The real cost of rationing menstrual products in jails and prisons

States are obligated to provide basic medical care to the people they’re incarcerating. Yet, in prisons and jails across the United States, access to menstrual products remains unreliable.

Most states provide some products for free, but they do so without clear statutory requirements governing how pads and tampons are provided, leaving access to the provision inconsistent and often insufficient. Some women are forced to extend use beyond hygienic limits or rely on makeshift alternatives, increasing the risk of infection and other preventable health complications. The gap in access and increased health risks reflect a broader failure to define and enforce menstrual care as a fundamental component of medical responsibility under state custody.

The United States incarcerates more women than any other country in the world, with 192,164 women behind bars according to the Prison Policy Initiative. Around 80 percent of these women are under the age of 55, which means the vast majority of those incarcerated face reproductive health needs that the system must be prepared to address. But only four states, Maryland, Alabama, Colorado, and New York, have explicit statutory requirements that guarantee broad menstrual product access for incarcerated individuals. In the remaining states, access to menstrual products is left to facility discretion, resulting in uneven standards and inconsistent availability.

When the supply of menstrual products is insufficient, women resort to making tampons out of socks, toilet paper, bedding, or even pages from a Bible—highly unsanitary methods. These improvisations expose women to preventable urinary and reproductive tract infections, bacterial vaginosis, and fungal infections, all of which are linked to the prolonged or unsafe use of menstrual materials.

In one documented case in Maryland, an incarcerated woman named Kimberly Haven developed toxic shock syndrome, a dangerous condition caused by bacterial toxins entering the bloodstream, after using makeshift tampons. She required an emergency hysterectomy, leaving her with permanent reproductive harm. Lack of access to hygienic products turns a normal biological process into a predictable medical crisis—one that the state failed to prevent. 

Challenges in accessing menstrual products inside prisons create problems that extend far beyond physical discomfort. A study published in the Journal of Women’s Health found that more than one-quarter of menstruating women in correctional facilities had to barter for menstrual products. As a result, some incarcerated women avoid family visits or meetings with attorneys during their periods because they cannot control their bleeding, which isolates them from critical social and legal support and deepens their sense of humiliation.

Yet even in the face of clear medical and psychological risks, the most common justification offered for restricting menstrual products is cost. In Wisconsin in 2024, legislators introduced Assembly Bill 770, which would have required state prisons to provide menstrual products free of charge. The measure failed after being framed as an unnecessary expense. State officials pointed to the ability to purchase pads and tampons through the canteen at a “small cost,” even though incarcerated women in Wisconsin earn between 12 and 42 cents an hour—wages that turn even basic hygiene supplies into an economic burden. 

In practice, commissary prices are often comparable to or higher than retail prices outside prison. According to the Prison Flow Project’s review of federal commissary lists, a package of tampons routinely costs between $5 and $7, with some facilities charging over $10 for certain products, while pads commonly range from $4 to $9 per package.

Outside of carceral settings, similar menstrual products are widely available at comparable prices but without the wage constraints imposed by incarceration. As a result, women report bartering for pads, going hungry to afford tampons, or stretching a single product far beyond hygienic limits. 

Although cutting back on menstrual supplies may seem like a way for prisons to save money, the available data paints a very different picture. Missouri lawmakers estimated that giving every incarcerated person unlimited access to tampons would cost about $171,000 a year, which is just over one-tenth of one percent of the entire prison budget. A Mother Jones article quoting a spokesperson from the Missouri Department of Corrections notes that hospital care makes up a large share of state correctional spending, often more than 20%, and that many of the conditions linked to inadequate menstrual care are both preventable and expensive to treat. A single hysterectomy costs anywhere from $30,000-$40,000, and treatment for toxic shock syndrome averages about $25,000 per patient. When you compare those costs to the relatively small expense of stocking adequate pads and tampons, it becomes clear that providing proper menstrual care is not only safer for incarcerated people but also a far more sensible use of public resources.

Even where states have passed laws promising free menstrual products, there is sometimes a gap between what is written and what is implemented. In Connecticut, two women were expected to share just five pads per week, and the pads were described by The 19th, a nonprofit newsroom, as much thinner than commercially sold products and with adhesive that barely stuck to clothing. Others who tore cloth from bed sheets to use as makeshift menstrual products were punished for “destroying public property,” demonstrating how poor implementation can escalate into inappropriate discipline. Implementation choices such as fixed allotments, low-quality supplies, commissary markups, and staff gatekeeping keep people in a cycle of deprivation.

These institutions are built on rigid inventory control, where every item, from toilet paper to soap to menstrual products, is tightly rationed to maintain order. Administrators often argue that unrestricted access creates management challenges, not because these items pose a security threat, but because they worry about clutter, misuse, plumbing issues, or disruptions to predictable distribution routines. This does not make the policy reasonable. These policies prioritize administrative convenience over basic health needs. Rules meant to keep facilities orderly end up denying people necessary care.

Harm reduction offers a framework for designing policies that focus on outcomes and actually reduce the risks created by current practices. Correctional systems should adopt policies that guarantee access to menstrual products. Menstruating women bleed in different amounts and on different schedules, which means fixed monthly allotments will always fall short for many. In addition, rationing does not eliminate costs or risks; it just shifts them into other areas, such as preventable infections, increased grievances, and disciplinary issues that arise when people are forced to improvise with unsafe materials. 

When the state takes control of people, it has an obligation to ensure that it is preventing serious health issues and other avoidable harms. Ensuring adequate menstrual care is one of the simplest ways to meet that responsibility.

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Source: https://reason.org/commentary/the-real-cost-of-rationing-menstrual-products-in-jails-and-prisons/