Thirty-eight adult female prisoners from four Zambian prisons were interviewed, including 20 convicted, 14 pre-trial, and four immigration detainees. Their ages ranged from 22 to 77 years, with an average age of 37 years. Thirty-two of the 38 women (84 percent) were of Zambian nationality. Female prisoners interviewed reported having been detained at the facility at which they were interviewed for an average of nine months (with a range from zero to 44 months). Twenty-one (55 percent) of the women had reached secondary-level education or higher, while six (16 percent) had received no education and 11 (29 percent) had only a primary-level education. In addition, 22 prison officers and 18 Zambian government officials from relevant ministries were approached for interviews; one prison officer declined. Twenty-eight representatives from local and international NGOs and donor governments and agencies were also interviewed.
Women in Zambian prisons live in conditions of severe overcrowding. Zambian prisons are over 300 percent of capacity, and female inmates reported sleeping four to a mattress, packed together in unventilated cells with young children and the sick . As one female inmate reported: "Our cells are normally stuffed. There is no ventilation, no windows. The sick and healthy are mixed up. There are those with diarrhea. We are breathing the same air" .
Both prisoners and prison officials reported that the food provided by the government to prisoners is insufficient and nutritionally inadequate. Prisoners rely on their relatives to supplement the meager food rations or trade work for food. As one female inmate noted, "Some people have no relatives–if you have no food, you are nobody in this place. You can trade a cup of sugar for work" .
The Zambia Prisons Service does not provide inmates with basic necessities including soap, toothpaste, or sanitary pads. As one inmate noted, "If others don't bring them for us, we have nothing. There are lots of people with no relatives here. They have nothing" . Female prisoners reported that sanitation and hygiene are poor, and water frequently unclean. "It tastes foul, but we drink it", stated one female HIV-positive inmate .
In April 2010 only 14 health personnel served 16,666 prisoners, and of Zambia's 86 prisons, only 15 had any health clinic or sick bay . For those at prisons without a clinic–and for those with more serious medical conditions at those with a clinic–access to care is controlled by medically unqualified and untrained prison officers. According to prisoners and prison officers, a lack of adequate prison staff for the transfer of sick prisoners, inadequate vehicles for transportation and fuel, and security fears keep inmates from accessing medical care outside of prisons, in some cases for weeks after they fall ill. As one inmate reported:
"There are delays in getting to the clinic. It depends on the officials, if they want to take you there or not. Sometimes you can go as long as a month waiting to go to the clinic....They don't open the door in the cell at night for anything. There are no windows, no air. Someone who was 28 years old died at night in my cell and they didn't open the door until the morning" .
Pregnancy and women with children
International standards dictate that for women in detention, there shall be "special accommodation for all necessary prenatal and postnatal care and treatment" . Zambia Prisons Service policy requires that "Women inmates, including those who are HIV infected, should receive...[p]rovision of antenatal care services as offered to all women in the general population" . But although prenatal care is widely available in the Zambian general population , incarcerated pregnant women interviewed described inadequate, and in some cases non-existent, prenatal care. One pregnant woman reported: "I had no initial exam when I came to the facility, even though I am pregnant. There is no special treatment for pregnant women, I take whatever I can" . Another female inmate, who reported she was six months pregnant, said:
"I have not been to the clinic yet, no antenatal care. I went to the clinic once but was told the nurses were not working. Since then I have not asked. I do not feel well, lots of ups and downs" .
For some prisoners, prenatal care existed but did not meet international standards. The World Health Organization (WHO) protocol for prevention of mother-to-child transmission (PMTCT) of HIV notes that "[a]ll HIV-infected pregnant women who are not in need of ART [antiretroviral therapy for HIV treatment] for their own health require an effective ARV prophylaxis strategy to prevent HIV transmission to the infant. ARV prophylaxis should be started from as early as 14 weeks gestation" . However, one female prisoner, who was eight months pregnant, reported:
"I had VCT [voluntary counseling and testing for HIV]–they tested my blood again and told me I was HIV-positive. They told me my CD4 court was too high for ART. I wasn't given any HIV drugs to prevent transmission, only folic acid and vitamins" .
Indeed, there is no PMTCT program under the prison medical directorate, though PMTCT programs have been scaled up in recent years in the general population. The estimated percentage of women in Zambia's general population living with HIV who received ART for prevention of mother-to-child transmission increased between 2004 and 2007 from 18 to 47 percent .
Inadequate nutrition is a serious problem for pregnant women and women with children in prison. Prisoners across facilities reported that meals consisted of approximately 400 to 450 grams of maize meal per day (400 grams of maize meal is equivalent to roughly 1,400 calories ), in addition to small quantities of beans and/or kapenta (tiny fish commonly eaten in Zambia). Normal-weight pregnant women require between 1,900 and 2,500 calories per day during the last six months of pregnancy for healthy weight gain . Yet there is no special diet for pregnant women or for women who are nursing.
Despite international standards calling for special provisions for children incarcerated with their parents  and Zambian law, which states that, "the infant child [up to age four years] of a woman prisoner may be received into the prison with its mother and may be supplied with clothing and necessaries at public expense" [18, 28, 29], the Prisons Service allocates no food to children who live with their mothers in prison facilities. In situations where women are unable to breastfeed, the prison does not offer infant formula. As the officer in charge at one prison reported: "I get no budget for the children's food, they must eat their mothers' food. They are hungry a lot" . As the incarcerated mother of a nine-month-old boy said:
"My child is not considered for food–I give my share to the baby, beans and kapenta–we each eat once a day. I am not given any extra food, and no special diet for the child. I simply make some porridge for him out of my nshima. The baby has started losing weight and has resorted to breast milk because the maize meal is not appetizing" .
Another female inmate said: "I am worried about the children who are here. There was a baby who died. They don't pay any particular attention to the children. They are mixed in with everyone, they don't have their own cell or better food" .
HIV and TB testing
HIV and TB are major health threats for the entire prison population–when last measured in 1999, HIV prevalence was 27 percent for the Zambian prison population, and 33 percent among female inmates . Whereas TB prevalence was estimated to be 0.3 percent in the Zambian general population in 2009 , a 2000-2001 study in 13 Zambian prisons estimated the prevalence of pulmonary TB to be between 15 and 20 percent . HIV testing and treatment are offered at six prisons nationwide with the assistance of an NGO, and as of March 2011, prison-based TB screening and treatment were offered only at three prisons nationwide as part of a pilot program. For both diseases, researchers found that female inmates were less likely to have been tested than their male counterparts .
Female prisoners face potential breaches of consent with HIV testing. The National HIV/AIDS/STI/TB Policy requires that women considering having a child be encouraged to seek counseling and testing and ensures that every pregnant woman has access to HIV/STI screening and treatment. It does not require mandatory prenatal testing ; Zambia Prisons Service policy prohibits compulsory HIV testing . However, interviews with prison officers suggested that this prohibition was either not understood or not respected for female inmates. One prison officer said: "For those who are pregnant, they are tested for HIV....Whether you like it or not you are tested to prevent transmission to the baby" .
Abuse of female inmates in police and prison custody
Female inmates, particularly women previously held in police custody, reported physical and sexual abuse indicative of a widespread and systematic pattern of brutality. Prisoners repeatedly reported that they were beaten in police custody in order to try to coerce a confession, often leading to serious injuries. One female inmate who had previously been held in police custody, said:
"When I was in police custody, they beat me, a torture I have never experienced in my lifetime. They beat me, undressed me, whipped me. They put handcuffs on me so hard that the blood couldn't flow. They turned me upside down and hung me upside down, with a steel cord between my legs. They swung me and beat me. They saw I was crying and screaming and put a cloth in my mouth to suffocate me. I fainted–I couldn't handle the pain. They were abusing me with their language, calling me a prostitute. They put me somewhere where I couldn't talk to anyone. They were trying to get me to say something–I don't know. They were just torturing me for four days, beating me. After, there was lots of blood where I was beaten. My hands were green and swelling.
They hit me on my ears and face with a metal band. There were scratches on my face. They said, 'you have to give us information about who had killed the person'. They tried to find out who had killed the person–I didn't know. The police are supposed to investigate a case, not to torture.
After, they were scared to take me to a doctor because I still had injuries. They only took me after one month, when the swelling was down. When I went to the doctor, the police [officer] followed me into the doctor's room and listened to me. The police told the doctor that I was lying. 'Just a simple torture that she was given, not much,' he said" .
Several female detainees reported that police officers tried to coerce them into sex in exchange for their release. One female prisoner who had been detained in police custody reported:
"They arrested and they beat me, asking questions. They beat me up when I said I didn't know anything. They said, 'we want you to say this, then we will let you go.' They didn't sexually abuse me, but they asked me to have sex with them. They said they would release me if I did, and I said no" .
Female inmates also reported particularly brutal forms of punishment that they were subjected to once incarcerated in prisons. Women in prison were subjected to beatings by their fellow inmates at the instigation of the officers:
"When I arrived here, the officers shouted to the inmates to say, 'the woman coming is a witch, a murderer–deal with her!' Shouting 'you witch, you murderer,' they rose up, hitting me. The officers just watched. My injuries were largely bruises and swellings on my arms where I was beaten....I felt humiliated and dehumanized to the extent that I almost committed suicide. I couldn't bear it" .
Reported another female inmate:
"Truthfully, each officer has her own problems. Some are harsh, some don't accommodate us. To tell the truth, we were told to say that there are no problems, but each has their own problems. They beat and shout at us, so we can't share a problem–they are not approachable....They degrade us, shout, call us names, make reference to the fact that we are criminals" .
In addition to beatings, at one prison, female prisoners reported sexual humiliation as punishment. Prisoners reported being stripped naked, smeared with mud, and placed in the direct sunlight of the prison central courtyard to be viewed by all female prisoners for an entire day as punishment. One female inmate described this punishment as "aimed at humiliating or insulting our personality" and asked: "How can they make me strip naked before younger women who could be my daughter, without taking to consideration how I would feel as a woman, as a mother?" 
Further forms of sexual humiliation and verbal abuse exist for female inmates. One inmate reported that as punishment, the officers may put the inmate into the center of a circle of the other prisoners at bath time, where each "showers insults at her, calling her the names of private parts" .
Female prisoners also reported feeling abused by routine strip searching by officers. Inmates reported that they were strip searched, both when returning from court, and at regular intervals in the cells themselves. Multiple inmates reported the shame involved. "I feel grieved about it", one said, "I even pray to God that I can just die. The pain and shame is too tough to bear" . In one instance, researchers received a report from a prisoner that a body cavity search for all female inmates was carried out with a single pair of gloves .