Health-care utilisation among women involved with the criminal justice system: a systematic review and meta-analysis of population-based observational studies

Purpose Despite growing recognition of substantial health-care needs among women involved with the criminal justice system (CJS), the patterns of health-care utilisation in this population remain under-investigated. This paper aims to synthesise global evidence on health-care utilisation among adult women with CJS involvment and examined factors associated with health service use. Design/methodology/approach The authors searched MEDLINE, PsycINFO, Embase, Scopus, ProQuest One Academic, Criminal Justice Abstracts and Google Scholar for peer-reviewed quantitative articles published between January 2015 and August 2025. Eligible studies included those reporting proportions of lifetime health-care utilisation among CJS-involved adult women. Risk of bias was assessed using the National Institute of Health Quality Assessment Tool for Observational Cohort and Cross-sectional Studies. Random-effects meta-analyses with logit transformation estimated pooled prevalence rates, with subgroup analyses by service types, timing and study characteristics. Findings Of 6,606 unique records, 42 studies met the inclusion criteria, 39 of which focused on women with incarceration histories. Overall, a substantial proportion of women with incarceration experience reported health-care utilisation. Emergency service use was particularly high before incarceration, while physical and general health service utilisation increased markedly during incarceration. Factors influencing health-care utilisation were mapped onto Andersen’s Behavioural Model for Health Services Use, highlighting predisposing, enabling and need-related factors. Originality/value The findings of this study highlight the need for correctional, health and research communities to address unmet health-care needs among incarcerated women and ensure continuity of services post-release, which is critical to reducing disparities and improving long-term health outcomes.