.3 
Public-order          2.9 %   5.1 %   5.7 %   10.5 %
offenses
Other offenses        0.9 %   0.9 %   0.6 %    0.3 %
Number of female    11,080   19,761   38,462  65,735 
inmates
aIncludes nonnegligent manslaughter.
bIncludes blackmail, extortion, hit-and-run
driving with bodily injury, child abuse, criminal
endangerment, and other unspecified offenses.
Source: GAO summary of BJS data.

Maximum Length of Sentence
Table III.7 shows that the maximum length of
sentence (the mean for all offenses) for female
inmates in state prisons was 66 months in 1986 and
102 months in 1997.4

Table III.7:  Maximum Length of Sentences (Median
and Mean) of Female Inmates in State Prisons
(1979, 1986, 1991, and 1997)
Most serious offense   Maximum
                      length of
                      sentence
                      (in months)
                      for female
                      inmates
                       1986      1991      1997
Violent offenses:                          
Median                 NR        180       144
Mean                   108       178       175
Property offenses:                         
Median                 NR        44        48
Mean                   53        74        74
Drug offenses:                             
Median                 NR        54        54
Mean                   54        79        84
Public-order offenses:                     
Median                 NR        36        26
Mean                   47        60        46
All offenses:                              
Median                 NR        60        60
Mean                   66        105       102
Legend
NR = Not reported in the BJS source documents.
Source: GAO summary of BJS data.

Marital Status and Number of Minor Children
Table III.8 shows the following statistics about
state female inmates' marital status and number of
minor children:

ï¿½    The percentage of female inmates in state
prisons who were never married increased from
about 36 percent in 1979 to about 47 percent in
1997 and
ï¿½    The total number of minor children whose
mothers were in state prison increased from 37,600
in 1986 to over 102,000 in 1997.5

Table III.8:  Marital Status and Number of
Children of Female Inmates in State Prisons (1979,
1986, and 1991)
Marital status and    Pe
number of children    rc
                     en
                     t
                     of
                     fe
                     ma
                     le
                     in
                     ma
                     te
                     s
                        1979   1986   1991    1997
Marital status:                                   
Married                21.4 %  20.1 %  17.3 %  17.3 %
Widowed                 8.2    6.7    5.9    5.8  
Divorced               18.9   20.5   19.1   19.9  
Separated              15.0   11.0   12.5    9.8  
Never married          36.4   41.7   45.1   47.1  
Have children under                               
age 18:
Yes                      NR   67.5 %  66.6 %  65.8 %
No                       NR   32.5   33.4   34.2  
Number of children                                
under age 18:a
1                        NR   31.7 %  37.3 %  31.4 %
2                        NR   28.7   29.9   28.6  
3-4                      NR   29.1   26.6   32.0  
5 or more                NR   10.4    6.1    8.0  
Total number of          NR  37,60  56,12  102,4  
children                         0      3     48
under age 18
Legend
NR = Not reported in the BJS source document.
aPercents are based on those inmates with children
under age 18.
Source: GAO summary of BJS data.

Living Arrangements of Minor Children
Table III.9 shows the following statistics about
living arrangements of minor children whose
mothers were in state prisons:

ï¿½    From 1986 to 1997, although still a large
majority, a decreasing percentage of female
inmates in state prisons who had at least one
minor child were living with their minor
child(ren) before entering prison; and
ï¿½    In 1986, 1991, and 1997, about 50 percent of
female inmates in state prisons who had minor
children said that at least one of their minor
children lived with their child's grandparent
after their mothers entered prison.

Table III.9:  Living Arrangements of Minor
Children of Female Inmates in State Prisons (1986,
1991, and 1997)
Living arrangements       Percent
                         of
                         female
                         inmates
                             1986    1991     1997
Did child(ren) under 18                           
live with mother before
she entered prison?a
Yes                        78.0 %   71.7 %   64.3 %
No                         22.0     28.3    35.7  
After the mother entered                          
prison, with
whom did minor children
live?a, b
Father                     22.3 %   25.4 %   27.7 %
Grandparent                52.2     50.6    52.7  
Other relative             22.3     20.3    25.6  
Friend                      3.5      4.1     2.9  
Foster home                 9.0      8.6     7.1  
Agency/institution          1.7      2.1     2.6  
Other/alone                 3.4      6.0     8.7  
Note: BJS did not report these data for the 1979
survey.
aPercents are based on inmates with children under
age 18.
bPercents add to more than 100 because inmates
with more than one child may have provided
multiple responses.
Source: GAO summary of BJS data.

Drug Use
Table III.10 shows that, from 1986 to 1997, an
increasing percentage of female inmates in state
prisons had used drugs before incarceration.

Table III.10: Drug Use History of State Prison
Female Inmates (1986, 1991, and 1997)
Drug use before             Perce
incarceration               nt of
                           femal
                           e
                           inmat
                           es
                               1986   1991    1997
Ever used                    71.8 %  79.5 %  84.0 %
Ever used regularlya         56.5    65.3   73.6  
Used in the month before     49.6    53.9   62.4  
current offense
Use daily in the month       39.2    41.4   50.7  
before current offense
Under the influence at the   33.7    36.3   40.2  
time of the
current offense
Committed offense to get       NR    23.9   29.0  
money to
buy drugs
Number of female inmates    19,812   38,743  65,338  
Legend
NR = Not reported in the BJS source document.
aRegular use is defined as once a week or more for
at least 1 month.
Source: GAO summary of BJS data.

Alcohol or Drug Use
Table III.11 shows the following statistics about
state prison female inmates' use of alcohol or
drugs before incarceration:

ï¿½    The percentages of female inmates in state
prisons who used alcohol in the year before their
current offense were similar in 1991 (about 58
percent) and 1997 (about 56 percent);
ï¿½    The percentage of female inmates in state
prisons who acknowledged daily use of alcohol
before incarceration increased from 19 percent in
1991 to about 25 percent in 1997.
ï¿½    From 1991 to 1997, an increasing percentage
of female inmates in state prisons were under the
influence of alcohol and drugs at the time they
committed their current offense; and
ï¿½    In 1997, drugs-and drugs in combination with
alcohol-were bigger problems than alcohol alone.

Table III.11: Alcohol or Drug Use by State Prison
Female Inmates (1986, 1991, and 1997)
Alcohol use before        Percent
incarceration             of
                         female
                         inmates
                             1986    1991     1997
Used alcohol in the year      NR    57.7 %   55.7 %
before the                              
current offense?
Frequency of use:                                 
Daily                         NR    19.0 %   24.6 %
At least once a week          NR    16.8    15.4  
Less than once a week         NR     6.3     4.4  
At least once a month         NR     7.1     6.0  
Less than once a month        NR     8.2     5.4  
Under influence of                                
alcohol or drugs at
time of offense?
Yes                         46.2 %   47.4 %   53.1 %
No                          53.9    52.6    46.9  
If yes:                                           
Alcohol only                12.4    11.6    12.9  
Drugs only                  25.5    25.5    24.1  
Both                         8.3    10.3    16.1  
Legend
NR = Not reported in the BJS source document.
Source: GAO summary of BJS data.

Prior Physical or Sexual Abuse
Table III.12 shows that, from 1986 to 1997, an
increasing percentage of female inmates in state
prisons indicated they had been physically or
sexually abused at some time during their lives
before their current incarceration.

Table III.12: Prior Physical or Sexual Abuse of
State Prison Female Inmates (1986, 1991, and 1997)
Physical or sexual abusea Percent
                         of
                         females
                         inmate
                              1986   1991     1997
Ever physically or                                
sexually abused
before current
incarceration?
Yes                         41.0 %  43.2 %   57.2 %
No                          59.0    56.8    42.8  
If yes:b                                          
Before age 18               25.0 %  31.7 %   36.7 %
                                 c
After age 18               25.0c    24.5    45.1  
Physically abused          23.0d    33.5    46.3  
Sexually abused            22.0e    33.9    38.8  
Number of female inmates  19,812   38,109  65,425  
Note: BJS did not report these data for the 1979
survey.
aSexual abuse includes fondling, incest,
molestation, sodomy, rape, and other types of
sexual assault.
bDetails add to more than total because some
inmates were abused both before and after age 18,
or were both sexually and physically abused.
cThese figures are estimates.
dThe percent represents abuse since the age of 18.
eThe percent represents abuse before the age of
18.
Source: GAO summary of BJS data.

_______________________________
1The U.S. Bureau of the Census conducted the
surveys of inmates in federal correctional
institutions for BJS and BOP and the surveys of
state inmates for BJS.
2Although the differences between these estimates
appear to be large, we were unable to determine,
using data provided by BJS, whether they were
statistically different from each other.
3We did not use the results of the 1974 survey
since comparable data were not available in many
cases.
4Although the differences between these estimates
appear to be large, we were unable to determine,
using data provided by BJS, whether they were
statistically different from each other.
5Although the differences between these estimates
appear to be large, we were unable to determine,
using data provided by BJS, whether they were
statistically different from each other.

Appendix IV
Correctional Facilities
Page 43GAO/GGD-00-22 Managing Female Inmate Popula
tions
     In response to the rapid growth in the female
inmate population, all three jurisdictions we
studied-BOP, California, and Texas-have increased
their capacities for housing female inmates. For
each of the three jurisdictions, this appendix
presents information on the number and location of
women's prisons, female inmate populations
compared with prison capacities, and the distance
between women's prisons and inmate release
residences and/or major metropolitan areas. Where
data were readily available, this appendix also
compares correctional facilities for female
inmates to facilities that house male inmates.

Federal Prisons for Women
The number of female inmates under the
jurisdiction of federal correctional authorities
increased from about 1,400 in 1980 to about 9,200
at calendar year-end 1998.1 In response to this
growth, the number of federal prisons for women
increased from 5 to 15 during this period,
exclusive of 10 administrative facilities that
house both female and male inmates.2 The names and
activation dates of the 15 women-only prisons are
as follows:

ï¿½    3 federal correctional institutions-Danbury,
CT (1994); Dublin, CA (became women-only prison in
1990); and Tallahassee, FL (1996);
ï¿½    2 federal prison camps3-Alderson, WV (1927,
mission changed from federal correctional
institution to federal prison camp in 1989) and
Bryan, TX (1989);
ï¿½    8 satellite camps-Carswell, TX (1994);
Coleman, FL (1997); Danbury, CT (1988); Dublin, CA
(1995); Lexington, KY (1994); Marianna, FL (1988);
Pekin, IL (1994); and Phoenix, AZ (1989);
ï¿½    1 medical referral center-Carswell, TX
(1994); and
ï¿½    1 intensive confinement center-Bryan, TX
(1992).

 As figure IV.1 shows, BOP's 15 women-only prisons
are located in 8 states-Arizona, California,
Connecticut, Florida, Illinois, Kentucky, Texas,
and West Virginia.

Figure IV.1:  U.S. Map Showing Location of BOP's
Women-Only Prisons

Note: The locations shown do not include BOP's 10
administrative facilities, which house both female
and male inmates.
aDublin (CA) and Danbury (CT) are locations for
both a federal correctional institution and a
satellite camp.
bCarswell (TX) is the location of the federal
medical center for female inmates and also a
satellite camp.
cBryan (TX) is the location of a federal prison
camp and also an intensive confinement center.
Source: BOP.

BOP Populations Compared With Rated Capacities
     Our analysis of BOP data shows that inmate
populations in prisons for women generally
exceeded rated capacities (i.e., the number of
inmates that planners or architects intended for
the facility) by a higher percentage than in
prisons for men.4 For example, as of August 6,
1999,

ï¿½    inmate populations in the 3 federal
correctional institutions for women were about 57
percent above rated capacity, on average, compared
with about 40 percent above rated capacity for the
53 federal correctional institutions for men; and
ï¿½    inmate populations in the 10 camps for women
were about 5 percent above rated capacity, on
average, whereas inmate populations in the 47
camps for men were about 6 percent below rated
capacity.

 As shown in table IV.1, the female inmate
population at the Danbury Federal Correctional
Institution was the highest percent (about 95
percent) above rated capacity of all BOP
facilities for women.

Table IV.1: Populations and Rated Capacities for
BOP Female Facilities (as of August 6, 1999)
Facility/st Type of      Populati  Rated     Percent
ate         facilitya         on capacit       above
                                     y    or below
                                             rated
                                          capacity
Danbury, CT Federal          992    508      95.3 %
           Correctiona
           l
           Institution
Dublin, CA  Federal        1,131    810      39.6  
           Correctiona
           l
           Institution
Tallahassee Federal        1,028    692      48.6  
, FL        Correctiona
           l
           Institution
Alderson,   Federal          890    838       6.2  
WV          Prison Camp
Bryan, TX   Federal          725    720       0.7  
           Prison Camp
Carswell,   Satellite        214    148      44.6  
TX          Camp
Coleman, FL Satellite        425    512     -17.0  
           Camp
Danbury, CT Satellite        194    178       9.0  
           Camp
Dublin, CA  Satellite        326    299       9.0  
           Camp
Lexington,  Satellite        221    193      14.5  
KY          Camp
Marianna,   Satellite        322    296       8.8  
FL          Camp
Pekin, IL   Satellite        301    256      17.6  
           Camp
Phoenix, AZ Satellite        273    272       0.4  
           Camp
aThe Intensive Confinement Center in Bryan, TX,
and the Federal Medical Center in Carswell, TX,
were not included in this analysis.
Source: GAO analysis of BOP data.

According to BOP, the acceptance of District of
Columbia female felony inmates-under requirements
of the National Capital Revitalization and Self-
Government Improvement Act of 1997 (P.L. 105-
33)-was a contributing factor to the high female
inmate population at Danbury. BOP plans to
activate a contract facility for District of
Columbia female felony inmates during calendar
year 2000.

Table IV.1 also shows that with the exception of
one camp (Carswell), the federal correctional
institutions were far higher over rated capacity
than the camps. Further, the Coleman camp was the
only BOP facility for women whose population was
below (-17 percent) its rated capacity.

To increase BOP's capacity to house female
inmates, BOP plans to activate a 256-bed prison
for women in Victorville, California during fiscal
year 2000 (in addition to the contract facility
for District of Columbia female felony inmates
mentioned previously).

Distance From Home for Federal Inmates
     BOP's policy for both female and male inmates
is to attempt to place them within 500 miles of
their release residences in the least restrictive
environment their security level requires, while
maintaining population balance throughout the
correctional system. According to BOP, the
placement of female inmates presents unique
challenges since it would be prohibitively
expensive to establish facilities for small
numbers of women in every state (relatively close
to their release destinations and presumably their
families). BOP noted that the economies of scale
by having a smaller number of facilities with
comprehensive programs and services for a larger
number of female inmates has limited BOP's ability
to assign female inmates to appropriately secure
facilities near their release residences.

     According to BOP, during the 1990s, the
mission of several BOP facilities was changed to
provide more low- and minimum-security bed space
so female inmates could be housed closer to home.
BOP also noted that due partly to the activation
of women's facilities in California, Florida, and
Texas, BOP has achieved greater parity with the
male inmate population regarding proximity-of-
release placements. Our analysis of BOP data shows
that, in October 1999, about 30 percent of BOP's
female inmates were assigned to facilities more
than 500 miles from their release residences,
compared with about 24 percent of BOP's male
inmates. As table IV.2 shows, 19 percent of BOP's
female inmates were 501 to 999 miles from their
release residences, and about 11 percent were
1,000 miles or more from their release residences.

Table IV.2:  Distance Between Prison and Release
Residences for Federal Prison Inmates (as of
October 1999)
Distance to release       Percent of    Percent of
residences            female inmates  male inmates
250 miles or less              41.5 %        53.2 %
251 to 500 miles               28.8         22.4  
501 to 999 miles               19.0         13.9  
1,000 miles or more            10.6         10.5  
Number of inmates             6,840       86,561  
Note: The data exclude (1) inmates with release
residences in foreign countries, Alaska, Hawaii,
and U.S. territories and possessions and (2)
inmates without an assigned security level.
Source: BOP.

     As noted in table IV.2, the BOP data likely
underestimate the percentage of all federal
inmates who were assigned to facilities more than
500 miles from their release residences since the
data exclude inmates with release residences in
foreign countries, Alaska, Hawaii, and U.S.
territories and possessions.

     According to BOP, inmates being placed in
locations further than 500 miles from their
release residences may be a result of several
factors, including security needs, population
pressures, and certain medical needs that can be
handled only at a particular location.

California Prisons for Women
     The number of female inmates under the
jurisdiction of the California Department of
Corrections increased from about 1,300 in 1980 to
about 11,700 at calendar year-end 1998.
California's female inmates are primarily housed
in five prisons, of which four are women-only
facilities. The names and activation dates of
these prisons are as follows:

ï¿½    The California Institution for Women (Corona)
was opened in 1952.
ï¿½    The cogender California Rehabilitation Center
(Norco) was opened in 1962. It is the only
California prison that houses both female and male
inmates within a shared exterior perimeter.
ï¿½    The Northern California Women's Facility
(Stockton) was opened in 1987.
ï¿½    The Central California Women's Facility
(Chowchilla) was opened in 1990.
ï¿½    The Valley State Prison for Women
(Chowchilla) was opened in 1995.

According to California Department of Corrections
officials, the Central California Women's Facility
and the Valley State Prison for Women are among
the largest women's prisons in the world, housing
about 3,500 and 3,600 female inmates,
respectively. Figure IV.2 shows the location of
California's five prisons for women in relation to
the state's major metropolitan areas.

Figure IV.2:  California State Map Showing
Location of California Prisons for Women

aChowchilla is the location of two prisons for
women-Central California Women's Facility and
Valley State Prison for Women.
Source: California Department of Corrections.

California Populations Compared With Design
Capacities
At the time of our review, all of California's
prisons (housing female and/or male inmates) had
inmate populations that exceeded design
capacities. California Department of Corrections
data show that the inmate populations in prisons
that house female inmates generally exceeded
design capacities by a lower percentage than in
prisons that house male inmates. For example, as
of October 1999,

ï¿½    the inmate populations in California's 5
prisons that house female inmates were about 78
percent above design capacity, on average,
compared with 95 percent above design capacity for
the 29 prisons that house male inmates; and
ï¿½    the inmate populations in the 5 prisons that
house female inmates exceeded design capacities by
a range of 65 to about 87 percent, compared with a
range of 59 to 170 percent for the 29 prisons that
house male inmates.

     For California's five prisons that house
female inmates, table IV.3 shows the female inmate
population, the design capacity, and the
percentage by which the population exceeded the
design capacity.

Table IV.3: Populations and Design Capacities of
California Female Facilities (as of October 3,
1999)
Facility                Populati Design     Percent
                             on capacit       above
                                     y      design
                                          capacity
California Institute      1,831  1,026      78.5 %
for Women
California                  825    500      65.0  
Rehabilitation Centera
Central California        3,499  2,004      74.6  
Women's Facility
Northern California         747    400      86.8  
Women's Facility
Valley State Prison for   3,600  1,980      81.8  
Women
aThe California Rehabilitation Center houses both
female and male inmates. The data in the table are
for female inmates only.
Source: GAO analysis of California Department of
Corrections' data.

California Department of Corrections officials
projected that by June 2000, the state will run
out of beds for both female and male inmates. The
officials noted that part of the problem is the
increasing number of violent inmates and inmates
with psychiatric needs who require single cell
housing. To address crowding conditions, the
officials told us the department is considering
options such as changing the classification levels
(so that more inmates can be housed in
dormitories), asking the state legislature to
construct more prisons, and expanding the capacity
of existing facilities.

Distance From Home for California Prison Inmates
The California Department of Corrections did not
have readily available data on the distance female
inmates are housed from their residences.
Department officials noted, however, that it is
not possible to house all female offenders close
to their home of record because about 60 percent
of the female inmate population is from Southern
California, and the two women's prisons located in
that area cannot accommodate this population. The
officials noted that most female inmates are
housed in Chowchilla, which is about 260 miles
from Los Angeles and 390 miles from San Diego.
Department officials added that the same distance-
from-home concerns apply for the male inmate
population.

Texas Prisons for Women
The number of female inmates under the
jurisdiction of the Texas Department of Criminal
Justice increased from about 1,200 in 1980 to
about 10,300 at calendar year-end 1998. Texas'
female inmates are housed in 14 facilities, of
which 10 are women-only facilities, and 4 are
cogender facilities. The names and activation
dates of these facilities are as follows:

ï¿½    five women-only prisons-Gatesville (1980),
Hilltop (1981), Hobby (1989), Mountain View
(1975), and Murray (1995);
ï¿½    two women-only state jails5-Plane (1995) and
Woodman (1997);
ï¿½    three women-only substance abuse
facilities6-Hackberry (1992), Halbert (1995), and Henley
(1995);
ï¿½    one cogender private state jail-Dawson
(1997);
ï¿½    one cogender psychiatric facility-Skyview
(1988); and
ï¿½    two cogender medical facilities-Hospital
Galveston (1983) and Texas City (1996).

 Figure IV.3 shows the location of Texas' 14
facilities for women in relation to the state's
major metropolitan areas.

Figure IV.3:  Texas State Map Showing Location of
Texas Facilities for Women

aGatesville is the location of six facilities for
women-Gatesville, Hackberry, Hilltop, Mountain
View, Murray, and Woodman.
bDayton is the location of two facilities for
women-Henley and Plane.
Source: Texas Department of Criminal Justice.

Texas Populations Compared With Design Capacities
As of August 1998, the inmate populations in all
Texas facilities (housing female and/or male
inmates) were at or under design capacity.

Distance From Home for Texas Inmates
     The Texas Department of Criminal Justice did
not have readily available data on the distance
female inmates are housed from their residences.
According to the women-only facility wardens we
interviewed in Texas, the majority of the state's
female inmates are from three major metropolitan
areas-Dallas, Houston, and San Antonio. Texas
Department of Criminal Justice data show that most
female inmates are housed in facilities clustered
near Gatesville, Texas, which is located about
135, 255, and 180 miles, respectively, from these
cities. Department officials told us that the
department generally tries to house female inmates
close to their home of record. The officials told
us, however, that this is difficult because of the
small number of facilities for women.

_______________________________
1According to BOP, as of September 30, 1999, the
number of BOP female inmates had increased to
10,053 (8,663 in BOP facilities and 1,390 in
contract facilities). However, to provide
comparable data for multiple jurisdictions, this
report contains calendar year-end population data.
2The 10 administrative facilities consist of 3
metropolitan detention centers (Brooklyn, NY;
Guaynabo, PR; and Los Angeles, CA), 3 metropolitan
correctional centers (Chicago, IL; New York, NY;
and San Diego, CA), 2 federal detention centers
(Miami, FL and Seattle/Tacoma, WA), 1 federal
transfer center (Oklahoma City, OK), and 1
detention center (Tucson, AZ).
3BOP camps house the lowest security level
offenders.
4Our analysis included all of BOP's federal
correctional institutions, federal prison camps,
and satellite camps. Our analysis did not include
other types of facilities, such as U.S.
penitentiaries, medical centers, detention
centers, and transfer centers.
5According to Texas officials, in 1993, to reduce
prison system overcrowding, the Texas legislature
created a state jail system to provide an
alternative form of incarceration for nonviolent
offenders (mainly drug and property offenders) for
sentences up to 2 years. Under the state jail
system, nonviolent felons are diverted from prison
beds and provided with community-based punishment
and rehabilitation. State jail inmates must serve
their entire sentences. That is, parole is not
available, and sentences are not reduced for good
behavior.
6In Texas, judges may sentence a probationer with
a crime-related substance abuse problem to serve a
term of 3 to 12 months in an intensive,
residential treatment program.

Appendix V
Correctional Policies, Classification Systems, and
Education/Job-Training Programs
Page 50GAO/GGD-00-22 Managing Female Inmate Popula
tions
     According to a 1998 National Institute of
Justice report,1 many needs of incarcerated women
are different from those of men and require
management approaches and programming tailored to
their special characteristics and situations. The
report noted that many correctional jurisdictions,
particularly those with small female inmate
populations, have little special provision, either
in management approaches or programming, for
meeting the needs of female inmates. The report
concluded, however, that progress is being made.
For example, according to the report, in 30
states, there was a clear indication of systematic
planning to respond to increased numbers of female
inmates.

     The following provides information on
correctional policies, classification systems, and
education and job-training programs as they relate
to female inmates in the three jurisdictions we
studied.

Correctional Policies Addressing Female-Specific
Needs
     Of the three jurisdictions we studied, only
BOP had a policy that requires programs and
services to address and consider the gender-
specific needs of female inmates. California and
Texas policies focus on standardized or equal
treatment of female and male inmates, although
both jurisdictions provided some level of female-
specific programs and services.

BOP Policy
     According to BOP, historically, most of BOP's
policies, programs, services, and facility designs
did not account for the different needs of female
inmates. BOP noted that in the early 1990s, BOP
made policy strides, particularly in the areas of
inmate classification and institutional
assignments for female offenders (see below). BOP
also noted that programs and services (e.g., work,
education, recreation, rehabilitative, and
psychological) for female and male inmates are
based on the different characteristics and needs
of the two populations.

     In response to the increase in BOP's female
inmate population, the Director of BOP issued a
memorandum to all executive staff in May 1997
describing expectations concerning BOP policy as
it relates to gender sensitivity. The memorandum
requires all BOP policymakers to ensure that
gender differences are taken into account in the
development of, or revisions to any BOP policy.
The memorandum also requires that all policy
clearance letters include the following statement:
"In the development of this policy, gender
differences were taken into account."

     In August 1997, BOP issued a formal policy on
the management of female offenders. The policy
specifies that all BOP policies, programs, and
services must consider and address the different
needs of female offenders. According to the 1997
policy, an expected result or objective is that
BOP will allocate sufficient resources to deliver
appropriate programs and services to the female
offender population. To help implement this
objective, the policy requires that each
applicable BOP facility develop a document (an
"Institution Supplement") describing local
programs and services that address the different
needs of female offenders. During our review, we
noted that all of BOP's women-only prisons had
developed the required document.

     BOP's policy on the management of female
offenders also requires that each BOP division
develop measurable objectives to ensure that
female offenders have access to programs and
services that meet their different needs, prepare
them to function in an institutional environment,
and return them to the community. The policy also
outlines specific responsibilities for staff at
all levels of BOP to ensure consistent
establishment of programs, services, and resource
allocations necessary for female offenders.

     In 1998, the Director of BOP issued a
strategic plan on the management of female
offenders. The strategic plan outlines BOP's
philosophy for managing female offenders, provides
a historical overview, and discusses future plans.

     BOP's National Institute of Corrections also
works with many state and local correctional
agencies on problems and issues concerning the
effective management and treatment of women
offenders in community corrections centers, jails,
and prisons. According to BOP, such efforts that
directly impact the management of women in prison
include:

ï¿½    A project to help state departments of
corrections develop classification instruments and
procedures that are valid and appropriate for
female inmates.
ï¿½    A multiyear development effort to collect and
synthesize empirical findings and best practices
on gender-responsive strategies for effectively
managing and intervening with female offenders.
ï¿½    Three 36-hour training programs for
corrections officials (Critical Issues in Managing
Women Offenders, Women Offenders-Developing an
Agency Plan, and Operational Practice in Women's
Prisons).
ï¿½    Major initiatives over the past 3 years
involving staff sexual misconduct with inmates.2

California Policy
     California had no specific policy guidance
addressing the unique needs of female offenders.
Rather, according to California Department of
Corrections officials, title 15 of the California
Code of Regulations, which governs the actions of
the California Department of Corrections,
specifies that conditions of confinement are to be
standardized for male and female inmates.

     In 1994, a California state commission report
on female inmate and parolee issues3 noted, in
part, that

     "In developing institution policies and
procedures, [the California Department of
Corrections] often fails to recognize the unique
characteristics of women. As a result, the
Department's policies and procedures are
frequently developed without considering the
effect they might have on female inmates and
parolees. . . This lack of recognition of the
unique characteristics of women places the
expectation on staff that the management and
treatment of female inmates and parolees must be
the same as that for males and leaves no room for
addressing the differences in the management of
male and female populations."

     Among other matters, the commission
recommended that the California Department of
Corrections issue a policy recognizing the unique
characteristics of female inmates and parolees,
with the expectation that policies and procedures
appropriately address these differences. In
response to our inquiry, a department official
told us that this recommendation has not been
implemented. The official noted that, based on
state legislative hearings in 1998, there is an
outstanding proposal to reorganize the state's
prisons. The official added that under the
proposal, all women's prisons would be placed
under one regional administrator, an alignment
that would foster recognition of the unique
characteristics of female inmates. Department
officials noted that, since 1998, the department's
Health Care Services Division has had one regional
administrator responsible for the five prisons
that house female inmates.

     According to the California Department of
Corrections, female-specific needs are addressed
in the following areas:

ï¿½    mother-infant/child residential programs (see
app. VI);
ï¿½    gender-specific programs at all California
facilities housing female inmates (e.g., anger
management, battered women, domestic violence,
adults molested as children, parenting, personal
hygiene, self-development, self-help groups, and
substance abuse programs); and
ï¿½    inmate grooming standards, allowable personal
property, and use of personal clothing.

Texas Policy
     According to Texas Department of Criminal
Justice officials, there are no state legislative
mandates or any written departmental policies
regarding the unique needs of female inmates. The
officials noted that the department generally
tries to treat male and female inmates equally.
Also, the officials noted that it is very
difficult to provide programs and services that
address gender-specific differences because the
female inmate population is small compared with
the number of male inmates. Nonetheless, Texas
Department of Criminal Justice officials noted
that female-specific needs are addressed in the
following areas:

ï¿½    a parenting program that addresses prenatal
education and child rearing (see app. VI);
ï¿½    a 30-day seminar in women's issues that
addresses healthy nutrition for females, positive
relationships with others, providing appropriate
child care, appropriate interactions with men,
women's health issues, and parenting; and
ï¿½    inmate grooming standards, allowable personal
property, and use of personal clothing.

Classification Systems for Female Offenders
     In the context of correctional systems, the
term "classification" refers to the systematic
scoring and subdivision of inmates into groups
based on their security and program needs.4 The
goal of a classification system is to house
inmates at the lowest and least restrictive
security level consistent with the safety of the
institution, its staff, and the community.

     According to a 1991 report on classification
of female offenders in state correctional
facilities,5 correctional officials voiced concern
that classification systems do not work well for
female offenders. The report noted that such
concerns included too few services for women,
women being housed unnecessarily long distances
from their families, and inappropriately high
security custody designations for women.

     Of the three jurisdictions we studied, BOP
had two distinct systems for classification-one
for female offenders and one for male
offenders-while California and Texas used the same
classification system for both female and male
offenders. However, all three jurisdictions
recognized that females are lower risk offenders
than males; and, as a result, female offenders
were generally placed in lower security level
facilities or less restrictive housing (i.e.,
dormitories versus cells).

BOP Classification System
     BOP implemented a female offender
classification system in 1994 to reflect the fact
that female offenders are less likely than male
offenders to be violent or attempt escape. As a
result, BOP's classification scoring is less
restrictive for female than male offenders, and
results in a greater percentage of female
offenders being assigned to lower security level
facilities.6 In 1998, 62 percent of BOP's female
offenders were housed in minimum-security
facilities, compared with 23 percent of federal
male offenders.

California Classification System
     According to California Department of
Corrections officials, one classification system
is used for both female and male offenders and has
been in place since 1980. Under this system,
California's female and male offenders are to
receive a security classification-ranging from
level I (low security) to level IV (high
security). Although female offenders receive a
security classification, female inmates of all
security levels are generally housed together in
dormitory rooms in the general prison population.

     As previously mentioned, in 1994, a specially
appointed commission reported on issues involving
female inmates and parolees in California. The
commission noted that California used a "universal
classification system" that had "little relevance
to female inmates" because female offenders of all
security levels were housed together in the
general prison population. The commission
recommended that the California Department of
Corrections develop and implement a classification
system specifically designed for female inmates.

     However, in May 1997, a contract analyst
working for the California Department of
Corrections reported that California's current
classification system (1) is an effective
indicator of misbehavior for the female inmate
population and (2) has worked well over the years.7
Nonetheless, California Department of Corrections'
officials told us that because of the increase in
the female inmate population, classification and
housing policies regarding female offenders will
be revisited within the next 2 years.

Texas Classification System
     According to Texas Department of Criminal
Justice officials, the classification process is
almost identical for female and male offenders,
with a few minor housing differences for females
(e.g., medium custody level females may live in
dormitories, but medium custody level male
offenders must live in cells).

Education and Job-Training Programs
All three jurisdictions we studied offered some
level of education and job-training programs.8
Officials in each jurisdiction told us that basic
education programs (e.g., General Educational
Development and English as a second language) are
offered at all facilities. However, the number and
type of job-training programs varied by facility.

BOP Education and Job-Training Programs
In May 1991, BOP raised its mandatory literacy
standard for inmates to a high school diploma or a
General Educational Development credential.
According to BOP, with limited exceptions, an
inmate who does not have a diploma or credential
must participate in a literacy program for a
minimum of 240 instructional hours or until a
General Educational Development credential is
earned. BOP noted that two laws-the Violent Crime
Control and Law Enforcement Act of 1994 (P.L. 103-
322) and the Prison Litigation Reform Act of 1995
(P.L. 104-134)-tie good conduct time awards to
inmates' participation in and completion of the
high school credential program. According to BOP,
many female and male inmates who are sentenced
under these two laws participate in the General
Educational Development credential program to
avoid negative impact on their good conduct time
awards. Federal law also mandates that non-English
proficient inmates participate in an English-as-a-
second-language program until they are able to
function at the equivalent of the eighth-grade
level in competency skills.

According to BOP, as of August 1999, about 35
percent of both female and male inmates were
without a verified high school diploma or its
General Educational Development equivalency. BOP
noted, however, that more than 70 percent of
female inmates with literacy needs were enrolled
in a General Educational Development program,
compared with about 45 percent of male inmates
with literacy needs.

BOP also offers female inmates a variety of job-
training programs. For example, the three BOP
women's facilities we visited-Bryan, Danbury, and
Dublin-each offered female inmates at least six
occupational and/or apprenticeship programs. More
specifically,

ï¿½    Bryan offered five occupational training
programs (business technology, computer-aided
drafting, computer refurbishing, cosmetology, and
master gardener) and one apprenticeship program
(dental hygiene);
ï¿½    Danbury offered five occupational training
programs (business management, business vocational
training, building trades, culinary arts, and
horticulture) and seven apprenticeship programs
(carpentry, cook, dental assistant, electrician,
painter, stationary engineer, and tool machine set-
up operator); and
ï¿½    Dublin offered five occupational training
programs (business, business accounting, computer
repair, bus driving operation, and forklift
operation) and one apprenticeship program (dental
assistant).

BOP noted that with the exception of Dublin's
business training program, all of the occupational
and apprenticeship programs offered at the three
BOP women's prisons we visited can lead to outside
certification or accreditation.

According to BOP, 3,708 (about 48 percent) of the
7,774 female inmates who had a designated
assignment to a BOP women's prison as of August
1999 were participating in educational programs,
including 879 (about 11 percent) who were
participating in some type of occupational
training program. In comparison, about 36 percent
of male inmates were participating in educational
programs at that time. BOP also noted that, on a
typical day, about 10 percent of female inmates
are enrolled in adult continuing education
classes, compared with about 7 percent of male
inmates.

California Education and Job-Training Programs
According to a California Department of
Corrections official, all inmates (female and
male) who academically test below the ninth grade
level must attend academic classes. The official
noted that department policy requires every able-
bodied inmate to work as assigned by department
staff. This may be a full day of work, education,
or other program activity, or a combination of
activities. The department also provides an
English-as-a-second-language program.

According to department data, female inmates are
offered a variety of job-training programs,
although the number and type of programs offered
varied by facility. For example,

ï¿½    California's two largest women's prisons-the
Central California Women's Facility and the Valley
State Prison for Women-offered 16 and 14 job-
training programs, respectively, including auto
mechanics, cosmetology, janitorial service,
landscape gardening, masonry, mill and cabinet
work, office services and related technologies,
printing graphic arts, small engine repair,
upholstering, and welding;
ï¿½    the California Institute for Women offered
seven programs (i.e., computer and related
technologies, electronics, janitorial service,
office services and related technologies,
plumbing, printing graphic arts, and
upholstering); and
ï¿½    the Northern California Women's Facility
offered three programs (i.e., janitorial service,
landscape gardening, and office services and
related technologies).

Texas Education and Job-Training Programs
According to Texas Department of Criminal Justice
officials, female and male inmates have equal
opportunities to participate in education and job-
training programs. The officials noted that
eligible inmates without high school diplomas may
enroll in academic programs (e.g., adult literacy
and General Educational Development) where they
can learn to read, write, and do math. An English-
as-a-second-language program is offered for
inmates with little or no English-speaking,
reading, and writing abilities.

Department officials also noted that most Texas
facilities offer several job-training programs
(e.g., trade and apprenticeship programs).
However, facility profiles show that one of the
three women's facilities we visited offered two
job-training programs and another facility we
visited offered one job-training program. More
specifically, as of May 1999,

ï¿½    Gatesville offered three trade programs
(janitorial services, office administration, and
graphic arts) and four apprenticeship programs
(welding, construction carpentry, construction
electrician, and pressman);
ï¿½    Murray offered one trade program (custodial
technician9); and
ï¿½    Woodman offered two trade programs (custodial
technician and painting and decorating).

 According to Texas Department of Criminal Justice
officials, all of the job-training programs
offered at the three Texas women's facilities we
visited can lead to outside certification or
accreditation.

Lawsuit on Conditions of Confinement for BOP
Female Inmates
     According to a BOP Office of General Counsel
official, over about the past 15 years, there has
been one class-action lawsuit filed by BOP's
female inmates. The lawsuit (Butler, et al. v.
Reno, et al.)10 was filed in 1984 by certain BOP
female inmates who alleged that BOP discriminated
against them by denying them access to facilities,
programs, and services available to similarly
situated male inmates.

In 1994, to facilitate resolution of the case, the
federal district court appointed an independent
fact finder who (1) visited all of BOP's minimum
security women's facilities and a selected group
of men's facilities and (2) interviewed samples of
approximately 8 percent of the inmates at each
facility. In a September 1994 report, the fact
finder noted that, since the lawsuit was filed,
BOP has implemented many positive changes
regarding female inmates; and, indeed, the present
conditions and BOP's future plans appear to
reflect a commitment to equality for female and
male inmates. As a cautionary note, the report
said that on-going monitoring and review will be
necessary to ensure continued progress toward
parity.

In June 1995, the parties signed a settlement
agreement, which acknowledged that the fact
finder's report indicated that BOP "has taken
substantial actions" to ensure that female and
male inmates are offered comparable facilities,
programs, and services. The settlement agreement
called for dismissal of the lawsuit and that BOP
would provide reports to the plaintiffs' counsel
for the next 3 years presenting comparative
information about facilities and other conditions
of confinement. In February 1998, BOP provided the
plaintiffs' counsel with the third and final
report. In January 1999, the plaintiffs' attorneys
told us they are not actively pursuing any issues
related to the lawsuit.

As previously mentioned, in August 1997, BOP
issued a formal policy on the management of female
offenders that (1) requires ongoing monitoring and
review by responsible BOP headquarters' divisions
and (2) outlines specific responsibilities for
staff at all levels of BOP to ensure consistent
establishment of programs, services, and resource
allocations necessary for female offenders.

_______________________________
1National Institute of Justice, Research in
Brief-Women Offenders, Programming Needs and
Promising Approaches (Aug. 1998). The report is
based on a 1993-1994 national study of state-level
correctional administrators, prison and jail
administrators, and program administrators. All
state correctional departments and at least one
prison in each state were surveyed.
2Earlier this year, we reported on staff sexual
misconduct in women's prisons, including the
National Institution of Corrections efforts in
this area-Women in Prison: Sexual Misconduct by
Correctional Staff (GAO/GGD-99-104, June 22,
1999).
3Senate Concurrent Resolution 33 Commission Report
on Female Inmate and Parolee Issues, June 1994.
4Classification is based on information such as
the severity of the offense, the length of
sentence, and an offender's prior criminal,
educational, social, and employment history.
Generally, an offender's medical needs override
all other housing considerations.
5Classification of Women Offenders in State
Correctional Facilities: A Handbook for
Practitioners, COSMOS Corporation, March 1991. The
project was supported by an NIC grant.
6BOP's female offenders are assigned among three
security levels (minimum, low, and high), whereas
male offenders' security levels include these
three plus medium.
7California Department of Corrections, A Report on
The Inmate Classification System, prepared by
Evaluation, Compliance and Information Systems
Division, Three Strikes Planning Office,
Sacramento, CA, May 1, 1997. The study was
undertaken at the request of the state
legislature.
8Job-training programs include occupational or
vocational programs (e.g., business management and
culinary arts) and apprenticeship programs (e.g.,
carpentry and dental assistant).
9Custodial technician includes knowledge of the
technologies and materials required to clean,
service, and maintain building components,
systems, and environments.
10Civil Action No. 84-2604-TPJ, U.S. District Court
for the District of Columbia.

Appendix VI
Parenting Issues
Page 58GAO/GGD-00-22 Managing Female Inmate Popula
tions
As mentioned previously, according to BJS'
national surveys of federal and state prison
inmates, in 1997,

ï¿½    about 60 percent of female inmates in federal
prisons and about two-thirds of female inmates in
state prisons had at least one minor child (under
age 18);
ï¿½    female inmates in federal and state prisons
were mothers to about 110,000 minor children, with
the preponderance at the state level; and
ï¿½    84 percent of minor children whose mothers
were in federal prisons and about 64 percent of
minor children whose mothers were in state prisons
lived with their mother before their mothers
entered prison.

Also, according to another national survey, over
1,400 pregnant female inmates gave birth in 1998
after being incarcerated. The number of female
inmates with family responsibilities has focused
increased attention on parenting issues, such as
mother-child visitations, mother-infant/child
residential programs, and parent education
programs.

Mother-Child Visitations
     According to a 1995 report on children of
incarcerated parents,1 inmate parent-child
visitations are beneficial because such visits
allow

ï¿½    children to express emotional reactions to
separation, which they may not be permitted to do
elsewhere;
ï¿½    parents to work out their feelings about
separation and loss, which better enables them to
help their children with the same issues;
ï¿½    children to see their parents realistically,
calming irrational feelings and unrealistic
fantasies;
ï¿½    parents to model appropriate interactions for
children who are misbehaving, to provide support
to the caregivers; and
ï¿½    parents and children to maintain their
existing relationships and, thereby, increase the
chances of successful family reunification after
prison.

 Although research indicates that inmate mother-
child visits can be valuable, BJS' 1997 national
survey of state prison inmates indicates that most
female inmates are not visited by their minor
children. For example, about 56 percent of female
inmates in state prisons who had minor children
(i.e., children under age 18) said they were never
visited by their minor children since entering
prison, as shown in table VI.1.

Table VI.1:  Female Inmates in State Prisons
Visited by Minor Children, 1997
Frequency of visits by minor     Percent of female
children                                   inmates
Daily                                        1.1 %
Once per week                                8.2  
Once per month                              15.1  
Less than once per month                    19.4  
Never                                       56.2  
Source: Preliminary BJS data.

     The BJS survey results also showed that an
estimated 38 percent of female state prison
inmates with minor children talked with those
children by telephone at least once a week, and
about 46 percent had contact by mail at least once
a week.

Mother-Child Visitations in Jurisdictions Studied
     Most of the facilities we visited did not
have statistics on the number of female inmates
with minor children. However, if the national
estimates mentioned above on the percentage of
female inmates with minor children are true, it
appears that most inmate mothers at the facilities
we visited did not receive visits from their minor
children. For example, during the 6-month period
October 1997 through March 1998, log sheets at two
federal prisons-each of which housed approximately
1,000 female inmates-showed that one facility
received a weekly average of 12 minor child
visitors and the other facility received a weekly
average of 44 minor child visitors.2 Also, from
May 1998 to October 1998, visitation logs at one
California prison-which housed approximately 3,250
female inmates-showed that on an average week a
total of 78 minor children visited. Texas prisons
did not track or record the number of minor
children visitors.

     Of the three jurisdictions we studied,
California was unique in providing for family or
overnight visitation at each of its facilities.
However, visitation logs and interviews with
prison officials indicated that few female inmates
used this program for mother-child visits. For
example, from January 1, 1998, to June 27, 1998,
visitation logs at one California prison-which
housed approximately 3,100 female inmates-showed a
total of only 57 child overnight visitors. Prison
officials told us that because overnight
visitation was infrequent at both of the
California institutions we visited, some of the
apartment-like facilities that were specifically
designed for family visitations have been
converted into offices for prison staff.

Reasons for Infrequent Mother-Child Visitations
     According to the federal and state
correctional system officials we contacted, travel
distances and economic costs associated with such
travel are the primary reasons why child
visitations were relatively infrequent in
reference to a facility's total mother-inmate
population. For example, as mentioned previously,
California officials told us that while
approximately 60 percent of all female offenders
are from southern California, the majority of
female inmates are housed in Chowchilla,
California-about 260 miles from Los Angeles and
about 390 miles from San Diego. The officials
explained that because there are only two prisons
located in southern California, it is difficult to
house women in prisons that are in close proximity
to their children.

     The lack of appropriate or adequate
visitation areas did not appear to be a barrier to
mother-child visitations. In fact, prisons in two
of the three jurisdictions we studied (BOP and
California) had separate visitation areas for
children.

Visitation Schedules in the Three Jurisdictions
Studied
     In the three jurisdictions we studied,
visitation policies are gender neutral ( i.e., the
policies are the same for female and male
inmates). However, visitation schedules in the
three jurisdictions we studied varied in both the
number of days and number of hours available for
visits, including mother-child visits.

     BOP policy requires that each federal
facility provide each inmate a minimum of 4 hours
of visiting time per month on weekends and
holidays. In practice, the visiting schedules at
the three women's facilities we contacted exceeded
the minimum. For example, at Danbury, visiting
hours were Thursday and Friday from 12:30 p.m. to
8:00 p.m. and Saturday3 through Monday from 8:00
a.m. to 3:00 p.m.

     California Department of Corrections policy
requires that each institution provide a minimum
of 12 hours of visiting time per week. The
visiting schedules at the two facilities we
contacted exceeded this minimum requirement. For
example, visiting hours for both the Central
California Women's Facility and the Valley State
Prison for Women were Thursday and Friday from
2:00 p.m. to 8:00 p.m.; and Saturday, Sunday, and
selected holidays from 9:00 a.m. to 3:00 p.m.

     Texas Department of Criminal Justice policy
provides for one 2-hour visit each weekend, on
Saturday or Sunday, between 8:00 a.m. and 5:00
p.m. If family members reside 300 miles or more
(one way) from the prison, the inmate may request
a special visit of 4 hours per day on both
Saturday and Sunday, once a month. Visits are not
allowed on holidays that fall during the week.
Department policy provides for both general (i.e.,
noncontact) and contact visits.4

     Officials in all three jurisdictions told us
that wardens may approve exceptions to
standardized visiting schedules in unusual
circumstances, such as a medical emergency or a
death in the family.

Mother-Infant/Child Residential Programs
     According to a national survey of U.S.
correctional systems, in 1998, there were about
1,900 pregnant females entering prison and more
than 1,400 gave birth.5 Survey results showed
that, in most correctional systems, newborns were
removed from the inmate mother's care during or
immediately following the hospital stay. The
relatively few residential programs for inmate
mothers and their infants/children-in BOP and
about 11 states-represent exceptions to general
practices across the nation.

Mother-Infant/Child Residential Programs in the
Three Jurisdictions Studied
     Two of the three jurisdictions we studied
(BOP and California) have mother-infant/child
residential programs.

BOP's Mother-Infant Residential Program
     BOP's program-known as Mothers and Infants
Together-was first piloted in 1988 in Fort Worth,
TX, and has since expanded to seven other
locations.6 Generally, low security-risk female
inmates who qualify and agree to participate are
placed in one of the eight community-based
facilities 2 months before expected delivery and
remain there for 3 months after delivery where
they receive prenatal and postnatal instruction
(e.g., childbirth, parenting, and coping skills
classes). According to BOP, participants are also
provided services related to chemical dependency,
physical and sexual abuse, self-esteem, budgeting,
and preemployment training. After delivery and the
3-month bonding period, the mother is returned to
an institution to complete her sentence, and the
infant is placed with a predetermined caregiver.
According to BOP data, of the 75 federal inmates
who gave birth in fiscal year 1997, 64 (or about
85 percent) participated in the Mother and Infants
Together program. A BOP official noted that there
was no waiting list to enter the program.

California's Mother-Infant/Child Residential
Programs
     A California statute passed in 1919, which
has since been repealed, allowed an incarcerated
mother to keep her child(ren) with her in the
institution for up to 2 years of age. On the
premise that "the prison was a poor place to keep
infants," a more recent California statute,
effective January 1980, established a community-
based treatment program for incarcerated mothers
and their children.7 Under this program-known as
the Community Prison Mother Program-the California
Department of Corrections has contracts with 6
private vendors to provide community-based housing
and services to a combined total of 94 female
inmates and their infants/children.8 The
infants/children may remain with inmate mothers
for up to 6 years.

     Generally, eligible female inmates must (1)
have less than 6 years remaining on their
sentences and (2) be pregnant or have been the
primary caregiver of their eligible children
(under 6 years of age) before incarceration.
Community Prison Mother Program components include
parenting/child development education, substance
abuse treatment, preemployment training, aftercare
planning, and counseling. Inmates are initially
restricted to the community-based facility; but as
they progress through the program, they can be
granted permission to participate in off-site work
furlough programs and to attend school functions
with their children.

     In response to the "dramatic increase in the
number of incarcerated women who are single
mothers or primary caretakers of children" and who
have a history of substance abuse problems, the
California governor signed the Pregnant and
Parenting Woman's Alternative Sentencing Program
Act effective on May 9, 1994. The act authorized
the development of residential programs for female
offenders, with a history of substance abuse, and
their children. In the first program developed
under the act-known as the Family Foundations
Program-pregnant or parenting offenders who meet
eligibility requirements are directly sentenced to
a residential facility in lieu of a state prison
for periods ranging from 1 to 3 years.9

     The first Family Foundations Program facility
opened in April 1999 in Santa Fe Springs (Los
Angeles County). Two additional facilities,
located in Fresno and San Diego, are scheduled to
open in 2000. Each facility is to house
approximately 35 female offenders and 35 children.
According to the California Department of
Corrections, program components are similar to
those offered in the Community Prison Mother
Program. Female offenders who do not successfully
complete the Family Foundations Program are to be
sent to a state prison where they must complete
their original sentences.

     According to the California Department of
Corrections, 429 California inmates gave birth
from July 1998 to October 1999. During this
period, department data show that 145 female
inmates were placed in the Community Prison Mother
Program. Department data also show that the courts
sentenced 10 women to the Family Foundations
Program from April 1999 (the month the program was
activated) to October 1999.  According to a
department official, 5 to 10 female inmates are
generally on the waiting list for the Community
Prison Mother Program. The official added that
there was no waiting list for the Family
Foundations Program.

Texas Procedures for Pregnant Female Offenders
     The Texas Department of Criminal Justice does
not have a mother-infant/child residential
program. Rather, pregnant female inmates are
transferred to a facility near the delivery
hospital (located in Galveston, Texas)-at 26 weeks
for inmates with a minimum-security custody level
and at 36 weeks for inmates with a custody level
above minimum security-where they can participate
in prenatal and parenting classes.10 Once the
inmate delivers, she is allowed to keep her baby
for the first few hours or days, after which time
the baby is placed with a family member or a
predetermined caregiver.

Mother-Infant/Child Residential Programs in Other
States
     In addition to BOP and California, by
interviewing experts on women in prison issues and
conducting literature searches, we identified 10
other states that have residential programs for
inmate mothers and their
infants/children-Connecticut, Illinois, Iowa,
Massachusetts, Minnesota, Nebraska, New York,
North Carolina, South Dakota, and Wisconsin. In
these programs, infants/children may remain with
inmate mothers for periods ranging from 30 days
(South Dakota) to 2 years (Illinois).

     Three of the 10 states (Nebraska, New York,
and South Dakota) allow infants to stay with their
inmate mothers in nursery-like facilities within
the prison. The other seven states' residential
programs operate out of separate community-based
contract facilities that are funded by public,
private, and/or nonprofit entities. Also, 3 of the
10 states (Iowa, North Carolina, and Wisconsin)
have alternative sentencing programs, whereby
eligible female offenders can be directly
sentenced to a residential facility and bypass a
prison altogether.

     In general, to qualify for inmate mother-
infant/child residential programs, applicants must
be classified as nonviolent offenders and have no
history of abusing or neglecting their children.
In addition to parenting classes, general program
components offered include substance abuse
treatment, mother and child counseling, life
skills training (e.g., budgeting), and general
education courses.

Parent Education Programs
     All three jurisdictions we studied provide
female inmates with some level of parent education
programs to help strengthen relationships with
their children, to teach them responsibility, and
to prepare them to rejoin their families after
release. However, the size and scope of these
programs varied, and waiting lists for
participation existed in all three jurisdictions.

BOP Parent Education Programs
     BOP first piloted a parenting program for
incarcerated parents in 1977. According to BOP, by
1990, BOP had established parenting programs at
all but one women's institution and at one men's
institution. And, in 1993, the BOP Director issued
a policy specifying that parenting programs shall
be established in all institutions housing federal
prisoners. BOP officials told us that all women's
and men's institutions have established a
parenting program.

     Each of the three BOP women's facilities we
visited had a parenting program that included
parent/child visitation activities and parenting
skills classes. Visitation activities at each
facility took place in a children's visitation
center. For example, the children's visitation
center at BOP's Danbury facility-located adjacent
to the general visitation area-had child-size
furniture, toys, games, and books. According to
Danbury officials, children's center activities
include reading, storytelling, board games,
puppetry, arts and crafts, and birthday and
holiday celebrations.

     Danbury officials also told us that parenting
skills classes are offered in both English and
Spanish and include anger management, how to
interpret children's behavior, how to administer
positive discipline, and how to "parent from a
distance." Danbury officials noted that inmates
are able to demonstrate what they have learned
when visiting with their children in the
children's visitation center. Other classes are
intended to teach inmates how to communicate with
their children through letters, pictures, and
telephone calls. According to Danbury officials,
at the time of our review, there was a 3-month
waiting list to get into the parenting program.

California Parent Education Programs
     The California Department of Corrections
offers two separate parent education programs for
female inmates. Since 1993, the department has
offered one program at two of the five California
prisons housing female inmates. This program runs
for 17 days, during which up to 29 inmates meet
for 6.5 hours a day. According to department
officials, this program focuses on child rearing
and providing inmate mothers with the knowledge
needed to become responsible and competent
parents. The officials noted that approximately
1,000 inmates were on the waiting list as of June
1998.

     The California Department of Corrections
offers a second program-known as the Friends
Outside parenting program-at all five of
California's women prisons through a private
contractor.11 According to program documentation,
the 30-hour program is designed to

ï¿½    reduce incidence of child abuse and neglect
in high-risk parents,
ï¿½    set the stage for a successful reunification
of the family after release, and
ï¿½    assist participants to achieve closure where
they have lost custody and/or contact with their
children.

 Department officials told us that due to the
waiting lists for both parenting programs,
priority is given to (1) inmates with court orders
for parenting training, (2) inmates who are within
1 year of their release date, and (3) inmates who
will be the primary custodian of their child(ren)
after they are released from prison.

Texas Parent Education Program
     According to Texas Department of Criminal
Justice officials, the state does not provide
funding for parent education programs. However,
since February 1996, a not-for-profit organization
has offered female inmates a parenting program
designed to improve parent-child interactions.
This program-known as Enhancing Quality and
Understanding of Incarcerated Parents-is not
supported by any state funds, except for use of
classroom space at one prison unit.12 Rather,
churches and other private donors provide funds,
and all instructors are volunteers.

     During the 15-week program, participants meet
once a week for 2 hours. Among other requirements,
female inmates must have children under age 18 and
must be eligible for parole within 18 months.
According to the program coordinator, as of
January 1999, there were over 6,000 female inmates
in the Texas correctional system with children
under age 18. The official noted that over 500
female inmates were on a waiting list for the
parenting program.

_______________________________
1Katherine Gabel and Denise Johnston, M.D.,
Children of Incarcerated Parents, Lexington Books,
1995.
2To calculate the average number of minor child
visitors each week, we divided the total number of
minor child visitors during the 6-month period by
the total number of weeks in the 6-month period
(i.e., 26 weeks).
3Because Saturdays are generally the busiest
visitation day at Danbury, inmates cannot receive
visitors on consecutive Saturdays (i.e., visits on
Saturdays must be on alternate weekends).
4General visits are usually held in a designated
area where the offenders and visitors are
physically separated by a glass wall or partition.
During contact visits, embracing and kissing is
permitted once at the beginning and once at the
end of each visit. During contact visits, the
offender and visitors are to be seated at the
opposite sides of the table, with the exception of
the offender's small children who may be held by
the offender.
5American Correctional Association, Corrections
Compendium, November 1999. Survey responses
covered the most recently reportable 1-year period
(calendar year 1998 or fiscal year through June
30, 1999). Alaska, Hawaii,  Maine,  Massachusetts,
Tennessee, Utah,  and West Virginia did not
respond to the survey.
6These program locations are in California
(Ventura), Connecticut (Hartford), Florida
(Tallahassee), Illinois (Springfield), North
Carolina (Raleigh), South Dakota (Sioux Falls),
and West Virginia (Hillsboro).
7James Boudouris, Ph.D., Parents in Prison:
Addressing the Needs of Families (American
Correctional Association: Lanham, MD, 1996).
8The six facilities are located in Bakersfield,
Oakland (two facilities), Pomona, Salinas, and
Santa Fe Springs.
9The probation department, the district attorney,
the sentencing judge, and the department of
corrections jointly determine eligibility.
10Pregnant female inmates at Texas' one private
facility for women (located in Dallas, TX) deliver
at a hospital near the private facility. According
to Texas Department of Criminal Justice officials,
these inmates are also offered prenatal and
parenting classes.
11 According to California Department of
Corrections officials, the Friends Outside program
is also offered at all of California's men
prisons.
12 Eligible inmates accepted into the program are
transferred from other female prisons to the one
applicable unit.

Appendix VII
Female-Specific Health Care
Page 70GAO/GGD-00-22 Managing Female Inmate Popula
tions
     While female inmates require the same types
of basic and specialty care as male inmates, they
also need access to gynecological and obstetrical
services. All three jurisdictions we studied have
policies and procedures for providing health care
related to female-specific issues (e.g.,
gynecological care). Two of the three
jurisdictions (BOP and Texas) either assessed or
recently began to assess female inmates' access to
such care using small nongeneralizable samples.
However, none of the three jurisdictions has
routinely evaluated the quality of health care
related to female-specific issues.

Female-Specific Health Care in U.S. Correctional
Systems
     Recent surveys indicated that the vast
majority of U.S. correctional systems provided at
least some health care related to female-specific
issues. For example, of the 44 U.S. jurisdictions
(BOP and 43 states) that responded to a 1999
national survey of female inmate health care,

ï¿½    43 jurisdictions (BOP and 42 states) said
they provided gynecological and obstetrical
services during 1998,
ï¿½    42 jurisdictions (BOP and 41 states) said
they provided prenatal/ postpartum services during
1998 (another state said it offered prenatal but
not postpartum services, and
ï¿½    all 44 jurisdictions said they provided
mammography during 1998.1

Also, in response to BJS' 1997 survey of state
prison inmates, about 90 percent of female inmates
reported having received a gynecological
examination after admission to prison.

Although BJS survey results indicated that most
female inmates received at least some female-
specific health care, the results also indicated
that a small but significant percentage may not
have received such care. For example, as indicated
above, about 10 percent of female inmates may not
have received a gynecological examination after
admission to prison. Further, during the 1990s,
several states have been involved in lawsuits
related to health care provided to female inmates.
As discussed below, one of the three jurisdictions
we studied (California) was involved in a class-
action lawsuit related to medical care provided at
two women's prisons.

Policies and Procedures in Jurisdictions Studied
     According to a nationally recognized
correctional health care expert, female-specific
health care services should include, but are not
limited to, the following:

ï¿½    The intake history should include questions
regarding the patient's menstrual cycle,
pregnancies, and gynecological problems.
ï¿½    The intake examination should include a
pelvic exam; a breast exam; a Pap smear; and,
depending on the patient's age, a baseline
mammogram.
ï¿½    Laboratory tests to detect sexually
transmitted diseases should be provided for all
females. Also, where medically appropriate, a
pregnancy test should be provided upon admission.
ï¿½    The frequency of repeating certain tests,
exams, and procedures (e.g., Pap smears and
mammograms) should be based on guidelines
established by professional groups, such as the
American Cancer Society and the American College
of Obstetricians and Gynecologists, and should
consider age and risk factors of the female prison
population.
ï¿½    All female inmates should be provided with
health education information on breast self-
examinations and pregnancy.
ï¿½    Pregnant inmates should have access to
regular prenatal care.

 All three correctional systems we studied have
policies and procedures for providing female-
specific health care, including the services
recommended above.

BOP Policies and Procedures
     BOP's Health Services Manual has a separate
chapter that addresses the special medical needs
of female inmates. Chapter sections include
initial health status screening, elective health
examinations, Pap smears, breast examinations,
chest x-rays, feminine hygiene, pregnancy,
childbirth, prescription birth control,
hysterectomies, immunizations, births and
abortion, and breast cancer surgery. According to
the manual, Pap smears and pelvic and breast
examinations shall be offered and conducted
consistent with American College of Obstetricians
and Gynecologists standards.

California Policies and Procedures
     The California Code of Regulations describes
the standards of health care and scope of practice
(including female-specific issues) applicable to
the state's inmates. According to a senior Health
Care Services Division official, female-specific
examinations and tests are offered in accordance
with recommended schedules developed by the U.S.
Preventive Services Task Force and American Cancer
Society, based on age and risk factors.

     In 1995, female inmates in two California
prisons filed a class-action lawsuit challenging
policies and procedures related to the medical
care provided. Under an August 1997 settlement
agreement, (1) the two California prisons were to
implement various health care policies and (2)
certain specified health care experts were to
assess compliance with provisions of the
agreement.2 In concurring with the provisions of
the settlement agreement, the department did not
admit that current policy and practice differ from
policy and practice contemplated pursuant to the
settlement agreement. In late 1997, the California
Department of Corrections' Health Care Services
Division issued additional policies and procedures
for the two prisons that specifically addressed
(1) health care evaluations, examinations, and
laboratory tests for newly arriving female inmates
and (2) recommended schedules for periodic
examinations for female inmates. These policies
and procedures cover, among other things, breast
examinations, mammograms, pelvic examinations, Pap
smears, and tests for sexually transmitted
diseases.

Texas Policies and Procedures
     According to the Texas Department of Criminal
Justice, gender-specific health care needs of
female offenders are governed by the department's
Health Services Division policy manual and the
National Commission on Correctional Health Care's
standards for health services in prisons. The
department's policy manual covers mammograms, Pap
tests, pelvic exams, and pregnancies. According to
department officials, American College of
Obstetricians and Gynecologists standards are to
be followed regarding examinations, testing, and
services available at women's correctional
facilities.

Reviews of Female-Specific Health Care
According to the American Correctional
Association's public policy on correctional health
care, since incarcerated patients do not have the
ability to "shop around" for providers, reviews of
programs and services should be conducted to
evaluate the actual care being provided. A leading
expert in correctional health care told us that
such reviews should cover both access to care and
the quality of care provided. The expert noted
that quality of care reviews should assess areas
such as (1) the amount of time a physician takes
to review the results of a test and (2) whether
appropriate follow-up care was provided. The
official also told us that such reviews should be
designed to evaluate health care outcomes and to
revisit policies if outcomes are not good. The
expert added that most U.S. correctional systems
lack sophisticated quality improvement programs.

Two of the three jurisdictions we studied (BOP and
Texas) either assessed or recently began to assess
female inmates' access to health care related to
female-specific issues. None of the three
jurisdictions routinely evaluated the quality of
such care. However, each jurisdiction took actions
in 1999 that could lead to increased monitoring of
the quality of female-specific health care.

BOP Reviews
     According to BOP, the health care systems at
all BOP institutions (female and male) are
accredited by the Joint Commission on
Accreditation of Healthcare Organizations.3 BOP
also assesses female inmates' access to female-
specific health care during program reviews.
During these reviews, a small nongeneralizable
sample (about 15) of female inmate health files at
each facility are selected and reviewed to
determine if required procedures were performed
and if health services standards and guidelines
were followed. Regarding female-specific health
care, program review questions include the
following:

ï¿½    Were gynecological and obstetrical histories
taken at initial physical examinations?
ï¿½    Were pelvic examinations and Pap smears done
at initial physical examinations?
ï¿½    Were instructions of self-breast examinations
documented (i.e., were inmates instructed on how
to conduct such examinations)?
ï¿½    Were initial baseline mammograms and other
mammograms offered according to standards (initial
between ages 35 to 40, every 3 to 5 years for
inmates in ages 40 to 50, and annually over age
50)?
ï¿½    Were appropriate gynecological examinations
being done (every 1 to 2 years under age 50 and
annually age 50 and older)?
ï¿½    Did inmates receive routine pregnancy
screening during initial physical examinations?

 During the most recent health services review at
the three BOP facilities we visited, program
review staff identified a total of five
deficiencies related to the areas listed above.
More specifically, Bryan had three deficiencies
(Pap smears, mammograms, and pregnancy screening),4
Danbury had two deficiencies (self-breast
examinations and mammograms), and Dublin had no
deficiencies. According to BOP, health services
examiners, for consistency purposes, agreed that a
25 percent discrepancy or higher in the sample
reviewed will result in a deficiency. Our analysis
of program review documentation revealed that 13
to 17 inmate files were reviewed for each area,
and that the program review team usually
identified an area as deficient if 3 or more
records did not comply with the standard. While
these findings may be accurate for the samples
selected for review, the sample sizes were too
small to make generalizations about access to
female-specific health care at each institution.

     According to BOP, over the past 10 years, the
health care professionals conducting program
reviews have found that the sample sizes used
during program reviews are sufficient. BOP also
noted the following:

ï¿½    The sample sizes specified in the program
review guidelines are considered to be minimum
standards.
ï¿½    When a trend occurs, the sample size can be
expanded at the discretion of the reviewer-in-
charge.
ï¿½    Experience has shown that where a sample size
has been increased, the results indicated the same
percentage of discrepancies, thus validating the
original sample size.

 Our analysis of program review documentation for
the three BOP women's prisons we visited revealed
that, although deficiencies were identified in
several areas, the sample sizes used were not
expanded for any area of review.

     According to a senior BOP quality management
official, BOP headquarters has no information on
the extent to which quality assurance reviews of
health care related to female-specific issues
(e.g., gynecological care) have been conducted.
Rather, individual facilities are responsible for
developing local plans for assessing and improving
the quality of their health care programs.5 For
example, a BOP women's prison could elect to
monitor Pap smears or mammography, but this is not
mandated by national BOP policy. According to BOP,
a thorough review of a facility's quality
assurance plan and areas of performance measured
is conducted during the Joint Commission on
Accreditation of Healthcare Organizations survey
process. BOP also noted that the effectiveness of
a facility's quality assurance program is
evaluated during BOP's program review process. BOP
further noted that both Joint Commission and BOP
program review results are aggregated and reported
to BOP's Medical Director and all BOP regional
directors.

     Of the three BOP women's prisons we visited,
only Danbury had female-specific performance
measures in its local plan. More specifically,
Danbury's three female-specific measures and the
results of the most recent reviews are as follows:

ï¿½    From August 15, 1999, to September 14, 1999,
98 percent of female inmates who had a
gynecological examination were given instructions
on self-breast examinations.
ï¿½    From July 16, 1999, to August 15, 1999, 74
percent of female inmates were offered the
measles, mumps, and rubella vaccination.
ï¿½    From August 16, 1999, to September 15, 1999,
100 percent of scheduled gynecological
examinations and Pap smears were conducted.

 These three performance measures are similar to
the BOP program review tasks mentioned previously,
in that they are designed to assess the percentage
of eligible female inmates who receive female-
specific care. In this sense, the female-specific
measures involve a quantification of outputs or
services provided and not an evaluation of the
outcomes or quality of care.

     Since January 1998, BOP has used six national
performance measures at BOP's medical referral
centers, none of which addressed health care
related to female-specific issues. At the time of
our review, BOP headquarters was considering
additional national performance measures and
expansion of the program to other BOP institutions
for late fiscal year 2000 or in fiscal year 2001.
Of the 35 proposed performance measures, 3 involve
female-specific tests (i.e., baseline Pap smears,
mammography screening, and HIV screening for
pregnant inmates). Like the BOP program reviews
and the performance measures used at Danbury, the
national female-specific measures involve a
quantification of outputs or services provided and
not an evaluation of the outcomes or quality of
care. According to the senior quality management
official mentioned above, the national plan, when
expanded, will allow BOP headquarters to identify
certain measures for institutions to select and
monitor. The official noted that, as the national
system evolves, additional performance measures
may be designed to address the outcomes or quality
of health care related to female-specific issues.

California Reviews
     In April 1999, the California Department of
Corrections declined to comment on whether reviews
of female-specific health care had been conducted
at one of the two women's prisons we visited
because of ongoing litigation related to such
care. Regarding the other women's prison we
visited, in April 1999, a department official told
us that no access to care or quality of care
reviews had been performed. Regarding such
reviews, the official commented substantially as
follows:

ï¿½    The California Department of Corrections
believes that access to care and quality of care
reviews are important and are useful tools to
evaluating health care services for women under
the department's care. Beginning in June 1999, as
part of the department's quality assurance
program, all institutions are being directed to
establish a mechanism for systematically and
objectively monitoring and evaluating the access
to and the quality of health care services. The
individual correctional facilities for women have
the flexibility to design and implement access to
care reviews to determine if female-specific
examinations and tests are being offered or
performed according to recommended schedules.
Under the same quality assurance program,
institutions are directed to implement quality of
care reviews to assess the quality of the female-
specific health care being provided. The quality
assurance program is a systemwide policy and,
thus, is applicable to all institutions.

 In October 1999, a department official told us
that health care quality assurance programs have
been implemented at the five California prisons
that house female inmates. The official noted that
reviews have been conducted but that the results
of the reviews had not yet been provided to
California Department of Corrections' headquarters
officials.

Texas Reviews
According to the Texas Department of Criminal
Justice Division Director for Health Services, all
Texas facilities are accredited by the National
Commission on Correctional Health Care. In March
1999, the Texas Department of Criminal Justice
revised its operational review audit questions to
cover access to three areas of female-specific
health care (i.e., annual physical exams,
mammograms, and Pap smears).6 In April 1999, the
department used these revised audit questions
during operational reviews at the three women's
facilities we visited and identified a total of
six areas of concern. More specifically:

ï¿½    Gatesville had two areas of concern: (1)
Baseline mammograms were not performed on female
inmates between the ages of 35 to 40 in 3 of the
13 cases reviewed and (2) Pap tests were not
performed as required by policy in 3 of the 4
cases reviewed.
ï¿½    Murray had three areas of concern: (1)
Baseline mammograms were not performed on female
inmates between the ages of 35 to 40 in 4 of the
16 cases reviewed, (2) Mammograms were not
performed every 2 years on female inmates between
the ages of 40 to 49 in all 4 cases reviewed, and
(3) Mammograms were not performed annually on
female inmates age 50 or over in 3 of the 10 cases
reviewed.
ï¿½    Woodman had one area of concern: Baseline
mammograms were not performed on female inmates
between the ages of 35 to 40 in 10 of the 13 cases
reviewed.

At the time of our review, the Texas Department of
Criminal Justice had not assessed the quality of
female-specific health care at its facilities
housing female inmates. According to the Director
of Health Services, the Texas Department of
Criminal Justice plans to implement a new health
care quality improvement program in January 2000,
which will require Texas facilities to assess
compliance with a set of about 10 practice
guidelines (e.g., infectious diseases) that have
been certified by the American Medical
Association. The official noted that the
department plans to use the results as statewide
indicators of the quality of care in those areas.
The official added that while female-specific
health care is not one of the practice guidelines,
it is expected that women's facilities will cover
this area as an additional review using national
treatment standards (e.g., American Medical
Association standards).

_______________________________
1Corrections Compendium, November 1999. Survey
responses covered the most recently reportable 1-
year period (calendar year 1998 or fiscal year
through June 30, 1999). Alaska, Hawaii, Maine,
Massachusetts, Tennessee, Utah, and West Virginia
did not respond to the survey.
2According to a California Department of
Corrections' official, as of October 1999, the
health care experts had completed their review but
had not provided the results to the department.
3To achieve and maintain accreditation, all BOP
institutions are surveyed by Joint Commission
officials at least once every 3 years.
4At the time the health services program review
was conducted at Bryan, the suggested standard for
performing mammograms on inmates in ages 40 to 50
was every 1 to 2 years.
5BOP's Health Services Manual has a separate
chapter on improving organizational performance.
This chapter provides the framework for all BOP
facilities to assess and improve the quality of
their health care programs. According to BOP, this
chapter is based on Joint Commission on
Accreditation of Healthcare Organizations
standards.
6Operational review audits are intended to
objectively measure operational adherence to
rules, regulations, policies, and practices, as
well as applicable court orders.

Appendix VIII
Substance Abuse Treatment, Mental Illness, and HIV
Infection
Page 73GAO/GGD-00-22 Managing Female Inmate Popula
tions
Many female inmates have histories of involvement
with substance abuse and related crimes. Also,
national surveys indicate that female inmates have
higher rates of mental illness and HIV infection
than male inmates. This appendix presents
information on (1) the availability of substance
abuse treatment for female inmates, (2) the rate
of mental illness among female inmates, and (3)
the rate of HIV infection among female inmates.

Substance Abuse Treatment
According to BJS' 1997 surveys of federal and
state prison inmates,

ï¿½    about 47 percent of female inmates in federal
prisons and about 74 percent of female inmates in
state prisons indicated they had used drugs
regularly prior to incarceration (once a week or
more for at least 1 month);
ï¿½    about 37 percent of female inmates in federal
prisons and about 62 percent of female inmates in
state prisons reported having used drugs in the
month before their current offense; and
ï¿½    about 19 percent of female inmates in federal
prisons and about 40 percent of female inmates in
state prisons reported using drugs at the time of
their offense.

In 1991, we reported that BOP and the states could
provide treatment to only a small percentage of
inmates that may have substance abuse problems.1
Since 1991, additional research and our work in
selected jurisdictions indicate that U.S.
correctional systems still face challenges in
providing substance abuse treatment.

National Studies on Substance Abuse Treatment
During the 1990s, several organizations have
conducted studies on substance abuse problems and
treatment in federal and state prisons. The
following sections summarize the results of
national surveys conducted by BJS, the National
Center on Addiction and Substance Abuse at
Columbia University, and the National Institute of
Justice.

Bureau of Justice Statistics
According to BJS, the percentage of female inmates
in federal and state prisons who acknowledged drug
use before incarceration increased from 1991 to
1997 (see app. III). However, BJS data show that
the percentage of female inmates who reported
being treated for drug abuse since admission to
prison-e.g., treatment involving residential
facilities, professional counseling,
detoxification units, and/or maintenance drug
programs-declined during this period. For example,
as shown in table VIII.1, the percentage of female
inmates in federal prisons who said they
participated in drug treatment since admission to
prison declined from about 19 percent in 1991 to
about 10 percent in 1997, and the percentage of
female inmates in state prisons who reported such
treatment declined from about 29 percent in 1991
to about 15 percent in 1997.

Table VIII.1:  Drug Treatment of Federal and State
Female Inmates Since Admission to Prison, by
Levels of Drug Use, 1991 and 1997
                     Drug treatment since      Participation in other drug
                          admissiona                      abuse
                                               program(s) since admissionb
                    Federal         State         Federal         State
                  1991   1997    1991   1997    1991   1997    1991   1997
All female        18.6 % 10.4 %   29.2 %  14.7 %   15.1 %  17.9 %   18.9 %  24.4 %
inmates
Female inmates                                                                   
who used drugs
before prison:
  Ever            36.3 % 16.2 %   36.9 %  17.4 %   29.6 %  27.2 %   23.8 %  28.5 %
  Regularlyc      43.1  19.9    40.4   19.3    34.2   31.4    26.4   31.3  
  In the month    44.3  20.8    41.6   20.9    36.3   32.9    27.3   32.2  
before
  current
offense
  At the time of  49.5  24.3    46.0   25.3    39.5   33.1    31.2   34.7  
current
  offense
Note: According to BJS, these data underestimate
the total number of prisoners who will ultimately
receive substance abuse treatment during their
current prison term. BJS noted that the likelihood
of receiving substance abuse treatment increases
as a prisoner's expected release date approaches.
Therefore, some of the inmates who did not report
substance abuse treatment since admission should
receive treatment before the completion of their
term.
aIncludes residential facilities, professional
counseling, detoxificaiton units, and maintenance
drug programs.
bIncludes self-help/peer counseling groups, as
well as educational or awareness programs.
cRegular use is defined as once a week for at
least a month.
Source: Unpublished BJS data.

Table VIII.1 also shows that the percentage of
female inmates with a drug abuse history who
reported drug treatment since admission to prison
declined from 1991 to 1997. For example, the
percentage of female inmates in federal prisons
who had been using drugs in the month before their
current offense and who reported participation in
drug treatment since admission to prison declined
from about 44 percent in 1991 to about 21 percent
in 1997, and the percentage of such female inmates
in state prisons who reported drug treatment
declined from about 42 percent in 1991 to about 21
percent in 1997.

Table VIII.1 shows that participation in other
drug abuse programs, such as self-help or peer
groups and drug education classes, remained
relatively constant from 1991 to 1997.

Regarding female and male inmates characterized as
drug- or alcohol-involved, a 1999 BJS report2
showed the following about inmates' participation
in treatment or other substance abuse programs
since admission to prison (see table VIII.2):

ï¿½    In federal prisons, similar percentages of
female inmates (about 13 percent) and male inmates
(about 12 percent) reported being treated for
substance abuse.
ï¿½    Also, in federal prisons, similar percentages
of female inmates (about 25 percent) and male
inmates (about 26 percent) reported participation
in other substance abuse programs.
ï¿½    In state prisons, about 20 percent of female
inmates reported being treated for substance
abuse, compared with about 14 percent of male
inmates.
ï¿½    Also, in state prisons, about 32 percent of
both female and male inmates reported
participation in other substance abuse programs.

Table VIII.2:  Drug- or Alcohol-Involved Federal
and State Prison Inmates Participating in
Treatment or Other Substance Abuse Programs, 1997
                                      Percent of drug or alcohol-involved
                                               inmates reporting
Jurisdiction                           Treatment for      Participation in
                                      substance abusea    other substance
                                                          abuse programsb
                                      Ever        Since    Ever       Since
                                              admission           admission
Federal                                                                           
Female                               28.8 %        13.3 %   34.2 %       25.2 %
Male                                 27.6         11.6    39.6        26.1 
                                                                           
State                                                                      
Female                               55.6 %        19.6 %   49.3 %       31.9 %
Male                                 40.5         14.2    49.4        31.9 
Note: According to BJS, these data underestimate
the total number of prisoners who will ultimately
receive substance abuse treatment during their
current prison term. BJS noted that the likelihood
of receiving substance abuse treatment increases
as a prisoner's expected release date approaches.
Therefore, some of the inmates who did not report
substance abuse treatment since admission should
receive treatment before the completion of their
term.
aIncludes residential facilities, professional
counseling, detoxificaiton units, and maintenance
drug programs.
bIncludes self-help/peer counseling groups, as
well as educational or awareness programs.
Source: BJS.

National Center on Addiction and Substance Abuse
In 1996, the National Center on Addiction and
Substance Abuse at Columbia University conducted a
national survey to assess substance abuse problems
among inmates and the availability of treatment.
According to the Center's January 1998 report,3
federal prison officials responding to the survey
estimated that 31 percent of federal inmates had a
substance abuse problem. Also, officials in the 47
states and the District of Columbia who responded
to the survey estimated, on average, that 74
percent of their inmates had a substance abuse
problem.4 However, the survey results revealed
that only one in four state inmates identified
with a drug or alcohol problem received any
substance abuse treatment over the course of a
year. This treatment could be short-term drug
education or self-help groups, or it could be
longer-term help.

Each of the correctional departments that
responded to the survey cited limitations in their
ability to expand treatment services for substance-
abusing inmates. As table VIII.3 shows, 71 percent
of correctional departments cited budgetary
constraints as a limitation to providing
treatment.

Table VIII.3: Limitations to Providing Substance
Abuse Treatment to Federal and State Prison
Inmates, 1996
Limitations to providing treatment                            Percentage of
                                                       correctional systems
                                                                respondinga
Budgetary constraints                                                   71 %
Space limitations                                                       51 
Limited amount of counselors                                            39 
Too few volunteer participants                                          18 
Frequent movement of inmates                                            12 
General correctional problems                                            8 
Problems with aftercare provision                                        4 
Legislative barriers                                                     2 
aPercentage of correctional systems does not equal
100 percent because correctional systems could
provide more than one response.
Source: The National Center on Addiction and
Substance Abuse at Columbia University.

National Institute of Justice
From 1993 to 1994, the National Institute of
Justice conducted a national survey of state-level
correctional administrators, prison and jail
administrators, and program administrators to
explore the special needs of and issues related to
women offenders. In 1998, the Institute reported,5
among other things, that substance abuse treatment
was widely identified by correctional officials as
not being sufficiently provided, and was linked to
a set of other problems as well (e.g., violence
and abuse, lack of job skills or training, and the
inability to form constructive relationships). The
survey also revealed that the larger the state's
female population, the larger the state-level
proportion of administrators who wanted substance
abuse treatment expanded.

Substance Abuse Treatment in Jurisdictions Studied
Each of the three jurisdictions we studied offered
female inmates a variety of substance abuse
treatment programs (e.g., residential treatment,
professional counseling, education programs, and
self-help/peer counseling). However, in each
jurisdiction, female inmates were on waiting lists
for participation in treatment programs.

BOP's Substance Abuse Treatment Programs
According to BOP, drug education programs and
nonresidential drug counseling are offered at
every BOP facility. BOP also provides a 6-month
residential drug abuse treatment program at 5 of
its women's prisons (a total of 523 beds).
According to BOP, 1,409 female inmates
participated in residential drug abuse treatment
programs during fiscal year 1999. BOP noted that,
as of October 1999, about 600 female inmates were
on the waiting list for residential drug abuse
treatment. All female and male inmates who had
participated in a residential drug abuse treatment
program and were otherwise eligible for community
corrections center or home confinement placement
could receive community-based substance abuse
treatment services upon their release from prison.

According to BOP, in September 1999, each BOP
residential treatment program for women received a
specialized substance abuse treatment curriculum
for female inmates.6 BOP also noted that, in June
1999, BOP's psychology services division began
modifying the current residential drug abuse
treatment curriculum to include "best practices"
based on current literature and research.
According to BOP, the revised curriculum will
include sections that focus on issues specific to
the treatment of female inmates, including
domestic violence, trauma, medical issues, and
interpersonal relationships.

In 1998, the American Correctional Association
recognized BOP's drug abuse treatment programs as
outstanding or "best practices" in corrections.

California's Substance Abuse Treatment Programs
California Department of Corrections' officials
told us that drug education programs and
nonresidential drug counseling are offered at
every California prison. According to a 1997
California Department of Corrections' report,7
although substance abuse treatment programs in the
department have grown rapidly in recent years, and
continue to do so, at projected levels there will
remain a large number of individuals with
histories of substance abuse who will not receive
treatment. The 1997 report shows that residential
substance abuse treatment programs were provided
at 2 of California's 5 prisons that house female
inmates, with a total of 200 beds.

Since 1997, the California Department of
Corrections has significantly increased its
capacity to provide residential substance abuse
treatment services to female inmates. As shown in
table VIII.4, as of October 1999, residential
treatment programs had been expanded to all 5
California prisons that house female inmates, with
a total of about 1,500 beds.

Table VIII.4: Residential Substance Abuse
Treatment for Female Inmates in California Prisons
(as of October 1999)
Facility                                                Number of substance
                                                       abuse treatment beds
California Institute for Women                                          240
California Rehabilitation Center                                        600
Central California Women's Facility                                     200
Northern California Women's Facility                                    200
Valley State Prison for Women                                           256
Total number of female beds                                            1496
Source: California Department of Corrections.

Department data show that from July 1997 to June
1998, 713 female inmates participated in in-prison
residential substance abuse treatment programs.
Department officials projected that another 1,879
female inmates will have participated in
residential treatment programs by calendar year-
end 1999. As of October 1999, a total of
approximately 275 female inmates were on waiting
lists for residential treatment programs at the
two California women's prisons we visited. One of
the 2 prisons was scheduled to activate another
306 beds in November 1999, and the other prison
was in the planning stages for another 256 beds.
Upon parole, inmates who graduate from
California's residential substance abuse treatment
programs can participate in community-based
treatment and recovery programs.

Texas' Substance Abuse Treatment Programs
According to Texas Department of Criminal Justice
officials, drug education programs and
nonresidential drug counseling are offered at
every Texas facility. All female and male inmates
are required to attend a 24-hour substance abuse
program and also have the option of requesting a
longer-term program. The department provides two
types of residential substance abuse treatment
programs for female and male inmates:

ï¿½    Substance Abuse Felony Punishment Facility
programs provide 9 to 12 months of residential
treatment for inmates with crime-related substance
abuse problems who have been sentenced to the
facility as a condition of probation or as a
modification of parole or probation.
ï¿½    In-Prison Therapeutic Community programs
provide 9 to 12 months of residential treatment
for inmates identified as needing substance abuse
treatment.

From September 1998 to August 1999, according to
Texas Department of Criminal Justice officials,
1,243 female inmates completed a Substance Abuse
Felony Punishment Facility program, and 428 female
inmates completed an In-Prison Therapeutic
Community program. As of September 1999, four
female inmates were on waiting lists (an
approximate 5- to 7-day wait) for residential
substance abuse treatment programs. Inmates who
complete either residential program are released
on parole to a community-based residential
facility for 3 months, followed by outpatient
treatment for 12 months.

The Texas Department of Criminal Justice also
offers a 4-month prerelease substance abuse
treatment program for male inmates who demonstrate
serious substance abuse dependence and antisocial
characteristics. Department officials told us they
would consider offering this program to female
inmates if the number of female inmates who need
this type of program increases.

Mental Illness
According to a 1999 BJS report,8 female inmates
have higher rates of mental illness9 than male
inmates. The report showed that about 13 percent
of female inmates in federal prisons and about 24
percent of female inmates in state prisons were
identified as mentally ill, compared with 7
percent of male inmates in federal prisons and
about 16 percent of male inmates in state prisons.
The report also noted that

ï¿½    In state prisons, an estimated 29 percent of
white female inmates, 20 percent of black female
inmates, and 22 percent of Hispanic female inmates
were mentally ill;
ï¿½    approximately 64 percent of mentally ill
female inmates in federal prisons and about 78
percent of mentally ill female inmates in state
prisons reported prior physical or sexual abuse;
and
ï¿½    approximately 77 percent of mentally ill
female inmates in federal prisons and about 67
percent of mentally ill female inmates in state
prisons reported receiving mental health services
while incarcerated.

HIV Infection
According to data BJS obtained from state
departments of corrections, female inmates in
state prisons have higher rates of HIV infection
than male inmates in state prisons.10 For example,
as table VIII.5 shows, 3.5 percent of all female
inmates in state prisons were known to be HIV-
positive in 1997, versus 2.2 percent of all male
inmates in state prisons. Table VIII.5 also shows
that the percentage of female and male state
inmates who were known to be HIV-positive remained
relatively constant from 1992 to 1997.

Table VIII.5:  Female and Male Inmates in State
Prisons Infected with HIV (at calendar year-end,
1991 to 1996)
Yearend                              Number of HIV- Percent HIV-positive in
                                     positive state   custody population of
                                    prison inmatesa        reporting states
                                    Females   Males       Females     Males
1991                                  1,159  16,150          3.0 %      2.2 %
1992                                  1,598  18,266          4.0       2.6 
1993                                  1,796  18,218          4.2       2.5 
1994                                  1,953  19,762          3.9       2.4 
1995                                  2,182  20,690          4.0       2.3 
1996                                  2,135  21,799          3.5       2.3 
1997b                                 2,185  20,153          3.5       2.2 
aIncludes the District of Columbia. In 1991, North
Carolina, South Dakota, and the District did not
report by gender. In 1995, Delaware, Indiana,
South Carolina, and the District did not report
data by gender.
bPreliminary data provided by BJS.
Source: BJS.

According to BOP, from 1991 to 1998, a total of
4,142 HIV patients were in BOP prisons, of which
370 were female inmates and 3,772 were male
inmates. BOP could not provide a breakout of HIV
patients by calendar or fiscal year. California
Department of Corrections data show that 132
female inmates and 1,504 male inmates were known
to be HIV-positive as of June 1999. Texas
Department of Criminal Justice data show that 267
female inmates and 2,089 male inmates had been
diagnosed as HIV-positive as of October 1998.

According to BJS, in 1997, BOP and 17 state
correctional systems had policies requiring HIV-
antibody testing of all inmates at intake and/or
release. BJS noted that most correctional systems
also test at the inmate's request or upon clinical
indication.

_______________________________
1Drug Treatment: Despite New Strategy, Few Federal
Inmates Receive Treatment (GAO/HRD-91-116, Sept.
16, 1991) and Drug Treatment: State Prisons Face
Challenges in Providing Services (GAO/HRD-91-128,
Sept. 20, 1991).
2BJS, Substance Abuse and Treatment, State and
Federal Prisoners, 1997 (January 1999). The BJS
report characterized inmates as drug- or alcohol-
involved if they had a current drug offense or a
driving while intoxicated offense, were under the
influence of drugs/alcohol at the time of their
most current offense, had used drugs in the month
prior to their most current offense, and/or had a
history of alcohol abuse or dependence.
3Behind Bars: Substance Abuse and America's Prison
Population, January 1998. BOP, 47 states, and the
District of Columbia responded to the survey.
4According to the center, survey results generally
cannot be broken down to compare female and male
inmates.
5National Institute of Justice, "Research in
Brief-Women Offenders: Programming Needs and
Promising Approaches" (Aug. 1998). All state
correctional departments and at least one prison
for each state were surveyed.
6BOP's specialized substance abuse treatment
curriculum for female inmates was based on a
curriculum used within the Texas Department of
Criminal Justice.
7California Department of Corrections, Overview of
Substance Abuse Programs, September 1997.
8BJS Special Report, Mental Health and Treatment
of Inmates and Probationers, July 1999. The report
was based in part on the BJS 1997 survey of
inmates in federal and state correctional
facilities.
9Offenders were identified as mentally ill if they
reported a current mental condition or if they
reported an overnight stay in a mental hospital or
treatment program.
10BJS data on HIV infection are contained in a 1999
National Institute of Justice report entitled,
Issues and Practices, 1996 to 1997 Update:
HIV/AIDS, STDs and TB in Correctional Facilities,
July 1999. The National Institute of Justice, the
Centers for Disease Control and Prevention, and
BJS sponsored and conducted the research presented
in the report.

Appendix IX
Comments From the Bureau of Prisons
Page 83GAO/GGD-00-22 Managing Female Inmate Popula
tions

Appendix X
GAO Contacts and Staff Acknowledgments
Page 84GAO/GGD-00-22 Managing Female Inmate Popula
tions
GAO Contacts
Laurie Ekstrand, (202) 512-8777
Danny Burton, (214) 777-5600
Eric Erdman, (214) 777-5600

Acknowledgments
In addition to those listed above, Lessie Burke,
Mary Ann Curran, Stella Flores, Daniel Garcia,
Mary Hall, Geoffrey Hamilton, Anthony Radford,
Katherine Raheb, and Barry Seltzer made key
contributions to this report.

*** End of Document ***