A PERIOD IN CUSTODY: MENSTRUATION AND THE IMPRISONED BODY

Internet Journal of Criminology © 2009
A PERIOD IN CUSTODY:
MENSTRUATION AND THE
IMPRISONED BODY

By Catrin Smith1

Abstract

This article, based upon pilot work conducted in a closed women’s prison in England,
explores women prisoners’ own experiences and accounts of menstruation and the
complex role of situation in determining reactions to menstrual symptoms and to
menstrual change. Socialised to see menstruation in negative terms, women prisoners
tend to perceive the experience of menstruation in prison as a particularly
uncomfortable intrusion into their lives. It is an imposition which cannot, however, be
accommodated in private. Negative expectations and experiences of menstruation in
prison may influence many women prisoners to focus on its associated unpleasant
symptoms. Here, imprisonment may well set up the circumstances in which women
come to regard themselves as suffering, which will, in turn, determine whether or not
they help-seek. The findings suggest a high level of menstrual distress in women
prisoners and a high rate of use of prison health services for menstrual complaints.
However, there is also evidence to suggest incongruous referral behaviour, a major
cause of which seems to be unease or dissatisfaction with prison health care and, in
particular, male doctors.








1 Dr Catrin Smith, School of Criminology and Criminal Justice, Griffith University, Australia

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“I had to use a wad of toilet paper because I didn’t know who to ask and I was too
embarrassed. I was desperately hoping that no one would notice the blood leaking
through. It was so degrading, the lowest point in my life.” (Woman Prisoner).

BACKGROUND

A high rate of utilisation of prison health services seems to be a common feature of
prison life and, while all prisoners make good use of the health care system, women
make proportionately greater use of medical services than do men. Women prisoners
tend to see prison doctors more frequently and take more prescribed medications than
their male counterparts and, each day in women’s prisons, approximately 20% of
women report sick, twice the rate of male prisoners (Home Office, 1997; Department
of Health, 2002). While this may well indicate a higher incidence of illness in women
prisoners, the reasons why prisoners report sick are likely to relate not only to new
and on-going health problems but also to a range of factors such as boredom,
loneliness, uncertainty and fear.

Accounts from prison health care staff indicate that menstrual disorders take up a high
proportion of doctors’ time in women’s prisons and that such complaints rank among
the conditions most frequently presented for consultation. Women prisoners
themselves also describe a range of menstrual symptoms including: increased pre-
menstrual tension (PMT), excessive menstruation, painful menstruation and menstrual
cessation (Smith, 1996). Smith (1996; 1998), for example, in a wider health survey of
three women’s prisons in England found that forty-eight percent of women prisoners
reported problematic menstrual or menopausal symptoms. Given the relatively young
age of the female prison population, these findings suggest a health disadvantage (also
see Genders and Player, 1988; Fleming, 1992).

While sociological studies have detailed the progressive medicalisation of
menstruation in patriarchal societies such as Britain (see, for example, Scambler and
Scambler, 1993), little is known about the role of situation in determining reactions to
menstruation. In addition, there is a lack of information on the experience of
menstruation and of menstrual symptoms in women’s prisons or about women
prisoners’ help-seeking behaviours. And yet, there are clear regime implications, not
least for the supply and provision of sanitary protection and access to sanitary
facilities, but also for work and disciplinary measures such as routine body-searching
and random urine analysis to detect prohibited substances.

The importance of identifying health care and health promotion needs within the
prison context and for ensuring that they are met has been increasingly recognised in
recent years (Department of Health, 2002) and there is also now a much greater
awareness among prison personnel and policy makers that the needs of women
prisoners may be different to those of their male counterparts (Home Office, 1997).
Menstruation and menstrual symptoms relate solely to women and yet this
fundamental aspect of the female experience has received little detailed attention in
the literature on women’s imprisonment. This is, in part, due to a desire to move away
from the overly deterministic and individualistic explanations for female deviance and
many analyses of women’s imprisonment have, instead, concentrated upon aspects of
the wider social environment that is structured by gender, inequality and disadvantage
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(see Howe, 1994; Smith, 2005). As a result, the issue of menstruation in prison
remains veiled in silence.

Menstruation is an example of a physical bodily process which seems to exist outside
the social (Jackson and Scott, 2001). However, it is something that needs to be
managed socially. If it is not managed sufficiently it may disrupt social expectations
and interactions. This article draws upon an analysis of women prisoners’ thoughts
and feelings about the bodily experience of menstruation and their attempts to manage
this natural bodily function within the prison environment. It explores the complex
role of context in determining how women think about their bodies and respond to
perceived bodily change. In so doing, it highlights the complex interaction between
the physical and the social and considers how a shared and closed environment affects
the experience of menstruation.

METHODS
This article draws upon data derived from pilot work conducted in a closed prison for
adult women in England2. The research was carried out over a twelve-month period
(2003-2004) and incorporated a mixed-method approach. In the first phase of the
study, a self-completion questionnaire was distributed to 214 women prisoners, the
total population of the prison on a given day. Questions on menstrual history,
symptomology3, menstrual change and help-seeking were included in a broader
questionnaire covering perceived health status, reported experiences of illness, social
history (including recreational drug use), as well as socio-demographic and
criminological information.

Completed questionnaires were returned by 111 women, giving a response rate of
52%. Because of assurances of anonymity, the follow-up of non-responders was not
possible. However, the sample reflected broadly the status, age range, ethnic origin,
sentence length and offence category found in women’s prisons as a whole. Data were
analysed using the SPSS statistical package. While the sample was somewhat small, a
conventional chi-squared test was used to screen for significant association, generally
accepting p<.05 as the ‘boundary of significance’.

The study also incorporated a rigorous qualitative method based on semi-structured
in-depth interviews with 30 women prisoners. Each interview lasted between 1-2
hours. All interviews were transcribed verbatim for analysis using the constant
comparative method of generating and linking categories (Glaser and Strauss, 1967).
Following on from the interviews, ten women prisoners kept ‘health diaries’ over a
time period of 14 weeks. The women were asked to keep a daily record of any
symptoms, problems or worries and were also asked to note down the days when they
were menstruating and any other issues, problems, positive or negative feelings.

FINDINGS: ‘READING’ THE IMPRISONED BODY
The salience of lay perceptions of health and illness has long been recognised in the
sociological literature. In addition, there has been an increasing focus in recent years

2 The research reported here was supported by an award from The British Academy (LRG-35416), for
which I am particularly grateful. I also acknowledge and thank those prisoners and staff who gave of
their time, histories and good humour.
3 The questionnaire included items adapted from the Menstrual Distress Questionnaire (Moos, 1985)
and the Menstrual Joy Questionnaire (Delaney et al, 1988).
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on the ways in which individuals experience and ‘read’ their bodies and bodily
change (see, for example, Nettleton and Watson, 1998; Howson, 2004). It has been
recognised, however, that getting people to think about their bodies and to articulate
those thoughts can be difficult for the empirical research endeavour, not least because
of a tendency to keep one’s body and bodily functions intimate and private (see
Cunningham-Burley and Backett-Milburn, 1998). Prison is a context, however, that
allows little bodily privacy. Personal control is taken away as the prisoner and her
body become subordinates to the formal regime and everyday bodily routines become
subject to high levels of control and surveillance. For prisoners, the body is
experienced as both a site of disciplinary power and a vital resource of survival (see
Smith, 2002) and prisoners tend to be highly aware of their bodies and are quick to
respond to questioning on the subject (also see King and McDermott, 1995).

While menstruation is a basic element of women’s lives, as a bodily experience it
remains largely hidden and not talked about (Weideger, 1975; Scambler and
Scambler, 1993). Laws (1985; 1990) suggests that this is due, in part, to ‘menstrual
etiquette’; the precept that women should keep menstruation concealed because it
contains an element that is in someway offensive. Thus, women draw upon strategies
to keep it out of routine social interaction (Jackson and Scott, 2001). As an intimate
topic and as a somewhat taken-for-granted part of the female experience, it is perhaps
difficult to discuss. However, when women are able to chat about the subject openly4,
a range of personal experiences and viewpoints emerge and, in women prisoners’
responses to questioning about menstruation, we can see a number of dominant
themes. In what follows, women prisoners’ attitudes towards menstruation in general
and their routine experiences of menstrual discomfort and distress are discussed
before a closer examination of the experience of menstruation in the prison context.


4 Here, it is likely that certain aspects of the researcher’s biography (for example, being female)
contributed to the processes of gaining the women’s trust, enabling them to talk so openly and in so
much depth on the issue and in ways they might not have done had the researcher been male.
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MENSTRUAL TABOOS, DISCOMFORT AND DISTRESS

Attitudes towards menstruation
Throughout history, menstruation has been something of a ‘taboo’ subject (Laws,
1990). Menstrual blood, in particular, has been viewed as having magical, polluting
and often destructive properties (Weideger, 1975). Menstruating women have been
physically and socially isolated and forbidden to prepare food or to engage in sexual
activity and there is evidence to suggest that, in some cultures, severe penalties have
been inflicted on the menstrually ‘deviant’ (Hays, 1972; Weideger, 1975; Martin,
1989; Kowalski and Chapple, 2000).

Menstrual myths and taboos still exist, albeit in a somewhat less extreme form. In
women prisoners’ accounts of menstruation there was no shortage of beliefs and
interpretations. For example, many of the women interviewed believed that
menstruating women should change their behaviour, avoiding exercise, sexual
intercourse and social activity (also see Martin, 1989). These are some of the
observations made:

It’s like your body needs to rest, you know, away from everyone else …
[I]t’s best to keep a low profile. Sex is out. I suppose there are just
things which you can’t do and shouldn’t do. We were always told not
to go swimming.

I was told that you shouldn’t have your hair done and to avoid cold
foods. That’s a bit extreme. But certainly there are a number of things
that I would think twice about doing when I’m on.

Our sex life always used to centre around whether or not I was on. If I
was on my period we used to avoid sex completely. I don’t know, it just
doesn’t seem right.

While there is little evidence to suggest fluctuations in performance over the
menstrual cycle (Golub, 1992), many of the women felt that they were physically and
mentally weaker during menstruation and, as such, were unable to function normally.
When questioned about why this might be, a number of women referred to the
‘openness’ of the body and it’s vulnerability to infection and illness.

In women’s commonsense accounts of menstruation, there was a clear association
with issues of bodily cleanliness. Many women expressed feeling ‘dirty’ during their
menstrual period and the function of menstruation was often seen as involving the
removal of unwanted substances from the system (also see Snow and Johnson, 1977;
Laws, 1990). As one woman observed:

It’s like the body cleaning itself out, a cleaning process.

Many of the women interviewed seemed to have a lack of understanding of the
menstrual cycle; admitting, for example, to having little or no knowledge of
menstruation prior to their first menstrual period, or to fully understanding the source
of menstrual blood. Some women with a history of heroin use, which may produce an
irregular menstrual cycle or even stop a woman’s period, believed that they could not
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get pregnant whilst using the drug and some had only learned of their pregnancies on
contact with criminal justice and/or drug treatment agencies. Indeed, a number of the
women interviewed were unsure about when it is possible to become pregnant.

None of the women used the word menstruation, preferring to use euphemistic
expressions such as ‘being on’, ‘having my period’ or ‘monthlies’. They could also
easily recite other, less neutral expressions associated with menstruation. In all the
women’s accounts, menstruation was seen as generally unmentionable, a taboo
subject. Most saw menstruation as something they considered bothersome, messy
and/or dirty and all acknowledged its hidden nature (also see Martin, 1989). For
example:

I hate it. It’s unfair, messy and painful.

It’s a curse on women, isn’t it? Every month we have to suffer the
mess, the pain, the indignity.

We have to suffer in silence. You certainly don’t talk about it or let
people know that you are on.

It’s just not something you advertise is it? Like when you meet people
you don’t say to them ‘Guess what? I’m having my period’. And you
definitely don’t talk about it in front of men. They’d run a mile
(laughs).

In all the women’s accounts, menstruation is seen as something in need of bodily
management, in order to be seen as a competent social actor. Menstruating women,
thus, strive to manage the tensions between public appearance and their own private
reality.

The women who came closest to expressing any positive feeling towards their
menstrual cycle were those who described menstruation as ‘normal’ and ‘healthy’ and
as signifying ‘being a woman’. Women not interested in having more children, or in
having children at all, also displayed a more positive response. Even these women,
however, often tended to qualify their responses in negative terms. For example, one
woman stated:

The only good thing about it as far as I am concerned is that it means
I’m not pregnant. For most of my adult life I’ve thanked god once a
month and put up with all the mess and the pain.

Negative attitudes toward menstruation may be associated with negative recollections
of menarche, the first menstrual bleed and the ‘sign and symbol of womanhood’
(Weideger, 1975: 158). All the women interviewed could recount, often with humour,
the story of their first menstrual period and all were invited to describe their reactions.
While some of the women recalled positive experiences, most reported negative
feelings; using words like ‘embarrassed’, ‘upset’, ‘scared’, ‘shocked’. The women
also reported feeling unprepared and uninformed about what to expect and confused
about the meaning of their emerging ‘womanhood’:

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I was only nine when I had my first period. I was terrified and
disgusted. On the one hand I was supposedly now a woman. But I
wasn’t ready for it. I was only ten.

I really didn’t know what it meant. I remember feeling quite pleased
that I was now a grown up. But that also scared me. No one tells you
how you are supposed to feel.

I was just really embarrassed. I remember thinking that everyone
could tell.

A negative attitude towards menstruation at menarche may be associated with greater
menstrual distress (Etaugh and Bridges, 2004). Certainly, women who had been told
little about pubertal changes or who had been led to believe that menstruation would
be uncomfortable and unpleasant found menarche especially distressing. Similarly,
those who began to menstruate earlier than their peers recounted particularly negative
experiences.

While all the women could recollect their first menstrual period, few could explain
why it occurred when it did. They could, however, describe the often unwanted
consequences of accelerated femininity/sexuality and, for many of the women, there
was a clear link between changes in biological maturity and changing expectations of
social and sexual maturity.

It was a real entry into the adult world. One minute I was this little
girl, the next I was expected to act and be a woman. I was made to
grow up practically overnight.

I was raped for the first time just after my first period. I remember
thinking ‘so this is what it’s like to be a woman’. Welcome to
womanhood.

Old enough to bleed, old enough to have sex. That was the attitude.

In a wider culture that tries to keep physical maturity and socio-sexual maturity apart
(Weideger, 1975), some young women are propelled into adulthood. Many women
prisoners are those whose biographies include accounts of disadvantage, abuse and
psycho-social distress (Carlen, 1983; 1985; 1988; Posen, 1988; Smith and Borland,
1999). For such women, the entry into adulthood is often accompanied by realistic
feelings of confusion and unhappiness. Here, a negative attitude towards menstruation
both before and at menarche may be linked to subsequent negative feelings and a
greater menstrual discomfort (also see Scambler and Scambler, 1993).

Menstrual discomfort and distress

For most women, a certain level of discomfort is part of the normal menstrual cycle
experience. Women may experience a number of ‘symptoms’ before or during
menstruation, including breast tenderness, anxiety, bloating, fatigue, pain, irritability
and mood swings. In some cases, the experience of discomfort may be so severe that
normal functioning is impaired (Miles, 1991). Studies assessing the prevalence of
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menstrual symptoms in the community suggest that the experience of physical and
emotional fluctuations is a common feature of many women’s lives and negative
experiences are reported by women from a range of cultural backgrounds (Snowdon
and Christian, 1983; Moos, 1985; Scambler and Scambler, 1985).

Of the women prisoners who completed the questionnaire, 58% stated that they had
regular periods; 31% were irregular; and 11% stated that they did not have periods
due to surgery, menopause or other reason. Of those whose periods were regular or
irregular, the prevalence of symptoms considered as discomforting was as follows:
54% reported moderate or severe pain; 40% reported breast tenderness; 48% said they
experienced bloating or swelling; 57% reported headaches; 30% reported backache;
36% said they gained weight; 46% reported feeling tired; 56% reported mood swings,
and 58% said they felt irritable, anxious or depressed either before or during their
menstrual period. These findings suggest a higher degree of menstrual irregularity and
symptom distress in women prisoners compared to women in the community (see
Scambler and Scambler, 1993).

The women interviewed also detailed embodied experiences of menstruation, most of
which can be described as unpleasant:

I become very sensitive to noise. I get headaches and feel generally
under the weather.

I have really, really bad period pains. Sometimes I’m all crouched up
because the pain is so bad.

I feel sad all the time, kind of low, weepy, you know?

I feel fat and bloated. My skin and hair feel sort of dull.

I get very clumsy. I have bad cramps and my back aches. My boobs
hurt and I get very tired.

While controversy exists in the research literature about the validity of premenstrual
syndrome (PMS) as a disorder (see, for example, Golub, 1992; Vines, 1993; Walker,
1997; Houppert, 1999), a number of the women interviewed considered themselves to
suffer from the symptoms associated with the idea of PMS:

I’ve always been a moody cow before my period. I can’t stand to be
around people or to be touched.

Every month, for about a week before I’m due on, I become a different
person. It’s like I’m not me. I feel very, very angry. I snap at everyone.
I feel out of control.

I become tense just before my period. I get cross with everyone around
me. My breasts swell and they feel very heavy, you know? I just want to
sleep all the time and if I can’t I become more irritable and more likely
to snap.

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I do suffer badly with PMT. I feel really tense. My temper is short. I am
fed up and tearful. I find stress really difficult to deal with.

In response to the questionnaire, 58% of the women considered themselves to have a
problem with PMS. A clustering of certain symptoms – headache, backache, pain,
irritability, body swelling and tenderness – one or two days before menstruation was
also evidenced in the health diaries of seven out of the ten women, although, feelings
such as anxiety, tiredness, sadness and stress were reported throughout the women’s
menstrual calendars.

Of course, the way in which menstruation is portrayed can affect the way women
think about their menstrual cycles and symptoms (Delaney et al, 1988; Scambler and
Scambler, 1993; Lee, 2002). Scambler and Scambler (1993: 41), for example, argue
that reports of menstrual symptoms may well reflect ‘women’s learned negative
stereotypes and attitudes towards menstruation as much as their experiences of it’. A
widely held stereotype in modern western culture is that women experience negative
moods premenstrually. Thus, if a woman feels anxious, irritable or moody and
believes she is in the premenstrual phase of her cycle, she may attribute her feelings
to PMS (Etaugh and Bridges, 2004). The association of negative feelings such as
irritability with the timing of their periods was evident in many women’s accounts. In
their comments, we can also see the role of others – often men - in the interpretive
process:

My husband reckons he knows when I’m due on … He says, ‘Time of
the month, is it?’ Because I get snappy.

If we were arguing he always would make a point of asking, ‘Are you
on the rags?’, or something like that.

It’s almost like you’re allowed to be moody. It’s expected. You say to
people, ‘Time of the month’, and it’s like they understand, no more
said.

Laws (1985; 1990) suggests that male culture generates and legitimises the
overwhelming discreditation of menstruation. This, in turn, may influence many
women to focus on the associated unpleasant symptoms and feelings more than the
positive aspects. In an attempt to move away from a focus solely on the negative side
of menstruation, women were asked to reflect on any more positive feelings that
might be experienced before or during menstruation (for example, self-confident,
affectionate, sexual). The replies to the questionnaire and the diary entries revealed
very few favourable feelings. Similarly, while not all the women interviewed
described menstrual symptoms as overly distressing or discomforting, only two
women came close to expressing what could be described as ‘menstrual joy’ (Delaney
et al, 1988). Even these women, however, recognised that their views were somewhat
unusual:

I know a lot of women suffer terribly and I do suffer with cramps and
the like. But … I am almost ashamed to say that I quite enjoy some of
the ways it makes my body feel. I do tend to feel more sexual around
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the time of my period. It’s like your senses are more aroused, sharper
somehow.

In some ways I really like it. I feel more womanly somehow, although
I’m not sure that that’s necessarily a good thing.

While there is evidence to suggest that some women experience their menstrual
periods as pleasurable and self-affirming (see Lee, 2002), in this study questions
about positive feelings tended to produce non-response, bewilderment or even
amusement on the part of the respondents. While all the women were able to speak at
length about the negative aspects, most said that they had never thought about
menstruation in a positive manner. If such a negative image of menstruation is
impressed upon women, how then do they decide how much pain and discomfort
should be regarded as normal and at what point is the threshold of normality crossed?

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