Free to Bleed

Free to Bleed: Policies on Menstrual Products in US Women’s Prisons

The following post is an excerpt from the Prison Flow Project’s newest report. To support this original research, please donate!

The Problem: Menstrual Injustice Behind Bars

The US Carceral System

The United States maintains one of the largest and most expansive systems of incarceration in the world. The Prison Policy Initiative estimates that nearly two million people are confined on any given day across prisons, jails, immigration detention facilities, youth facilities, and other forms of confinement (Sawyer et al., 2026). Each facility operates under different laws, policies, budgets, contracts, and administrative practices, making access to reproductive healthcare and basic hygiene non-uniform across correctional settings.

The American College of Obstetricians and Gynecologists notes that no mandatory national standards or comprehensive oversight system guarantees consistent reproductive healthcare across prisons, jails, and detention centers. As a result, the quality and availability of care can vary substantially from one facility to another (American College of Obstetricians and Gynecologists, 2021). The National Commission on Correctional Health Care similarly identifies inconsistent and often inadequate access to menstrual products and gynecologic care as significant correctional-health concerns (National Commission on Correctional Health Care, 2025).

The absence of clear standards can create conditions in which ordinary menstrual management becomes a disciplinary issue. A national review of prison rules and sanctions found that policies concerning property, hygiene, sanitation, movement, contraband, and alleged feigning of illness can be applied in ways that punish people for the consequences of inadequate menstrual access (Vishniac & Widra, 2025). When a person is denied enough products and subsequently bleeds on clothing, bedding, or facility property, the resulting condition may be treated as misconduct. In this way, institutional rules can transform the consequences of deprivation into grounds for further punishment.

There is no national standard governing safe disposal, privacy, or access across all correctional settings. Menstrual management requires clean water, sanitation, adequate changing facilities, privacy, safe disposal, and the ability to obtain additional products as needed.

The Menstruators We Incarcerate

Understanding menstrual inequity also requires understanding who is disproportionately exposed to the conditions of incarceration. Incarceration is deeply connected to poverty, racial inequality, housing instability, limited access to healthcare, disability, trauma, and other structural conditions. The Prison Policy Initiative reports that people in prison are disproportionately poor and that the poorest incarcerated people are disproportionately women and people of color (Sawyer et al., 2026).

Gender is central to this analysis. Women have experienced dramatic growth in incarceration over the past several decades, and women have been identified as the fastest-growing correctional population during major periods of expansion. The Vera Institute of Justice documented a fourteen-fold increase in the number of women held in jails between 1970 and 2014, a growth that far outpaced the increase among men (Swavola et al., 2016).

Not everyone who menstruates identifies as a woman. Transgender men, nonbinary people, and some intersex people may menstruate while navigating correctional systems organized largely around binary assumptions about sex and gender. A menstrual-equity framework must therefore avoid treating menstruation as synonymous with womanhood.

Race and socioeconomic status further shape exposure to incarceration. Black people are disproportionately represented in prisons and jails, while American Indian and Alaska Native people also experience incarceration at rates substantially higher than the general population (Sawyer et al., 2026). These disparities matter because the people most affected by incarceration may also be those who entered custody with the fewest financial and healthcare resources.

Many incarcerated women also report histories of trauma, violence, mental-health conditions, and unmet healthcare needs. The American College of Obstetricians and Gynecologists emphasizes that the legacies of racism and racialized medical outcomes shape reproductive-health inequities among incarcerated populations and that incarcerated people should receive reproductive healthcare consistent with community standards (American College of Obstetricians and Gynecologists, 2021). These vulnerabilities can compound one another: a person who enters custody with limited financial resources and untreated reproductive-health concerns may become even more dependent on an institution that does not adequately address either need.

The design of correctional institutions further compounds these disparities. As Wood et al. observe, American correctional institutions were historically designed around male populations, leaving contemporary systems to respond to the needs of women and other menstruators within structures that were not originally built for them (2025).

Menstruation exposes this structural mismatch particularly clearly because it requires regular, predictable access to supplies and sanitation while occurring on a biological timetable that cannot be controlled by institutional schedules (Wood et al., 2025).

Menstrual Health Issues

When products are unavailable or insufficient, menstruators may be forced to improvise, ration, barter, or continue using products longer than recommended. These strategies are not evidence of individual irresponsibility; they are responses to institutional scarcity. They also expose a deeper contradiction within correctional systems: institutions can restrict a person’s ability to obtain the resources necessary to manage menstruation and then discipline that person for the visible consequences of not having those resources.

Menstruators from across the country have come forward to describe their experiences with managing a menstrual cycle behind bars. They describe having to use alternatives to safe products, such as paper, dirty clothes and rags, mattress padding, sheets, or makeshift tampons to prevent accidents. Stories of menstruators having to fight, steal, or create unsafe, home-made products outline the importance of assuring that access to menstrual products is understood as a biological necessity rather than a privilege in correctional facilities. The humiliation of soiling their clothing, undergarments, and bedding when denied the appropriate products is well documented, as is the use of withholding menstrual products as a lever of power for correctional employees (Moss et al., 2025). Possession of period products is a basic component of menstrual health, but access within correctional facilities remains inconsistent.

Issues with Current Policies

The federal system demonstrates that formal policy alone does not guarantee meaningful access. In 2026, the U.S. Government Accountability Office examined menstrual-product access in Bureau of Prisons institutions and Immigration and Customs Enforcement facilities. GAO found that federal facilities generally made some menstrual products available, but some Bureau of Prisons institutions did not fully adhere to policy requirements. For example, not all institutions provided all required product types in common areas or replenished products within the required timeframe. GAO concluded that stronger, routine oversight was necessary to ensure that products were consistently and equitably available (U.S. Government Accountability Office, 2026).

Experiences reported by incarcerated menstruators demonstrate the human consequences of these institutional gaps. In a national survey of women involved in the criminal legal system, just over half of respondents reported that they did not receive enough menstrual products when they needed them while incarcerated. Nearly 30 percent reported bartering food, items, or personal favors to obtain menstrual products, and approximately one-quarter reported negative health outcomes associated with prolonged use of menstrual products (Darivemula et al., 2023). These findings illustrate why menstrual inequity cannot be reduced to a question of whether a facility technically distributes products.

A national review of state statutes and correctional policies found that 46 jurisdictions had some form of policy addressing menstrual-product provision, but many policies were vague about the type, quantity, quality, cost, and process for obtaining products (Wood et al., 2025). The existence of a policy, therefore, does not necessarily translate into access.

Standard, implementable policy that translates into increased access must address whether: products are available in adequate quantities, menstruators can access them as needed, a sufficient variety of products is offered, products are free of charge, and access is protected from punishment, coercion, discrimination, or retaliation. The Collaborative on Justice-Involved Women and Children (JIWCC) found that 35 states and the Federal Bureau of Prisons had enacted legislation addressing menstrual-product access by 2025, yet many of those laws still fell short of consistently guaranteeing appropriate quantities and varieties of quality products (Thomas et al., 2025).

Economic Deprivation and the Cost of Menstruation Behind Bars

Economic deprivation intensifies menstrual inequity. People incarcerated in the United States generally have extremely limited earning power, while many basic necessities must be obtained through institutional commissaries. Prison Policy Initiative research has documented extraordinarily low prison wages and substantial economic inequality among incarcerated people, with incarcerated women and people of color among those experiencing the greatest poverty (Sawyer et al., 2026).

The economics of menstrual products are particularly important because a product’s price cannot be evaluated independently of the wages available to the purchaser. A 2026 study of prison commissaries found substantial variation in menstrual-product prices and availability and demonstrated that the number of work hours required to purchase products can contribute directly to period poverty inside prisons (Anjum & Moss, 2026). When free institutional supplies are inadequate, the ability to manage menstruation can therefore become dependent upon a person’s access to prison wages, commissary funds, or financial support from family and friends.

This economic dependency is compounded by the broader costs of incarceration. Families may bear communication, travel, commissary, and other expenses associated with maintaining relationships with incarcerated loved ones. These burdens can weaken the very financial and social networks that might otherwise help a resident obtain basic necessities. Menstrual products should not become another expense that residents and their families must absorb simply because an institution has failed to provide an adequate supply.

Fundamentally, a free person can generally seek another source of assistance when supplies run out. In confinement, those alternatives are severely restricted. The institution is therefore the gatekeeper of access.

Menstrual Health Is Healthcare

Menstrual management must also be understood as a healthcare issue. Menstruation can be accompanied by pain, heavy bleeding, irregular cycles, and other symptoms that may signal underlying conditions requiring medical assessment. The National Commission on Correctional Health Care reports that incarcerated people experience higher rates of certain gynecologic conditions and that access to menstrual products is often inconsistent or inadequate (National Commission on Correctional Health Care, 2025).

Correctional healthcare is also fragmented and non-uniform. A qualitative study of formerly incarcerated women found that experiences of healthcare while incarcerated were shaped by fragmented systems and barriers to accessing appropriate care, particularly in the area of reproductive health (O’Connor et al., 2023). These barriers are consequential for menstruators who enter custody with existing reproductive or menstrual health conditions or who develop symptoms while incarcerated.

Professional medical guidance recognizes that reproductive healthcare should not become lower-quality healthcare simply because a person is incarcerated. The American College of Obstetricians and Gynecologists recommends respectful, consistent, high-quality reproductive healthcare for incarcerated people and specifically calls for menstrual products to be available at no cost and in adequate supply (American College of Obstetricians and Gynecologists, 2021). Menstrual equity is therefore consistent with established standards of reproductive healthcare rather than an additional or optional service.

The relationship between menstrual products and healthcare is especially important for people experiencing heavy or prolonged bleeding, fibroids, endometriosis, chronic pelvic pain, or other conditions that may require more products or specialized care. A uniform product allotment may appear equal on paper while producing unequal outcomes in practice because people do not experience menstruation in identical ways. Menstrual equity must therefore account for differences in individual health needs.

Conclusion

Menstrual inequity is embedded within the broader structure of incarceration. It intersects healthcare access, institutional dependency, economic deprivation, surveillance, restricted movement, and diminished bodily autonomy. The problem is not simply that some people behind bars lack pads or tampons. The problem is that an institution can control whether, when, and how a person is able to manage an ordinary biological function.

Priced Out of Dignity: How Labor Injustice Creates Period Poverty in Carceral Settings

Priced Out of Dignity: How Labor Injustice Creates Period Poverty in Carceral Settings

The Commissary as A Scapegoat

Individuals who are incarcerated have long faced barriers to period products, whether these barriers be product choice, cost, quality, or quantity. As advocates – as a measure of harm reduction – push for institutional, county, and state policy change to mandate that facilities provide quality products at no charge to persons who are incarcerated, facilities point to the commissary as a place where products can be accessed. Ambiguous policies, such as ones in North Carolina, might even leave it up to facilities to decide whether products are free or available for purchase: “Paragraph (a) of this Rule, each jail shall make these items available either for inmate purchase or without charge, as determined by the jail.” (10A NCAC 14J .0705). This makes it unclear whether people who are incarcerated are actually being provided products. Further, this creates the grounds for facilities to rid themselves of the responsibility of ensuring all persons that use period products during menstruation have access to safe, quality, period products and dignity, safety, and health while bleeding. 

The use of the commissary as a scapegoat for facilities raises the question of the affordability of period products available for purchase at commissaries. The 13^th Amendment to the United States Constitution abolished slavery except as punishment for a crime. Thus, people who are incarcerated are legally enslaved. As such, they earn no money or cents on the dollar, making the positioning of the commissary as the source of dignity largely inaccessible. 

A Closer Look: Wages, Commissary Prices, and Product Availability

To examine how commissary pricing and wage disparities contribute to period poverty in U.S. women’s prisons, we conducted a systematic content analysis of commissary price lists across the Southeastern US. We selected this region due to its high incarceration rates, elevated poverty levels, and documented resistance to menstrual equity legislation. Using publicly accessible primary data sources like The Appeal’s Freedom of Information Act (FOIA) database and the Prison Policy Initiative, we collected DOC commissary lists from 14 states: Tennessee, Georgia, Arkansas, Alabama, Florida, Texas, Mississippi, Louisiana, North Carolina, South Carolina, Oklahoma, Kentucky, West Virginia, and Virginia. The collected listings were published from 2022 to 2024. To analyze, two independent reviewers inductively coded each listing to categorize product type, listing price, quantity, and associated taxes and inter-rater reliability was used throughout the analysis process. To estimate affordability, we compared commissary prices against incarcerated wage data from the Prison Policy Initiative and calculated how many hours of labor it would take to afford menstrual products in each state. Monthly wages were converted to hourly wages by 22 workdays per month and 6.35 working hours per day. In these analyses, wages were reported as ranges and hours-to-afford calculations were calculated at both the minimum and maximum of the range to reflect the full scope of economic burden. 

An Impossible Task: Products Out of Reach

Through our analysis, we found that commissary data was accessible for only 11 of the 14 states included in the analysis: Alabama, Louisiana, and Tennessee did not provide commissary lists in response to FOIA requests sent out by the Prison Policy Initiative. North Carolina and South Carolina provided lists that did not include menstrual products, but this is consistent with state laws that mandate free provision. The remaining nine states formed the basis of product-level findings for this analysis. Only three states, Oklahoma, Kentucky, and Virginia, offered pads, tampons, and panty liners. We found that pricing across commissaries varied substantially. For instance, tampon unit prices ranged from approximately $0.15 in Virginia to $0.49 in Georgia and Florida. Notably, wages for incarcerated workers were at or near zero in most states, with the highest recorded wages found in West Virginia at 0.04-0.58 per hour.

In Florida, which was the only state to explicitly list a pay rate according to The Appeal’s list, a worker earning $0.32 per hour would need to work over 15 hours to afford a single 10-count box of tampons.

In Georgia, Arkansas, Mississippi, and Texas, workers earn nothing at all, making commissary access entirely dependent on outside financial support from family or loved ones. 

What does this mean? 

Free provision of period products through facilities is the only true form of access to products for people who are incarcerated and menstruating. Policies that allow for facilities to either provide products for free or allow for access through commissaries are in effect permitting manufactured period poverty; these policies are inadequate. 

Period product access is a matter of human rights, and our results show that prisons systematically deny access to products through financial constraints. When incarcerated people earn nothing or near nothing, commissary-based access to period products is not a choice. These practices are not oversights in our correctional systems, but a feature of carceral control. 

Until wages, pricing, and free provision are reformed, incarcerated menstruators will continue to be priced out of dignity. 

How can you take action?

Support organizations such as Worth Rises, which are fighting to reform the 13th amendment and abolish all forms of slavery. #EndTheException

Engage with organizations focused on addressing economic and labor injustices in carceral facilities, such as the ACLU of Rhode Island, which is fighting for incarcerated persons to be covered by minimum wage laws.

Advocate for states to mandate the provision of free period products for any person who menstruates in any carceral facility and demand accountability mechanisms to ensure the successful implementation of policies. 

To connect about the Menstruation & Incarceration study, contact: ram0083@auburn.edu