A new nurse-led initiative is enabling more women to access cervical screening in Limerick Female Prison. It includes a peer-to-peer education programme and a new, trauma-informed, female-led health clinic.
Until 2023, if women at Limerick Female Prison wanted a cervical screening test, they had to be escorted to a GP practice by members of the prison staff. This arrangement, while well-intentioned, presented logistical challenges and personal barriers to access.
Edel Muldowney, the prison’s Nurse Manager, identified these challenges and led efforts to address them. One significant barrier was the shared medical wing between male and female prisoners. Additionally, the prison employed a male GP who was not a trained CervicalCheck sample taker, limiting in-house screening options.
Women in prison often face compounded barriers to healthcare access, education, and may experience heightened fear of screening. As a result, studies show they are diagnosed with cervical cancer at rates four to five times higher than women in the general community
Despite national reductions in cervical cancer rates due to organised screening, we know from research that women in prison typically receive later diagnoses with poorer outcomes.
Recognising this gap, the prison implemented a new trauma-informed, on-site screening model in 2023. This was supported by the establishment of a dedicated medical facility and the recruitment of a female GP. The initiative reflects Limerick Female Prison’s commitment to equitable healthcare, rehabilitation, and trauma-informed care.
Edel, along with colleagues, led the development of the initiative which aims to:
- offer women trauma-informed HPV cervical screening
- educate women in prison about HPV, cervical screening, and HPV vaccination
- train healthcare staff in trauma-informed care and health promotion
- increase screening and treatment rates in eligible prisoners
- equip nurses to deliver cervical screening services.
The initiative received expert input from consultant gynecologist Dr Mary McCaffrey. Informal ‘yard sessions’ provided accessible education, and the Red Cross supported peer-to-peer engagement. Our CervicalCheck screening training unit provided formal accreditation to participating nurses, and Rape Crisis Centre counsellors offered trauma support.
"Initially, we ran a screening clinic twice a month. Now our GP, Dr Adebolu, runs a Well Woman clinic one day a week alongside her general practice service. The clinic offers screening, contraception, and menopause advice and is still evolving," says Edel.
On arrival, all women meet the GP who reviews their screening history and offers a Well Woman appointment. The prison ensures continuity of care, including return of results and follow-up for those being released.
Strong relationships with the colposcopy unit at University Hospital Limerick ensure timely specialist care when needed. Edel notes, “the prison ensures female officers accompany the women to appointments to support their comfort and dignity”.
"Before Christmas we had three referrals to colposcopy; it’s a high number for such a small population but many of our women face factors that increase risk: homelessness, domestic violence, sex work, trauma."
She adds, "Many of the women we work with are starting from scratch in terms of health priorities. Trauma, addiction, and mistrust of systems can be barriers. The prison provides a safe, stable environment where we can introduce health as a priority."
Since the initiative began, 33 women have received cervical screening – a 200% increase on previous screening uptake. Eight were referred to colposcopy. HPV prevalence in the prison population was double the general population, and 88% of HPV-positive women required referral.
"Implementing on-site screening has improved access, increased awareness, and reduced stigma. Women say it feels safer and less traumatic," Edel says. "The CervicalCheck team here in Limerick continue to support us. I know we’re having an impact for the women in Limerick Prison."