Editor's Note: This story is part of a three-part series on menopause, incarceration, and the climate crisis as a collaboration with the authors of The Black Girl's Guide to Surviving Menopause.
What many outside carceral systems fail to consider is that reproductive aging in captivity is not incidental. It is a form of state-sanctioned violence. The denial of care, the forced aging, the silencing of pain, and the systematic erasure of trans and nonbinary people all serve to reinforce the disposability of certain bodies. In this way, menopause becomes a frontline for reproductive justice. That framework reminds us that all people have the right to bodily autonomy, to parent or not parent, and to live and age with dignity in safe and supportive environments. That includes those behind bars. That includes those in ICE custody. That includes trans, nonbinary, and gender-expansive people who are so often excluded from dominant narratives of aging and care.
Kwaneta's reflection in part one of this series, "Burning Inside: What Prison Heat Does to a Menopausal Body," is not an isolated account but part of a longer history of reproductive injustice inside carceral systems. To understand the depth of this experience, we must confront how reproductive aging is pathologized, how Black caretaking becomes a form of resistance behind bars, and how these harms remain tethered to the afterlife of slavery.
If we are to talk seriously about abolition, we must interrogate how the State punishes people for bleeding, aging, and surviving. Reproductive aging behind bars is not a marginal issue. It is a central indictment of a system that was never meant to protect us.
Carceral Neglect and Medical Abandonment
Extreme heat in U.S. prisons isn't merely an occasional hardship—it's a systemic, measurable threat tied to high morbidity and mortality, a threat that's driven by inadequate infrastructure and policy neglect. The lack of air conditioning, access to cooling, clean water, and basic medical care—including hormone therapy—creates a dangerously inhumane environment. Many facilities, especially in the South, were built without climate control and offer little relief during sweltering, 100-degree summers, putting incarcerated people at risk of heatstroke, dehydration, and death. In March 2025, a federal judge called the extreme heat in prisons "plainly unconstitutional," but declined to order immediate air conditioning since the work could not be completed within the court order's 90-day-window.
These conditions are especially brutal for vulnerable populations, including older adults, people with chronic illnesses, and those undergoing menopause or gender-affirming hormone therapy. Access to consistent hormone treatments is often delayed, denied, or abruptly discontinued, leading to severe physical and psychological consequences. The combination of environmental neglect and medical indifference reflects a broader failure of the prison system to meet even the most basic human needs, raising urgent ethical and legal concerns about cruel and unusual punishment.
The lack of climate control in many prisons turn cells into dangerous heat traps during summer months. Incarcerated individuals—who have limited access to hydration, cooling methods, and medical care—are especially vulnerable to heat-related illnesses. These dangers are compounded for people with chronic health conditions or those taking medications that interfere with the body's ability to regulate temperature. Additionally, extreme heat can exacerbate tensions within prisons, increasing the risk of violence and psychological distress.
In states like Texas, Louisiana, and Arizona, prisoners are frequently required to perform physically demanding tasks—such as agricultural labor, construction, or facility maintenance—during peak summer temperatures, often without adequate water, rest breaks, or protection from the sun. Because incarcerated workers have limited legal rights and protections—and because the 13th Amendment permits involuntary servitude as punishment for a crime—they often have no choice but to comply. This dynamic creates a system where vulnerable people, disproportionately Black and brown, are exploited for labor under conditions that would be illegal in most other contexts. This is medical neglect—a slow, deliberate act of violence against people the state considers expendable or 'criminal,' exploiting their bodies while letting them suffer or die—whether it takes the shape of forced prison labor or the denial of basic healthcare like menopausal treatment.
In many correctional facilities, menopause and its symptoms are often met with silence or outright dismissal by prison medical staff, leaving incarcerated people to suffer without proper care or understanding. Medical personnel lack training or awareness around menopause and tend to minimize or misdiagnose symptoms like hot flashes, night sweats, mood swings, or insomnia. Instead of offering appropriate treatments—such as hormone replacement therapy or even basic comfort measures—staff may label people as disruptive or emotionally unstable, further stigmatizing their experience. The lack of gender-responsive healthcare in prisons reflects a broader neglect of people who menstruate and their health needs within the system, compounding the physical and emotional toll of incarceration. For aging, reproductive bodies in prison, this neglect can turn a natural biological transition into a source of chronic suffering and isolation.
Reproductive Aging and Punishment
The aging reproductive body, especially in the form of menstruation, menopause, and post-surgical healing, is not protected within carceral institutions. For incarcerated people, these physiological milestones become sites of punishment. These systems, built on racial capitalism, patriarchy, transphobia, and anti-Blackness, intentionally neglect the full humanity of those held inside. Reproductive aging in this context is not simply biological. It is political.
In jails, prisons, and immigrant detention centers, menstrual and menopause-related needs are systematically ignored or deliberately restricted. Despite federal guidelines like the First Step Act mandating access to menstrual products, a 2019 ACLU report found widespread failures in implementation. Incarcerated people often receive only a limited number of low-quality pads each month, and requests for more are met with skepticism or outright denial. "You have to bleed through your clothes sometimes before they believe you really need more," one person shared in testimony collected by the ACLU.
Perimenopause and menopause care are virtually nonexistent. Hormonal fluctuations that cause hot flashes, joint pain, insomnia, and emotional dysregulation are often misinterpreted as behavioral problems rather than medical issues. There are no standard protocols across facilities to support people navigating menopause. Hormone therapy to alleviate these symptoms is rarely offered. Access to fresh air, temperature regulation, or even showers, which are basic forms of symptom relief, can be withheld as part of disciplinary action.
For trans and nonbinary people, these realities are even more layered. Trans men and nonbinary people who menstruate or experience menopause while incarcerated are often denied basic reproductive and gender-affirming care. They are frequently misgendered, placed in facilities that do not align with their gender identity, and subjected to daily violence from staff and other incarcerated people. A 2015 U.S. Trans Survey found that nearly one in five trans people who had been incarcerated reported being denied access to necessary health care, including hormone therapy. For those experiencing menopause, this denial adds another dimension of harm—one that erodes both physical well-being and gender affirmation. Menopause becomes a battleground where gender dysphoria, systemic neglect, and untreated suffering collide.
The aging reproductive body, especially in the form of menstruation, menopause, and post-surgical healing, is not protected within carceral institutions.
In ICE detention centers, the violations multiply. A 2020 investigation by The New York Times revealed non-consensual gynecological surgeries, including hysterectomies, performed on dozens of immigrant women at Irwin County Detention Center in Georgia. Many were denied language interpretation or informed consent. Trans and gender-expansive immigrants face even greater barriers to reproductive care, often navigating both xenophobia and transphobia within systems designed to disappear them.
This medical neglect persists within a collapsing system of accountability and hyper-criminalization under the current administration. According to a 2025 report from the Women's Refugee Commission, access to legal advocates, ombudspersons, and inspectors inside detention centers has been drastically reduced, particularly for women and girls. Without oversight, the suffering becomes invisible. Menstrual hygiene, menopause care, and reproductive health outcomes cannot be tracked or challenged in environments designed to shield institutional neglect. The erosion of transparency is not just bureaucratic. It is a direct assault on the safety and survival of detained people.
This medical neglect must be understood through the lens of "weathering," a term developed by Dr. Arline Geronimus to describe the accelerated deterioration of the body caused by chronic exposure to social, economic, and political stress. Incarceration intensifies weathering. The confined, toxic environments of jails and prisons, marked by poor nutrition, inadequate medical care, constant surveillance, and emotional isolation, cause people to age faster, get sicker, and die younger. A 2017 Human Rights Watch report noted that incarcerated people in the U.S. experience chronic illnesses at rates comparable to free-world populations who are 10 to 15 years older.
And now, the climate crisis deepens these harms. Rising temperatures, prolonged heat waves, and insufficient cooling infrastructure inside prisons, jails, and detention centers have become additional vectors of state violence. Menopausal people experiencing hot flashes or temperature sensitivity endure severe physiological distress when forced to live in units without air conditioning or ventilation. In states with large ICE facilities and prison populations, like Texas, Louisiana, and Georgia, internal temperatures regularly exceed 100 degrees. For people who are aging, pregnant, perimenopausal, or managing chronic conditions, these conditions are not merely uncomfortable—they are deadly. Climate injustice is not separate from reproductive injustice. In a system designed to warehouse and forget people, heat becomes a silent accomplice to harm.
Weathering in carceral spaces is both a medical and reproductive justice crisis. The body holds trauma, and within the walls of incarceration, there is no space to release or repair. Menopause, often a time of transition and reflection, becomes another terrain of suffering. There is no acknowledgment. There is no care. There is only endurance.
This Isn't New: Legacy of Black Midwives and Nurses Inside Prison
Behind these walls, where they strip people of everything—their name, their children, and their dignity— there have always been Black women who carried what healing looked like in the before times, from the ones who came before, who delivered babies in plantation quarters and tenement halls, who knew every word that could ease pain and every prayer that could save a life. They passed down something the powerful ones couldn't steal—the knowledge that our bodies belong to us.
When countless unnamed Black caretakers whispered instructions about self-care in dark corners, away from overseers, wardens, cameras, and medical staff, they were continuing a tradition of resistance that started generations ago. They knew that healing happens in the spaces between surveillance. We continue to practice the same medicine our ancestors used to keep us alive, when survival itself was rebellion. This legacy lives in our bodies, in our knowing, and in our refusal to let them reduce us to cases and problems to be solved.
This tradition runs deeper than the walls. During chattel slavery, Black midwives were often the only source of reproductive care for enslaved women from menarche to menopause, attending births under threat of violence or in the shadow of forced breeding. Figures like Bridget "Biddy" Mason, who was enslaved and later became a free nurse and midwife in Los Angeles, show how midwifery evolved from captivity into care rooted in community healing and economic autonomy. Others, like the renowned "Granny" Midwives of the American South, such as Mary Francis Hill Coley, carried forward this knowledge during Jim Crow, when Black women were barred from hospitals and medical training. Their work paralleled that of prison healers who labored in equally hostile carceral conditions.
Inside Reconstruction-era convict leasing camps and chain gangs, formerly enslaved women who had learned midwifery through necessity became caretakers for other imprisoned women. Women imprisoned in Georgia in the early 1900s were often required to care for sick or pregnant people in prison without training or institutional support, making do with what they had and knew. In modern-day prisons and ICE detention centers, this lineage continues. Black women who enter as incarcerated people become de facto nurses and doulas when formal care is delayed or denied. Incarcerated people have testified to the trauma of reproductive health care behind bars, where medical neglect is the norm, not the exception.
They passed down something the powerful ones couldn't steal—the knowledge that our bodies belong to us.
In Texas and Georgia, incarcerated women have been disciplined for sharing sanitary pads, for asking for more than two Tylenol, for bleeding too heavily. In Louisiana, women at Angola and St. Gabriel report being denied gynecological exams for years. In ICE detention centers, immigrant women have been shackled while in labor, placed in solitary confinement after miscarriages, and denied access to OB/GYN care. Still, other women detained alongside them sit vigil, translate, advocate, and make medicine out of memory.
These caretakers, some trained, many not, have offered compresses made from socks, shared herbal wisdom passed down from grandmothers, and taught each other how to survive menopause, miscarriage, and chronic pain when the clinic door remains locked. Their labor is not recognized in policy. It is rarely acknowledged in health equity reports. But it is what keeps people alive.
The State has always tried to disappear this care, either by refusing to acknowledge it or criminalizing it. But it lives on. The tradition of Black midwifery and nursing, inside and outside of institutions, is a quiet rebellion and an unbroken promise. It says we will care for one another when the system won't. We will name our pain when they try to erase it. We will make medicine out of scraps, wisdom out of memory, and liberation out of each other.
Carceral Control of Reproductive Bodies and the Afterlife of Slavery
The regulation of reproductive bodies has long been a tool of the State. What we witness today in ICE detention centers and prisons—forced hysterectomies, lack of menstrual products, untreated menopause symptoms, and miscarriages without medical support—is not a new phenomenon. It is part of a much longer arc of domination that began on the auction blocks of the transatlantic slave trade. The wombs of enslaved African women were commodified, monitored, and violated to serve the economic and political machinery of slavery. This legacy did not end with Emancipation. It evolved.
Historian Dr. Deirdre Cooper Owens, author of Medical Bondage, reminds us that Black women's reproductive bodies were used to develop American gynecology practices. She traces how medical science was built through the violent experimentation on enslaved Black women, whose bodies were seen as expendable and who were never asked for consent. These truths, often omitted from mainstream narratives, help us understand how modern neglect inside carceral institutions is not a deviation from the past but a direct extension of it.
This is the afterlife of slavery, as Saidiya Hartman describes it. Not metaphor, but structure. One that determines who is seen as worthy of care and who is left to suffer in silence. Enslaved women were forced to give birth under surveillance and threat. They were subject to forced sterilizations, sexual violence, and reproductive exploitation. That logic was replicated during Jim Crow, and it was reinforced through 20th-century eugenics laws. In North Carolina, for example, more than 7,600 people were sterilized between 1929 and 1974. Many of them were Black girls and women, institutionalized or poor, and deemed "unfit" to reproduce.
Today, those systems persist. In 2020, whistleblower Dawn Wooten exposed widespread non-consensual gynecological procedures at the Irwin County Detention Center in Georgia. In prisons and jails across the country, menstruating and menopausal people are still denied access to hygiene products, hormone therapy, or consistent medical care. For many, this is not just medical neglect. It is reproductive punishment.
And still, we resist. From Harriet Tubman's liberation work to Fannie Lou Hamer's testimony before Congress about her forced sterilizationˇ, to the visionary organizing and the leadership of the current reproductive justice ecosystem, Black women and gender-expansive people have never stopped fighting for reproductive liberation. As Loretta Ross writes, "Reproductive justice is the complete physical, mental, spiritual, political, economic, and social well-being of women and girls." It is also for those of us who live outside the margins of binary gender, heterosexual norms, or economic safety.
The trauma is ancestral and biological. It lives in our blood, our bones, and our cells. The body remembers what it has endured and what it was never allowed to fully heal from. That memory is not just personal. It is collective. It shapes how we experience care, how we navigate harm, and how we fight back.
What many may not have considered is this: The carceral state is not only about cages or courtrooms. It is about control of time, identity, and the intimate processes of bleeding, birthing, aging, and surviving. Menopause, miscarriage, menstruation, infertility—these are not afterthoughts. They are sites of struggle and liberation. And history has already shown us that where there is struggle, there is resistance. Always.