Kwaneta Harris is an incarcerated journalist from Texas. She is a member of the mentorship program Empowerment Avenue, which pairs writers with editors in the outside world to hone their craft and pitch stories to the media. Their mission is to “normalize the inclusion of incarcerated writers and artists in mainstream venues by bridging the gap between them and harnessing this creative proximity as a path to de-carceration and public safety.”
When I was working as a nurse in Detroit from 1997 to 2007, I helped 11-year-olds deliver babies, saw women diagnosed as “just anxious” die of heart failure, and witnessed ectopic pregnancy pain dismissed as drug-seeking behavior. And that’s only the tip of the proverbial iceberg. I know what it’s like to provide care to struggling women — and I know what it’s like to be on the other side of the stethoscope. Our healthcare system can be racist, sexist, and broken — and that’s outside of the prison walls.
I’ve been incarcerated in Texas women’s prisons since 2009, where I’ve become a de facto nurse for many of the hundreds of women inside. You’d think that with such a large population, the institution would have adequate health care, but, in many ways, we’re third-class citizens, scrounging for basic supplies and care. Forget real medical issues or, God forbid, an unwanted pregnancy. I’ve seen true tragedy unfold behind these concrete walls over the course of the past 15-plus years — and as the Trump administration takes hold on the outside, I fear that our reality could become American women’s future.
“With this new administration and Congress, we’re really on the precipice of a fundamental shift away from health coverage and health care,” says Gretchen Borchelt, VP for reproductive rights and health at the National Women’s Law Center. “Right now, Congress is debating these massive cuts to the Medicaid program, which will affect low-income folks throughout the country, and, in particular, women in their reproductive years, two-thirds of whom are enrolled in Medicaid. There is an outright hostility right now toward health access and health care. Women in prison are the canary in the coal mine.”
A Black Market for Basics
The urine smell gives her away every time. MP, 26, shifts uncomfortably during another mandatory prison strip search, shielding herself from the judgmental eyes of a dozen other women. Although it’s rare for a woman her age to have such an overactive bladder, MP had six children by age 23 — and she’s suffering. She pleads with the staff for Ditropan, a bladder-control medication, but they shoot her down. She’s too young for that, they say — leaving her to endure a discomfort and embarrassment that could be solved with $7 per dose.
It’s not as though prisons don’t have health care — there’s actually a 1976 Supreme Court decision that institutions address serious medical conditions. But how that works varies prison by prison. As Dr. Carolyn Sufrin, director of Advocacy and Research on Reproductive Wellness of Incarcerated People, says: “It’s really fundamental to understand that the Supreme Court case did not come with any system or any regulatory body or anything. So there are no mandatory sets of health care standards that prisons and jails have to abide by — and there’s no mandatory system of oversight.”
In my Texas prison, incarcerated folks do have access to health care — but the bare minimum. We get annual dental cleanings and physicals (plus mammograms for those over 40), but additional injuries or illnesses come at our own cost. Given the fact that most of us have nothing, and work prison jobs for free, a flu, cold, or pulled muscle could wipe out our entire life savings. (A spokesperson for the Texas Dept. of Criminal Justice says that patient should never pay more $100 a year in medical costs, and that “if a patient requires immediate care and must receive medical services at a hospital outside of the prison, that cost is covered by the university medical partners, which receive money from TDCJ.”)
And, just as it is on the outside, disputing a medical bill is a frustrating, byzantine, bureaucratic process with a time limit. Try dealing with all of that when you’re stuck in a cage with a seventh-grade education, like some of my friends. And if a medication or medicine isn’t covered? Women trade whatever they can — often their already-paltry commissary supplies.
Sanitary products in particular are in fierce demand. In my experience, women are given only five tampons and a handful of pads per monthly cycle, so we’re left to fend for ourselves if we run out. Many folks, desperate for any form of relief, have been forced to roll pads into makeshift tampons, putting themselves at risk for Toxic Shock Syndrome, a potentially fatal bacterial infection. I know the dangers better than anyone; countless women have come to me with symptoms of that issue. But when the alternative is the humiliation of bleeding through our clothes, what choice do we have? It’s not like we can stay home sick, either. We’re forced to work four to 12 hours per day under the threat of solitary confinement (which is now referred to as “administrative segregation.”)
(The spokesperson for the Texas Dept. of Criminal Justice claims that there should be no monthly limit on tampons or pads in Texas prisons, insisting that women are allowed an “unlimited number of feminine hygiene products.” )
This may all seem cruel and unusual, but our reality isn’t that dissimilar to folks’ struggles on the outside. Just look at the recent alleged assassination of UnitedHealthcare CEO Brian Thompson by Luigi Mangione, which set off a wave of folks sharing stories about their issues with the insurance industry. And women’s access to health care? Even those who are gainfully employed are suffering. In fact, the American Journal of Managed Care recently reported that American women face the worst health care access in the world compared with other high-income nations — and their life expectancy is the lowest. What happens, then, if planned cuts to Medicaid come to fruition? Will our black market expand beyond the prison walls when access to lifesaving medicine and procedures becomes a luxury rather than a right?
Reproduction Control and Coercion
When a woman is pregnant in prison, she basically loses all control of her body — from the birthing process to whether or not she actually wants to give birth. And given the current administration, this could become the norm on the outside as well.
“The Trump administration is seeking to exert more control and take rights away from pregnant women,” says Borchelt. “They are trying to upend long-standing laws that protect against pregnancy discrimination, carve pregnancy out of federal law guaranteeing emergency medical care, and want more data collection into pregnancy outcomes. Being pregnant should not mean that you have fewer rights.”
Those on the outside may think that pregnancy isn’t much of an issue in prison — very few states have conjugal visits — but Dr. Sufrin’s organization found that around 3,000 pregnant women enter prison per year. In 2022, more than 180,684 women were behind bars, a 500 percent increase since 1980. And those women basically have zero control over the process.
“You can’t erase the trauma of being pregnant and incarcerated,” Dr. Sufrin says. “There’s so much uncertainty around what’s happening with your medical care — not having direct access to your medical records the way people on the outside would if we go to our doctor. And while we don’t have distinct data yet, we know that incarcerated people who are incarcerated during pregnancy have many risk factors for adverse pregnancy and postpartum outcomes.”
And then there are pregnancies that occur after women are sexually assaulted by prison employees or guards — which, in states without access to abortion, cannot be terminated. Sexual assault is sadly relatively common inside among incarcerated women and staff. In fact, Texas, where I am currently incarcerated, was dubbed the “prison-rape capital of the world” by Newsweek. And it’s not just Texas; A bipartisan Senate report from 2022 found that, since 2012, women were abused by prison staff in at least 19 of the 29 federal facilities that held women. In that decade, the Bureau of Prisons opened over 5,400 cases alleging sexual abuse by federal employees. And given that many forms of contraception can sometimes be verboten — condoms are off-limits — STDs are likely, and women behind bars in red states with no incest and rape exceptions are forced to give birth. In those cases, women are expected to endure voyeurism, rape, in-custody pregnancy, and delivering their rapist’s baby as part of their punishment.
Prisons favor health care strategies that take control away from women, and this is something that should concern and outrage all women. Our bodies’ basic biological functions become weapons of control — this is true from the prison to the state legislature to the U.S. Supreme Court, as evidenced by the dissolution of Roe v. Wade. “Pregnancy has already been criminalized, but it’s getting worse,” Borchelt says. “Pregnancy Justice documented more than 200 cases in the year after Roe was overturned, in which a pregnant person faced criminal charges for conduct associated with pregnancy, pregnancy loss, or birth.
“We are in a state of crisis when it comes to abortion access,” she adds. “People are scared. They don’t have the rights, they don’t know who to turn to, and they can no longer trust that the federal government will protect them — in fact, the federal government is working against them.”
Cold Comfort
Love is a basic human right. Our heart doesn’t stop beating at the prison gates, and orientation isn’t erased by a prison ID. Whether straight, gay, bi, or trans, the human need for connection and intimacy persists behind bars — as natural as breathing.
Yet, while guards trade sexual favors for privileges with impunity, and male staff freely access women’s most private moments, when incarcerated women are caught kissing, they’re faced with a barrage of consequences. It’s not a sexy free-for-all like on Orange Is the New Black. Inside, we’re not allowed to engage in consensual sexual acts with one another, and if we’re caught, that’s when things turn criminal. The punishment can vary from phone, visit, recreation, and commissary restrictions up to solitary confinement and/or prison transfer. Moreover, I have watched staff lie to women after catching them in the shower having sex, saying they will have to register as a sex offender upon release.
As a result, we live in fear. Health care is too risky when suspicions can be weaponized, turning every yeast infection into potential evidence of “sexual deviancy.” Women often avoid seeking medical treatment for basic infections, fearing accusations of intimate same-sex relationships that could trigger disciplinary infractions that can lead to parole denials. I could easily see this kind of policing of health care expanding to the outside world, where politicians are trying to defund Planned Parenthood (which provides all manner of sexual-health care in addition to abortion), and are increasingly looking to limit women’s access to contraception and other sexual-health necessities.
And while women on the outside are legally allowed to marry and same-sex relationships are generally accepted, that could change under the current administration. Already, trans folks inside and out are fearful that their identity and autonomy will be entirely abolished. How long until this kind of wanton control spreads to the wider country? Borchelt agrees: “For LGBTQ+ individuals, for pregnant people, for people who have capacity for pregnancy, we really are just at the beginning stages of a whole host of harmful actions yet to come.”
My Body, My Choice?
As anti-women strategies of control and coercion become more deeply embedded in U.S. laws, our experiences on the inside could become the norm — if we’re not careful. Women outside of prisons will have to learn to get creative like their incarcerated sisters, to take back control over their bodies that politicians are steadily trying to capture. Women on the outside can learn from our experiences and us — if they’re willing to listen.
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