By: Aneesh de Vos and Helen Douglas
As of June 2022, there were 3181 women prisoners [1] housed across 12 women’s prisons [2] within the UK. Statistics from the US Bureau of Justice [3] showed 152,854 women in jail, state prison & federal prison during 2020; a figure representing a year-on-year increase since 1980 [4].
Pre-covid statistics from the Institute for Criminal Policy Research [5], Birkbeck UK, indicated the number of women incarcerated has increased across all continents of the globe, with African countries reporting the lowest percentage female prison population to national population (2.5 per 100,000) compared to 64.6 and 66.4 in the US and Thailand respectively [5].
The average age of menopause in the US and UK is around 51, whereas research suggests elsewhere in the world, India for example, the transition may occur earlier, around the age of 46. Approximately 75% women will experience bothersome symptoms as a result of the hormonal transition. Symptoms may include vasomotor issues (hot flushes and/or night sweats), emotional and psychological issues (including low mood, anxiety, rage, paranoia, panic attacks), as well as numerous other symptoms i.e., unpredictable and/or heavy bleeding (aka ‘flooding’), insomnia, sore joints, itchy skin, vaginal dryness, tender breasts, urinary tract infections, nausea, dizziness, hair loss, migraines.
Kemp [6] introduced the concept of the ‘ticking timebomb’ in reference to a potentially catastrophic collision of trauma, menopause, and mental ill-health. Moreover, Douglas [7] described a ‘nexus of shame’ in relation to menopause and childhood sexual abuse, which, we posit, can only be further exacerbated by incarceration.
Women inmates have higher rates of mental health problems compared with male inmates; three-quarters reported mental health symptoms in the preceding year and a similar percentage reported PTSD symptoms in the same period [8-10]. In their report entitled ‘Women and Jails in an Era of Reform’ Swavola [11] highlighted the “very high rates of victimisation—including childhood sexual abuse, sexual assault, and intimate partner violence” amongst jailed women. We believe it highly likely that a proportion of those women will be experiencing some degree of symptomology as a result of peri-menopause/menopause.
“Health systems in jails and prisons frequently fail to meet basic needs of women and transgender people. Services like reproductive health care and prenatal care are woefully inadequate” [12]
The availability and quality of women’s healthcare within the prison population is hard to accurately assess. A county jail in Michigan was accused of “inhumane and degrading policies” which extended to “denying women menstrual hygiene products, toilet paper, and clean underwear” Swavola [11]. Stephen Ginn, writing in the British Medical Journal [13], concluded “It seems that for many women prison serves little purpose except to disrupt sometimes already chaotic lives”. Information on how women experience menopause within prisons is equally scarce, and what little is available, gives cause for concern [14]:
“…you had to suffer in silence. The lack of sleep due to the side effects of night sweats and insomnia meant I was too exhausted to work most of the time but had to go or I would be punished by being put on the basic regime and endure cell confinement as well as loss of earnings”
“The doctors refused to take me seriously”
“They referred me to a male psychologist who had no understanding of what I was going through”
Childhood abuse and/or neglect is associated with an increase in vasomotor symptoms during the menopausal transition [15,16]. More recently, Kapoor [17] expanded on the work of Thurston [15,16] by linking overall menopause symptom burden to adverse childhood experiences (ACE’s). The authors concluded “there was a significant association between ACE’s and menopausal symptoms” and went on to call for “appropriate management and counselling” to be made available.
According to The Prison Reform Trust [18] “most women in prison have been victims of much more serious offences than those they are accused of committing”. The PRT further report; “research on the impact of long-term imprisonment found that women reported an acutely more painful experience than men. This was linked to separation from their children and family, the loss of relationships, experiences of abuse and trauma in pre-prison life, the strain on their mental health, and the lack of control, privacy and trust inside prison” [18, 19].
We suggest these people are largely forgotten, and the recent global pandemic has only served to exacerbate the situation. Describing women’s experiences of prison during the pandemic, Greater Manchester Women’s Support Alliance stated [20]: “It’s a ball that just doesn’t stop rolling”. We’re suggesting that perhaps now is the time to stop the ball rolling?
References:
[1] https://www.gov.uk/government/publications/prison-population-figures-2022
[3] Bureau of Justice Statistics: Historical Corrections Statistics in the United States Washington, DC.
[4] www.sentencingproject.org/publications/incarcerated-women-and-girls/
[5] Walmsley R. (2015). World Female Imprisonment List (third edition) Institute for Criminal Policy Research at Birkbeck. https://www.bbk.ac.uk/news/global-statistics-of-female-prisoners-published
[6] Kemp H.F. (2021). Surgical Menopause: Not Your Typical Menopause (Ed). UK: LuLu Books.
[7] Douglas H. (2021). Menopause & Trauma. Community Connections with Aneesh de Vos and David Buckler. https://youtu.be/msCc0XGzJv0
[8] James D.J. & Glaze L.E. (2006). Mental Health Problems of Prison and Jail Inmates. Washington, DC: U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics.
[9] Lynch S.M., DeHart D.D., Belknap J. & Green B.L. (2012). Women’s Pathways to Jail: The Roles & Intersections of Serious Mental Illness & Trauma. PsycEXTRA Dataset. https://doi.org/10.1037/E528222013-001
[10] Steadman H.J., Osher F.C., Robbins P.C., Case B.A. & Samuels S. (2009). Prevalence of Serious Mental Illness Among Jail Inmates. Psychiatric Services 2009 60:6, 761-765
[11] Swavola E., Riley K. & Subramanian R. (2016). Overlooked: Women and Jails in an Era of Reform. Centre on Sentencing and Corrections, Vera Institute of Justice. New York. www.vera.org/downloads/publications/overlooked-women-and-jails-report-updated.pdf
[12] Dholakia N. (2021) www.vera.org/news/womens-voices/womens-incarceration-rates-are-skyrocketing
[13] https://www.bmj.com/bmj/section-pdf/187724?path=/bmj/346/7891/Analysis.full.pdf
[14] https://insidetime.org/the-bloody-truth/
[15] Thurston R.C. (2018). Vasomotor symptoms: natural history, physiology, and links with cardiovascular health, Climacteric, 21 (2) 96–100.
[16] Thurston R.C. et al. (2008). Childhood abuse or neglect is associated with increased vasomotor symptom reporting among midlife women. Menopause, 15 (1) 16–22.
[17] Kapoor E. et al., (2021). Association of adverse childhood experiences with menopausal symptoms: Results from the Data Registry on Experiences of Aging, Menopause and Sexuality (DREAMS) Maturitas, 143, 209–215
[18] http://www.prisonreformtrust.org.uk
[19] Prison Reform Trust (2017) “There’s a reason we’re in trouble”: Domestic abuse as a driver to women’s offending, London: PRT. See also: MacGuigan, G. and Walker, R. (2019) Survived…but at what cost? A study of women in the criminal justice system who experienced domestic abuse, and the potential for change, London: Griffins Society.
Photo by Markus Spiske on Unsplash
