Over the course of 12 years, former inmate Beverly Henry watched hundreds of untreated women die in the Central California Women’s Facility, a sprawling complex in Chowchilla that comprises the largest female prison in the nation.
One woman had liver disease, with eyes "yellow as a warning sign" and two tampons stuck up her nose to stem the bleeding that poured from every orifice. Henry brought her to the prison's clinic where, she said, the two were told to return to work. Within a week, the woman was dead.
"I watched 17 women die in one year," said Henry, now 62, who spent 40 years cycling in and out of the state system for her drug addiction and worked as a peer health educator inside prison clinics during most of her incarceration. "I’ve seen things that make me wish the mind was not so unique that we have the ability to store memories."
Two weeks ago, the U.S. Supreme Court ruled that overcrowding in California's prison system, which houses just over 140,000 inmates but was built to accommodate only 80,000, constitutes cruel and unusual treatment and violates the Eighth Amendment.
The contentious ruling sparked investigations into the abysmal conditions of the state's 30 male prisons, including allegations of race-based discrimination.
But the reports and the Supreme Court ruling largely ignored the state’s three female facilities, where former inmates and prison rights advocates say that 12,000 women live in grossly overcrowded and unsanitary conditions. These women must navigate a host of dangers, including insufficient medical care, sexual abuse by guards and increasing levels of violence between inmates.
Nearly 3,700 women live at Central California Women’s Facility, putting it at more than 180 percent capacity. Eight women pack into cells built for four, sharing one bathroom and shower and each receiving a single locker, one-cubic-foot large, for their possessions. The rooms rarely have adequate ventilation and temperatures soar during the summer months. As in the men’s prisons, the gymnasium has been converted into housing.
A report by the United Nations Special Rapporteur on Violence Against Women released Friday confirms Henry’s account of fatally poor medical care inside women's prisons.
"Inadequate access to health services in prison and detention facilities is characterized by delays, neglect, and mistreatment of inmates and detainees," wrote the Special Rapporteur, who visited Central California Women’s Facility in addition to two prisons in other states.
"At the core of these health concerns is an inadequate system which is insufficiently responsive to gender-specific needs, including the reproductive health needs of women, and is understaffed and under-resourced," the report said. It particularly condemned the alleged routine practice of shackling inmates during labor.
Female-specific care has been absent in the California system for decades, an oversight that prison-rights advocates say illustrates the "invisible" state of women inmates. When one of the first lawsuits over medical care, for example, was settled in the late 1990s between the Prison Law Office and California Department of Corrections and Rehabilitation, the initial settlement decree didn’t include one word about pregnancy, pap spears or reproductive health.
More recently, the Department has come under fire for allowing 116 women to be sterilized through post-partum tubal ligations between 2006 and 2010 at contract hospitals. According to prison-rights advocates, this practice violates both federal law, which does not allow inmates to give informed consent during pregnancy, and California state law, which does not allow the state to pay for the sterilization of institutionalized people, including inmates.
"This is an illegal practice," said Cynthia Chandler, director of Justice Now, a prison-rights organization that learned of the sterilizations through public records requests. "This shows the complete lack of awareness of federal health law. It’s an extension of how little attention has been placed on understanding women's health care needs in prisons."
California Prison Health Care Services, which has been under federal receivership since 2006, does not deny that some sterilizations occured. But Nancy Kincaid, the agency's director of communications, said the procedures happened in outside contract hospitals, where the doctors may not have known the patients were inmates and the state could not have legally paid for the operations. Kincaid said the Department met with all contract doctors in 2010 and informed them the state does not pay for post-partum tubal ligations.
Sexual abuse by male guards constitutes another threat for female inmates that the system has yet to resolve. The U.N. report noted the situation has improved in the last decade due to the 2003 Prison Rape Elimination Act, citing a 2008-2009 study that found a mere 2.1 percent of female inmates had experienced sexual misconduct from a staff member.
But former California inmates tell another tale.
"Guards have sex and women are harassed by the guards," said Henry. "Women get pregnant; babies are born: These things happen here and the guards are responsible."
Recently, the Department began rationing supplies such as toilet paper, tampons, soap, toothbrushes and toothpaste in order to confront its budget crisis, a policy change that led some inmates to turn to prostitution with guards in order to gain access to these basics.
"It’s indicative of level of desperation," said Chandler, who noted that she’s seen this type of prostitution for basic supplies in women's prisons across the country.
The rationing has also increased tension and unsanitary conditions in the incredibly close quarters.
Each inmate gets a maximum of two tampons and one pad for each day of her period, according to Chandler, which is not enough for many women. In addition, each woman receives only one roll of toilet paper per month. The combination has led to bloody, humiliating scenes rarely seen in the developed world.
Unchecked bleeding in close quarters also poses a significant health risk among a population with high levels of HIV and Hepatitis C, both blood-borne diseases.
And the food remains far from adequate, even by prison standards. According to research by Justice Now, the Department spends twice as much on food for each male inmate compared to each female inmate, even though the caloric difference in meals is only 30 percent.
The conditions of poor food, cramped quarters, increased lockdowns and the debasing lack of sanitation incite higher levels of violence between inmates than ever before.
"Women are a little more subtle in their violent propensities than men, but they do exist," said Henry, who has been drug-free for 15 months and has spent the last two years out of jail -- the longest stretch of freedom in her life since she was 16 years old.
"People really think, 'Oh the women, they’re fine.' No, we’re not. This is a psychological part of slavery that is totally inhumane."
Correction: An earlier version of this article incorrectly suggested the California Department of Corrections and Rehabilitation was in charge of medical treatment in California's prison system and misstated Nancy Kincaid's title. The agency in charge is the California Prison Health Care Services, where Nancy Kincaid is the director of communications.