Menstruation as misconduct: How prisons punish people for having their periods

Our analysis of prison rules and sanctions across all fifty states and the federal system — as well as accounts of incarcerated people — reveal troubling trends in how the carceral system punishes people for a physiological process they have no control over.

by Miriam Vishniac and Emily Widra, November 12, 2025

Prisons are primarily designed to confine and control men, which makes managing menstruation extraordinarily difficult, uncomfortable, and often downright dangerous for people inside. Incarcerated people are routinely denied the basic dignity of having the sanitary products and practices they need to care for themselves. When they band together and try to cope by engaging in survival strategies such as sharing supplies, they often fall prey to prison disciplinary systems used to target them for cruel punishment. To make matters worse, those punishments erect even greater barriers to menstrual health and hygiene.

Prison disciplinary systems lay out the wide-ranging rules that govern nearly every aspect of prison life, as well as the power of corrections officers to identify rulebreaking, enforce arbitrary rules, and determine the consequences. While corrections departments justify these far-reaching disciplinary systems as necessary to ensure safety, security, and order by deterring and punishing “misconduct,” in practice, they grant corrections officers wide and virtually unchallenged discretion to turn everyday behaviors into “rule violations” that jeopardize access to important programming and services.

Source: Prison Policy Initiative analysis of data from the Bureau of Justice Statistics’ 2016 Survey of Prisoners, The state prison experience: Too much drudgery, not enough opportunity.

In recent years, more attention has been paid to how people in prison and jail are denied access to menstrual products and are made to suffer for menstruating behind bars. Prisons punish people with periods in a number of ways, including by restricting access to necessary products either by legislation, policy, or by price at the commissary. A 2014 federal investigation of Alabama’s only women’s prison, for example, found that period products, laundry, and clean uniforms were “severely limited” and that staff used supplies to coerce, exploit, and punish incarcerated people. Other reports from carceral facilities across the country highlight how incarcerated people are subjected to assault, withholding of supplies, and humiliation while menstruating, in addition to being forced to live in unsanitary and unsafe conditions. While accounts from people in prison sometimes touch on disciplinary sanctions related to menstruation, prison systems themselves do not collect data on how often people are subject to punishments for period-related infractions. Our analysis is one of the first to systematically explore how prisons operationalize their disciplinary processes to punish people menstruating behind bars.

In this briefing, we analyze prison rules and sanctions from every state, the District of Columbia, and the federal Bureau of Prisons to explain how many of them allow corrections departments to unjustly punish people for the normal bodily process of menstruation. We are making these findings available in two appendix tables at the end of this briefing. While the rules in question are not explicitly about punishing menstruation, they are so broad and vague as to leave open the possibility that they can be used toward those ends. Importantly, the issue is not just that such rules are in place, but that correctional officers are allowed to practically unilaterally interpret and enforce them. In her extensive research into menstruation in prisons, lead author Miriam Vishniac (of the Prison Flow Project) collected invaluable reports from directly impacted people on their experiences of menstruating in prison. These are crucial data points because there is very little data available on this subject, and analyzing policy alone cannot explain how these discipline systems are weaponized against menstruating people. To better understand the reality facing people who menstruate, we include some firsthand reports from Vishniac’s research and other sources. Throughout this briefing, these accounts from incarcerated and formerly-incarcerated people are shared in blockquotes formatted like this:

“They were not getting what they needed and then often being ridiculed or punished for not having adequate equipment to take care of their periods…” – A.K. (Vishniac, 2025)

In Vishniac’s analysis of prison disciplinary policies, we found that at least six types of rules that can be used against people for menstruating:¹

• Damaging property: Rules designed to prevent damage to prison property result in punishing people for bleeding on prison-issued property, using more menstrual products than allotted, and supplementing their limited menstrual products with other materials like toilet paper, paper towels, or rags. ⤵
• Maintaining personal hygiene: Rules that mandate tidiness and personal cleanliness can be used against people who are menstruating when they have inadequate menstrual products and limited changes of clothing. ⤵
• Contraband: Rules restricting the type of property people can have in their cell, as well as the amount of allowed property that people can have in their cell and how that property is used, can turn basic or makeshift hygiene products into prohibited items. ⤵
• Movement: Rules that govern the physical movement of people throughout prisons inevitably impact people who are menstruating by limiting access to bathroom, shower, and laundry facilities. ⤵
• Work assignments: Rules requiring participation in work assignments — or impose sanctions for unauthorized absences — unfairly punish people who are menstruating and cannot maintain their usual job performance or tolerate being at work. ⤵
• “Feigning” illness: Rules supposedly designed to reduce the unnecessary and expensive use of healthcare resources undoubtedly results in the dismissal of real, severe symptoms experienced in menstruation. ⤵

In addition to rules that put people who menstruate in the crosshairs of the disciplinary system, many of the sanctions for breaking them further restrict access to menstrual products,² including:

• Confiscation: A common sanction for being found in possession of “contraband” is confiscation — and it is easy to see how prisons can classify menstrual products as contraband if people have more than the allotted number of products, have traded for menstrual products, or use products acquired in an unauthorized manner. ⤵
• Work assignments: Sanctions that result in the loss of work assignment or lowered pay can make it even more challenging for people to afford menstrual products, and requiring additional labor as a punishment can be impossible for people who do not have access to menstrual products or who are experiencing menstruation-related symptoms and medical conditions, including pain and heavy bleeding. ⤵
• Fines, fees, restitution and assessed costs: Sanctions requiring monetary payment disproportionately impact women, trans, and nonbinary people, who tend to enter prison with fewer financial resources than men, and who need to spend what little they have on menstrual products from the commissary. ⤵
• Loss of privileges: Revoking access to the commissary prohibits people from accessing menstrual products (when it is the sole provider of them) and disallows people from safely supplementing the menstrual products they have when needed. Other privileges are often revoked as well, including visitation, recreation, and programming, all of which are tied to lower rates of prison misconduct and recidivism. ⤵
• Restrictive housing: Sanctions that confine people to their cells or restrict access to personal property inevitably limit access to necessary menstrual products when they are otherwise unavailable in restrictive housing or disciplinary segregation. ⤵

Basic menstrual care runs afoul of several common prison rules

Prisons typically have many rules, many of which may seem mundane — or even reasonable — that can cause serious issues for people menstruating behind bars.³ Combined with officer discretion, the general lack of oversight in prisons means even the most basic rules can be weaponized. As it stands, research shows that women are more likely to be written up and disciplined for breaking prison rules, and receive disproportionate punishment for minor, subjective infractions like “disrespect.”⁴

While in prison, having a record of rule violations of any kind can exclude people from placement in less-restrictive housing units, program participation, and other services that could benefit them. In addition, pathways to release like parole and clemency proceedings take disciplinary records into consideration, so even the most minor infractions can influence how long someone spends in prison.⁵

Rules governing possession, damage, and misuse of property

Carceral settings often limit access to any and all items for people behind bars. Prison administrators argue that having “too much” property could pose safety risks in small cells (fires, clutter, sanitation), make people targets for theft, or create opportunities for incarcerated people to accrue money or leverage among others.⁶ While there may be some merit to these concerns, the tight restrictions of people’s property offers an additional tool of control and prevents people from having the things they need in the necessary quantities, inflicting real pain on people in response to imagined scenarios.

Damaging state property. Almost every single prison system has a rule about damaging property belonging to the state or the prison system.⁷ However, an inevitable consequence of restricted access to menstrual products like tampons and pads (as well as necessary hygiene products like toilet paper) is inevitably the “damage” (i.e., staining) of property, whether that be prison-issued clothing, bed linens, or upholstered chairs.

“I remember a time when I bled through the pad and I was working at my job. So now the chair has blood all over it. And I’m like, ‘Oh my gosh, what am I gonna do?!’” – A.K. (Vishniac, 2025)

“If you bleed all over state property they can charge you for destruction of state property. You know?’” – Ann (Vishniac, 2025)

Crucially, many rules about property explicitly disregard intent, stating that even “negligently” damaging property is a rule violation.⁸ In some prison systems, there are also rules about damaging “personal property” belonging to the individual or another incarcerated person, meaning that even if menstrual blood “damages” or stains property that is not state-owned, people are still at risk of disciplinary action.⁹

Wasting state property. Poor quality menstrual products are typical in prisons and result in people needing to use more pads and tampons. People menstruating in prison must request additional products and take the risk that they will be punished for “wasting” them by running through their allotted tampons and pads too quickly.¹⁰ Even when prisons do provide free menstrual products, people report that the free pads need to be changed more frequently than every 30 minutes on days of heavy flow.¹¹ In a 2023 survey of women involved in the criminal legal system, almost half of respondents reported using menstrual products for longer than they wanted (presumably because of quality issues) while incarcerated, and nearly a quarter of respondents reported negative health outcomes associated with prolonged use and limited supplies.

Misusing or altering state property. Prisons are places of extreme neglect. Incarcerated people often cope by finding ways to meet their own needs however they can — including using makeshift materials as menstrual products. People report using mattress stuffing,¹² dirty rags, socks, pillowcases, toilet paper, and shirts as menstrual products. Using these materials as makeshift menstrual products is an example of “unauthorized” use or using an item for something other than its “original intent or purpose.”¹³ In the same 2023 survey of women, more than one-third of respondents reported using materials other than pads and tampons to stanch menstrual bleeding. Even toilet paper has its limits as a supplement to menstrual products: most facilities only give women as much as they give men, meaning they have about one-third to half as much as they need once menstruation is taken into account (due to changes in bowel movements that often accompany menstruation), even if they don’t need to use toilet paper in lieu of pads or tampons.

“If you are using toilet paper, and you don’t have a sanitary napkin, that is also considered an infraction.’” – Jane (Vishniac, 2025)

Of course, using toilet paper or any other piece of property as a makeshift menstrual pad or tampon is a “misuse” of property and subject to disciplinary write-up and sanction,¹⁴ in addition to the punishment of physical discomfort, humiliation, and the cost of purchasing more toilet paper from the commissary.

Rules about personal hygiene and sanitation

Over thirty prison systems in the country have rules about personal hygiene and sanitation. The most generous interpretation of these rules may be to incentivize keeping shared spaces clean and encouraging sanitary practices like showering and hand-washing. However, the broad subjectivity of these rules allows them to be weaponized against people menstruating in prison, who already lack many of the resources they need to maintain basic hygiene while menstruating.¹⁵

“You see women being forced to free bleed because they don’t have access to anything else, but then they get told that they’re not being hygienic and they get put on lock [disciplinary housing] because they’re free bleeding.” – L.B. (Vishniac, 2025)

The exact time when menstruation begins is not predictable, and not having access to products leads to a situation in which people who bleed on themselves are disciplined, even though it is — inside and outside of prison — unavoidable. People in prison do not have sufficient access to menstrual products at baseline, let alone sufficient access to proactively wear pads and tampons before their menses begin.¹⁶

In addition to rules mandating personal hygiene, most prison systems have a rule violation associated with exposure to “bodily fluids.” Such rules are occasionally accompanied by a definition that restricts the violation to instances of “spitting” or “throwing,” which would obviously exclude unintentional bleeding on furniture or clothing during menstruation. At the same time, such vague rules coupled with practically unchecked officer discretion could — especially in cases where it is not explicitly limited by intentionality — be used to punish people who menstruate. For example, in New York, corrections unions cited concerns around “splashings” if menstrual cups were provided, essentially arguing that access to menstrual products should be limited.

Rules about possessing “contraband”

While most people think of drugs and weapons as “contraband” in prisons, the reality is that the definition is far more expansive. Behind bars, “contraband” also includes permitted items that a person may use for an unintended purpose, give to another person, or have in excess of what’s allowed.¹⁷ In other words, practically anything can become “contraband” if an officer says so, and therefore opens a person to the possibility of punishment.

Excess property. People report serious punishments in prison for trying to be prepared with more than the allowed number of menstrual products, including losing the ability to call their children. In one case, the excess property in question was 30 tampons, which is fewer than are in most boxes of tampons available outside prison.¹⁸

Unauthorized acquisition or exchange of property. As we previously noted, prisons frequently prohibit people from sharing items under the justification that it may create power disparities. Unfortunately, this also means that incarcerated people are not allowed to help each other deal with the facility’s failure or refusal to provide enough menstrual products.¹⁹ Even those few people who can afford additional products from the commissary are not allowed to share those items.

“You could ask somebody [for menstrual products], but if you got caught giving that to one another, even though it was a state-issued product, uh, you’re, you’re gonna get disciplinary ‘cause you’re not allowed to give each other stuff.” – J.T. (Vishniac, 2025)

Incarcerated people are forced to watch others be humiliated and punished just for menstruating, negatively impacting their mental health and emotional well-being — especially the large proportion of incarcerated women, trans people, and nonbinary people who are survivors of abuse.

In addition, because prisons are largely staffed by people who do not menstruate, there is no institutional understanding that people need access to these products at all times and in all locations. People in programming, in treatment for mental and physical conditions, at work, and in disciplinary housing may have restricted access because menstrual products are not included in the list of acceptable items for those locations, making them “contraband” in that specific context.

Rules regulating movement

Nearly all state prison systems and the federal prison system have rules that prohibit people from being “out of place” or in an “unauthorized area.” The physical movement of people in prison is highly regulated and scrutinized, and in the context of menstruation, these rules can seriously restrict the health and hygiene of people menstruating. People who are menstruating require more trips to the bathroom, either to change products²⁰ or due to changes in bowel movements, yet many prisons strictly limit bathroom, laundry, and shower access.²¹

“I had a fibroid on my uterus, so I had a lot of bleeding. But, the pads are so cheap and they don’t absorb well. I would go through three of them a night and still bleed through my clothes onto my sheets. It was so embarrassing and shameful, I would get up early and wash myself, my clothes, and my sheets, even though this was against the rules. I would get in trouble, but I couldn’t just stay with my clothes and sheets like that. It made me feel less than a human being, let alone a woman. Even though we are in prison, we are still women.” – Evelyn (Texas Criminal Justice Coalition, 2018)

People who are menstruating — and particularly those who experience irregular or heavy flows — not only have to worry about being punished for bleeding on themselves and their bedding, but must also face potential rule violations if they try to clean themselves up in the bathroom or access the laundry facilities without prior authorization.

Rules about work assignments

The majority of prison systems have rules about failing to meet expectations in work assignments²² or about absences from work or programming assignments.²³ Without prior authorization, people in prison cannot miss work assignments without risking a write-up. People can also be disciplined for not meeting job performance and productivity expectations. Outside of prison, almost half of women have taken time off work in the last 12 months due to menstrual symptoms. But in prison, people with work assignments do not get any sick leave. In fact, they are often required to work while sick, unless a healthcare provider officially excuses them.²⁴

“We are not allowed to take days off from work to rest, and we must adhere to a strict daily schedule in which virtually all of our movement is controlled.” – Kelsey Dodson (2025)

“I used to get terrible menstruation cramps! Bad! There was a long time, especially when I first came into the system, that they did not sell ibuprofen. They did not sell it. You could ask the officers for one Tylenol tablet that came in this little mini little envelope, right? And you couldn’t have more than six in your possession. So I would dread when I started my period because the pain would go almost all the way down to my knees. And I would have to work out in the heat.” – J.T. (Vishniac, 2025)

It’s unclear how people can access menstrual products while at work or required programming because incarcerated people are not able to carry property with them from their housing unit. Incarcerated people may be forced into a disciplinary catch-22: attend mandatory programming and face possible sanction for bleeding on themselves, or refuse to attend and be sanctioned for being absent or “out of place.”

Rules against “feigning” illness

More than one-third of all prison systems have rules condemning “faking” or “feigning” illness or injury.²⁵ These rules reflect a disturbing assumption by prison systems, correctional healthcare providers, and correctional staff that people in prison routinely lie about their healthcare needs in an effort to better their circumstances by, for example, avoiding work assignments, transfers to a different facility or new cell, etc. This presumption of ‘malingering’ can have dire consequences for incarcerated people in general, but more specifically among menstruating people:

“The nurses are just like, ‘You’re trying to get something out of us. We don’t wanna do the paperwork.’ And they make it challenging for people to get what they need and they never look at the source of the problem.” – S.B. (Vishniac, 2025)

Even though it is widely understood that menstruating people experience serious and painful cramps, it’s often dismissed or overlooked inside and outside of the carceral context.²⁶

Sanctions for rulebreaking further restrict access to menstrual products

In prison disciplinary systems, rule violations are punished based on the severity classification of the offense. Lower-level infractions may result in warnings, reprimands, probation, “agreements” or informal resolutions, and other more lenient responses.²⁷ The rules discussed above are considered lower-level infractions in most prison systems, but even this involves equating different types of rulebreaking that are in no way comparable.²⁸

In addition, most prison systems will consider repeated rule violations as a higher level of violation (and therefore subject to more severe sanctions).²⁹ Given that menstruation occurs approximately every month, menstruation-related rule violations are likely to occur repeatedly, especially for people who experience particularly heavy flow, painful cramps, or irregular menstruation. While correctional leaders often frame repeatedly breaking certain rules as evidence of antisocial behavior, it can also be interpreted as a sign of rules that are impossible to follow in a system where constant punishment and humiliation is the point.

As we previously mentioned, women, trans, and nonbinary people are more likely than men to be written up and disciplined for breaking prison rules: eight in ten women who reported being written up for a violation in the past year also reported receiving some form of disciplinary action.³⁰ These harsh, punitive sanctions, which include solitary confinement and restrictive housing,³¹ loss of good time credits,³² fines and fees,³³ forced labor,³⁴ and lost access to programming³⁵ and visitation,³⁶ are destabilizing and traumatizing. But what’s important to understand here is that many sanctions actually further restrict access to menstrual products, leading to a dangerous cycle of violations and punishments that inhibit access to hygiene products.

Confiscation of property

At least 20 state prison systems and the federal Bureau of Prisons have sanctions on the books that include “confiscation,” “loss of authorized property,” “dispose of property,” or “loss of personal property.”³⁷ These sanctions are primarily associated with contraband-related rule violations, but when the “contraband” in question are menstrual products, incarcerated people are left without enough supplies as their period approaches.

“If you had more than [the allotted number of pads] you got a disciplinary case for it. So the women that, that bled heavily, you know […] they would hoard those things. And they would get them confiscated.’” – J.T. (Vishniac, 2025)

Carla, a formerly incarcerated woman, described cell searches and arguing with prison staff: “‘Wait a minute. I’m just getting ready to bleed. Why are you taking it?’ ‘Why do you have excess?’ ‘Well, I’m a heavy bleeder.’ You know? And, they just, they would take it.” (Vishniac, 2025)

In many places, personal property — including authorized property — can be confiscated in response to a rule violation (even rule violations not related to that personal property).³⁸ And while some states prohibit the confiscation of “personal hygiene items,”³⁹ menstrual products are frequently left out of the definition of those items.

Work-related sanctions

More than three-quarters of prison systems have sanctions that include “extra duty” or “extra work assignment,”⁴⁰ and at least twenty prison systems — including the federal Bureau of Prisons — have sanctions that result in “change or loss of work assignment” or “work without pay.”⁴¹ Losing a job or being punished with unpaid labor can also mean incarcerated menstruators are left unable to purchase the items they need from the commissary. Additional labor can be a problem for the same people who struggle to perform heavy labor without access to tampons or who struggle with pain and other menstruation-related conditions. On top of the physical discomfort and exhaustion, jobs used as punishment may require significant movement, meaning the need for additional menstrual products could be even greater due to the impact of exercise on menstrual flow.

Fines, fees, restitution, and assessed costs

Almost every prison system imposes financial sanctions like fines, fees, restitution, or assessed costs.⁴² In at least 16 prison systems, we found policies specifically referencing fines and/or fees as punishment when someone is found or pleads guilty to a disciplinary violation. In many cases, the severity classification determines the amount of the fine, but in other cases there is a “flat” charge. In either case, charging fines means that some of the most innocuous behaviors — like making “loud or disturbing noises” in Kansas prisons — have a price tag. Even fines that may seem small to people on the outside — like the $15 maximum fine for a low-level rule violation in Oregon — can be devastating in a situation where people have extremely limited access to money and, when they are paid for their labor, make mere pennies per hour. Sanctions can also include “restitution,”⁴³ “repayment for damages,”⁴⁴ and “forfeiture of cash monies.”⁴⁵ And because women, transgender, and nonbinary people tend to enter prison with fewer resources than their cisgendered men counterparts, financial sanctions are likely far more significant for them.⁴⁶ Ultimately, punishing people with fines, restitution, and assessed costs leaves them with less money for the basic essentials, including menstrual products at the commissary:

“To put in perspective now, to think that a box of pads or tampons could cost my income for how many days? Like, there’s no way. You know, it’s like buying tampon boxes for hundreds of dollars a box.” – A.K. (Vishniac, 2025)

Loss of privileges

Almost all prison systems limit privileges as a punishment for rulebreaking, and at least 32 prison systems have sanctions that explicitly restrict access to the commissary (including loss of commissary while in disciplinary restriction).⁴⁷ Some of these sanctions include caveats for “personal hygiene items,” but again, they often do not define what is considered a “personal hygiene item.”⁴⁸ We found only three state prison systems that specify that the loss of commissary privileges must not restrict access to menstrual products in their sanctions,⁴⁹ while an additional eleven state prisons systems prohibit restrictions on the more general category of “hygiene” or “essential” items, without defining those terms to include menstrual products. When all basic necessities are dispensed through the commissary, lost access can easily lead to a cycle of rule violations as people subsequently barter for menstrual products, damage state property, or are seen as “unhygienic.” The loss of other privileges (visitation, phone calls, exercise and recreation, programming)⁵⁰ can also have a serious impact on people’s lives and wellbeing in prison, as visitation can reduce prison misconduct and recidivism, exercise and recreation can improve physical health, and educational programming is associated with reduced recidivism.

Restrictive housing, solitary confinement, and movement restrictions

Every prison system — except Arizona — has some sort of restrictive housing available as a punishment for rulebreaking. This includes disciplinary detention, confinement to cell, or other types of restrictive housing.⁵¹ In some cases, even low-level rule violations can lead to such placements: in Iowa, for example, a “minor” rule violation like “unsatisfactory work performance” or “minor insolence (abusive language, cursing, obscene language)” can result in restriction to the cell.

“When I was in SHU [special housing unit], every day, you’re not allowed to keep anything in your cell. So every morning they have something called ‘go-around’ and if you need pads that day they will give you two in the morning go-round. That’s it. That’s all you have for the whole day. And if you miss the go-round, you can’t ask them for pads later in the day.” – S.B. (Vishniac, 2025)

When someone is confined to disciplinary housing or their quarters, they tend to also lose access to the commissary and the normal distribution of items like menstrual products. Only six state prison systems have language on the books explicitly requiring access to menstrual products while in restrictive housing.⁵²

Conclusion

There is no “safety and security” interest in denying people the basic sanitary products they need to manage normal bodily functions. In all of our research — combing through state statutes, department policies, and facility handbooks — we found no documentation explaining how exactly menstrual products could threaten safety. When pressed on this issue, corrections officials have been unable to provide any further clarity.

Punishing people for menstruating is cruel, dehumanizing, and unnecessary. This practice damages their self-esteem and mental well-being, triggering serious consequences both in prison and once released. As we have said, survival practices like sharing hygiene products is prohibited, in-part, due to a supposed fear of creating power imbalances inside. But this overlooks the simple fact that these practices create other devastating power imbalances: from 2011 to 2021, there were at least five substantiated incidents of correctional staff using their power over access to menstrual products to abuse people in their custody.⁵³ It is not enough just to enact laws that make pads and tampons free in prison or change the rules being used to discipline incarcerated menstruators:

“Because, if you have these laws, the people that work at the prisons always get the last say and can just overpower them.” – L.B. (Vishniac, 2025)

Effectively ending the mistreatment of those who menstruate in correctional facilities also requires oversight and accountability of prisons, and an end to mass criminalization of women and other menstruating people.

Bowing to pressure from jails and companies, FCC raises phone rate caps

The agency has voted to raise rate caps to accommodate complaints made by companies and facilities, saddling low-income families with higher costs.

by Wanda Bertram, October 30, 2025

This post was updated on November 7, 2025 to include a link to the FCC’s order, and updating the table of rate caps, which changed slightly between the FCC’s proposed order and the final order.

On Tuesday, the Federal Communications Commission voted to increase phone and video calling rate caps for incarcerated people, changing the rules that it adopted last July and then suspended earlier this year. The new rate caps hike prices by as much as 83% compared to the rates announced last year.

The FCC issued rules last year — as required by the Martha Wright-Reed Fair and Just Communications Act — bringing unprecedented relief to families who, all too often, were forced to choose between the cost of communicating with their loved ones behind bars and meeting basic everyday needs. After issuing the rules, the FCC received complaints from phone companies, sheriffs, and state attorneys general. Bowing to this pressure, the agency suspended its 2024 ruling and calculated new rate caps, which inflate the rates and impose new costs on families.

Phone companies and sheriffs challenged the 2024 rules, claiming that they made it unprofitable for companies to serve certain very small jails, as well as to offer call monitoring technology — previously given to jails as a kickback. Neither the companies nor the FCC have ever published any data to back up these claims.¹ Nevertheless, the FCC adjusted its calculations to:

• Incorporate all “safety and security” costs (such as call monitoring and surveillance services) into rate caps;
• Add a 2¢ “facility fee” to all rate caps;
• Create a new tier of “extremely small jails” with fewer than 50 people, where rate caps will be higher.

The FCC also added, at the eleventh hour, a 6.7% “inflation factor,” which increased most of the rates in its proposed order from October by one or two cents per minute.

The final rate caps are much higher than those passed in 2024. However, in a rare piece of good news, the FCC will reinstate two parts of its 2024 ruling: the ban on site commissions (kickbacks that companies give to facilities) and on ancillary fees, both of which had had the effect of inflating the final costs families paid.

Ultimately, these higher rate caps further burden incarcerated people and their families, while lining the pockets of companies and facilities.

Facilities still have a choice

The new rate caps are set to go into effect as soon as the order is published in the Federal Register, although facilities will have 120 days to come into compliance.

It’s worth noting that the rate caps instituted by the FCC represent the legal maximum that prisons and jails can charge for phone service. The new rate caps are higher than what many facilities were charging even before the 2024 rules, and in the few months when those rules were in effect, thousands of facilities across the country implemented them successfully.

It is up to each individual jail and department of corrections to decide whether it will keep these lower rates — which guarantee more family contact and thus reduced recidivism — or choose to raise them, imposing the cost of call monitoring technology and other perks from companies onto families struggling to stay connected.

Almost half of all incarcerated people are in rural jails and prisons and at risk of losing access to hospitals

The Trump administration's One Big Beautiful Bill Act will result in the closure of many rural hospitals, leaving people in the surrounding communities — including those in prisons and jails — facing elevated healthcare costs and limited access to necessary healthcare.

by Emily Widra, October 28, 2025

Nearly a million incarcerated people depend on rural hospitals for routine off-site and emergency medical care.¹ Almost 60% of people in prisons and 25% of those in local jails are confined in rural counties, which are home to 3,000 of the nation’s correctional facilities. Following massive cuts to Medicaid passed by Congress this year, many rural hospitals will be forced to scale back operations or close entirely. As a result, critical, lifesaving healthcare will be further out of reach for huge swaths of the incarcerated population and those who live and work nearby, making an already bad situation far, far worse.

Rural and jail prison population estimates are based on an analysis of Vera’s Incarceration Trends jail data and the Bureau of Justice Statistics’ Census of State and Federal Correctional Facilities, 2019. The percentage of rural hospitals at risk of closure in each state as of August 2025 comes from the Center for Healthcare Quality and Payment Reform’s report, Rural Hospitals At Risk of Closing. See the methodology for more details.

The divisive “One Big Beautiful Bill Act” imposes significant cuts to Medicaid that slash funding for rural hospitals,² which are largely dependent on federal subsidies to stay afloat.³ Closing rural hospitals has disastrous consequences for entire communities, but especially for incarcerated people who have no choice about where they receive medical care. Rural communities can expect limited access to emergency care, higher costs for healthcare, and less-timely and more geographically distant medical treatment. The resulting loss of jobs and healthcare providers risks escalating poverty, unemployment, and disability rates, exacerbating an already dangerous cycle that often leads to incarceration.

Policy TrackerHow Trump is making the criminal legal system worse

In this briefing, we present our estimates of the number of people in prisons and jails who are locked up in rural counties and explain how rural hospital closures would spike healthcare and incarceration costs while worsening public health. We are also making these state-by-state estimates available in an appendix. Additionally, we examine how a weakened rural hospital system can make healthcare delivery even worse than it already is for people on the inside. Finally, we highlight ways in which the consequences of rural hospital closures — unemployment, inadequate healthcare access, poverty — are felt across entire rural communities, not just behind bars.

The incarcerated population is disproportionately sick, aging, and locked up in rural areas

With more than half of prisons and around a quarter of local jails situated in rural counties, rural hospital closures pose real risks to incarcerated people’s health and wellbeing.⁴ Incarceration has a negative impact on the health of people behind bars and shortens life expectancies — a state of affairs that is especially worrisome given the increasingly elderly and sick incarcerated population.⁵ Researchers warn that closing rural hospitals “can increase the risk of bad outcomes for conditions requiring urgent care, including that for high-risk deliveries, trauma, and heart conditions.” These bad outcomes are particularly likely among the incarcerated population, where some of these conditions are common: for example, about 2% of women entering jail are pregnant and many jail births are high risk. Additionally, heart conditions are the second leading cause of death in prisons and jails. Many correctional facilities already struggle to provide basic healthcare to incarcerated people and have disturbingly high mortality rates. These issues will inevitably worsen with the loss of important medical infrastructure nearby.

The impact on state prison systems

In almost every state, thousands of people in prison who need emergency and routine off-site medical care (such as imaging and x-rays, surgeries, and specialist care) rely on nearby rural healthcare systems that are now threatened by Medicaid cuts. This is particularly alarming in states that almost exclusively hold incarcerated people in rural areas, like Idaho, where 91% of people in prison are in rural counties.⁶ But the scale of the problem is worse in states with some of the largest prison systems — like Texas, Florida, California, Georgia, Pennsylvania, Arizona, and New York — where between 30,000 and 117,000 people in rural prisons rely on those hospitals in each state. Nationally, more than 783,000 people are in prisons in rural counties.⁷

People in prison already have to contend with delayed referrals to medical specialists, which (along with understaffing) contribute to higher mortality (death) rates on the inside. The carceral system is notorious for denying and slow-walking medical care, and for the convoluted, lengthy process required to be seen by a healthcare provider — practices that undoubtedly contribute to higher mortality rates on the inside.⁸ In rural facilities, these conditions are often exceptionally bad.

Prisons vs. jails Learn more about the difference.

In Louisiana — where 42% of the state prison population is incarcerated in rural counties — the prison mortality rate is more than double the national rate in state prisons, according to the most recent national data. From 2001-2019, Louisiana had the highest prison mortality rate overall, as well as for deaths related to heart disease, cancer, AIDS-related illnesses, and respiratory disease. Such severe healthcare needs require ready access to emergency and specialist care at a nearby hospital, and yet the Center for Healthcare Quality and Payment Reform estimates that 46% of Louisiana’s rural hospitals are at risk of closure, with at least nine at immediate risk of closure due to federal funding cuts.

Impact on local jails

Nationally, almost 170,000 people are incarcerated in rural jails. In 19 states, more than one-third of the statewide jail population is confined in rural counties. Six of those states confine more than half of their entire jail population in rural counties.⁹ Even in states with large rural populations overall, the share of the jail population in rural counties still stands out: for example, in Mississippi, where about half of the statewide population lives in rural areas, almost 70% of people in jail are held in rural counties. In Kentucky, where around 40% of the state lives outside of metropolitan areas, a disproportionate 67% of the statewide jail population is confined in rural jails.

Each year, more than five million people are arrested and booked into jail and they are more likely to have serious health needs — including mental illness, substance use disorders, HIV, Hepatitis B or C, cirrhosis, and heart conditions — than people who are not jailed. Troublingly, small, predominantly rural jails consistently report the highest jail mortality (death) rates in the country.¹⁰

The medical care that people receive inside jails is terrible in most places, but it is particularly bad in states with mostly rural jails and prisons. These facilities compete with community healthcare systems for limited resources, including qualified staff, and their failure to provide adequate medical care on the inside puts additional strain on local hospitals. When patients arrive from the jail or prison, their care has often already been delayed, making their health issues more severe and likely to require emergency or specialized treatment.

For example, in Virginia, where about 40% of the state’s prison and jail facilities are in rural areas, there have been at least three civil rights cases related to healthcare in prisons and jails since 2010. In U.S. vs. Piedmont Regional Jail Authority (2013), the U.S. Department of Justice alleged that the rural regional jail in Prince Edward County was permitting unqualified staff to evaluate medical conditions, inadequately screening for medical issues on admission, and providing subpar mental healthcare. The lawsuit resulted in the appointment of a court monitor to oversee the jail’s efforts to address these issues, but subsequent jail deaths suggest problems persisted. Similarly, in West Virginia — where 53% of the jail population is in rural counties — formerly incarcerated people already report serious healthcare issues on the inside, including delays in cancer screenings, lack of access to insulin, and abrupt discontinuation of prescription medication. Accordingly, West Virginia also had the second highest jail mortality rate in the nation at last count in 2019.

Rural hospital closures are associated with rising healthcare and incarceration costs, and worse public health outcomes

In the past decade, more than 100 rural hospitals have closed and more are at risk: the Center for Healthcare Quality and Payment Reform reports that in most states, over 25% of rural hospitals are at risk of closing, and in 10 states, at least half are at risk as of August 2025. Aside from providing crucial emergency care, inpatient medical care, and laboratory testing and diagnostics, rural hospitals are often where the community receives routine primary care and inpatient rehabilitation services. These closures can “wreak irreparable havoc on rural communities” and will, in turn, make it harder to reverse local population declines, threatening to turn these communities into “ghost towns.”

Beyond the community-wide effects of hospital closures – including unemployment (including in non-healthcare industries), lower income levels, and slower economic growth – the tendency of police to target poor and chronically ill populations means that people who fall through the cracks as a result of these cuts to crucial federal subsidies risk being swept into the system. With evidence that high county jail incarceration rates are associated with a rise in county-wide deaths, Medicaid cuts risk accelerating a dangerous cycle of poverty, illness, incarceration, and death in rural communities.

Medicaid cuts also stand to make already-costly medical care for incarcerated people far more expensive by placing services further out of reach. People living in rural areas live an average of 10.5 miles from the nearest hospital (roughly twice the distance in other areas), and over one-third of rural hospitals that closed between 2013 and 2017 were more than 20 miles from the nearest hospital. States, counties, and municipalities are ultimately on the hook for the high and steadily rising costs associated with medical care for incarcerated people. In Cheshire County, New Hampshire, for example, the county jail already budgets $50,000 for healthcare outside of the facility, which is expected to cover medical care for 100 people in jail, including one person who requires dialysis to the tune of $6,000 every month. In Virginia, 27% of the prison healthcare budget in 2015 was spent on off-site hospital care.

In particular, the costs of transporting incarcerated people to hospitals for off-site or emergency care are already extreme. In Michigan, the cost for 224 ambulance trips to the rural Chippewa County Correctional Facility is upwards of $430,000.¹¹ Meanwhile, in New Hampshire, Department of Corrections expenditures on ambulances rose by 176% from 2022 to 2023. Requiring transport to hospitals that are further away will cause these costs to climb even higher, and will incentivize corrections departments to avoid doing so as much as possible.¹² Prisons and jails already engage in this practice because of untenably high transport and staffing expenses.¹³ In Allegheny County, Pennsylvania, (which is not even a rural county), medical transport from the jail “takes two correctional officers out of the jail for up to 10 hours.” In a survey of jail staff in southeastern states, one jail employee reported that they “try and get rid of dialysis patients as quickly as [they] can, too, because they don’t wanna have to transport them three days a week to dialysis.” In addition to delaying offsite transportation as much as possible, corrections authorities may also try to deflect rising costs onto their (typically poor) incarcerated patients. As the National Consumer Law Center notes, jails in at least 25 states already engage in such practices:

“When an incarcerated person suffers from an acute medical issue that requires care that the jail cannot provide in-house, some sheriffs will release the person on “medical bond” before transporting them to a hospital so that the jail will not have to pay the medical bills. Once the person receives treatment and recovers, the sheriffs then often quickly move to rearrest and book the person back into jail.”

The failure to address people’s health needs while incarcerated exerts pressure on the remaining healthcare infrastructure as sick people leave correctional facilities and return home. For example, people on probation and parole face higher rates of substance use disorders, mental health diagnoses, chronic conditions, and disabilities than the general population, and over a quarter of people on community supervision have no health insurance, further limiting their access to adequate healthcare in the community.

Conclusion

The latest cuts to Medicaid pose substantial risks to both rural communities and the people who are incarcerated within them. Healthcare for incarcerated people is already abysmal, and jails and prison systems have been complaining about the rising medical costs for years. Medicaid cuts will pour fuel on this fire by forcing many rural hospitals to close. Further restricting timely access to routine off-site and emergency medical care will stoke worse health outcomes and higher mortality rates for an aging confined population. Given that most incarcerated people will eventually return to the community, these problems will exacerbate larger public health issues, impact community-wide mortality, and further burden the existing, limited emergency medical services in rural communities. Taken together, these factors paint a grim picture of the future for all people in rural communities as the combination of poor health and poverty makes rural communities more of a target for policing and incarceration. The destruction of rural public health infrastructure is a policy choice that inevitably favors using jails and prisons to manage increasingly poor, sick, and neglected populations through punishment rather than care.

Highlights from a busy year at Prison Policy Initiative

In our new annual report, we share examples of how we are building on the foundations of our research and visualizations to meet the challenges of this moment

by Danielle Squillante, October 23, 2025

We wrapped up another productive year at the Prison Policy Initiative, and are thrilled to share our 2024-2025 Annual Report with you. We released 5 major reports, 24 research briefings, 2 new resources as part of our Advocacy Toolkit, and several briefings related to our campaign to end prison gerrymandering. We also provided technical support to advocates at the state and local levels working on issues such as fighting jail expansion, making prison visitation a right, and water contamination in prisons.

Here are a handful of accomplishments we’re particularly proud of:

• We published an update to our flagship Mass Incarceration: The Whole Pie report detailing the scale of mass incarceration in the U.S.
• We released reports tackling two of the most consequential issues for incarcerated people — prison disciplinary systems and prison health care. Using a combination of deep analysis and first-hand accounts of these systems, we peeled back the curtain to show how these systems traumatize incarcerated people both physically and mentally.
• As part of our campaign to end prison gerrymandering, we produced 5 reports that highlight the scale and impact of prison gerrymandering in Oklahoma, North Carolina, Louisiana, West Virginia, and Kansas.
• Through our partnership with the Jail Data Initiative, we published 3 briefings utilizing present-day data from roughly 900 jails to provide a better understanding of those who are criminalized and locked up. Our briefings focused on the criminalization of unhoused people, the demographics of people booked into jails multiple times, and offense data for people in local jails.
• We expanded our focus on federal criminal legal system policy and launched our new federal tracker that connects the dots of the Trump administration’s actions to show its larger strategy of doubling down on the failed policies that created the nation’s mass incarceration crisis in the first place.
• Our Policy & Advocacy team hosted 3 webinars on organizing legislative testimony from incarcerated people, pushing back against unproductive and inaccurate uses of recidivism stories and statistics, and fighting back against jail expansion.

This is only a snapshot of what we produced this past year. We are proud of our accomplishments and look forward to sharing new projects with you in the year to come.

How to get started reporting on issues with parole release in your state

We explain how to use our 35-state report Parole in Perspective to jumpstart investigations into your state's parole system.

by Wanda Bertram, October 20, 2025

Frustratingly little data exists about discretionary parole systems in the U.S. — a gap that hinders policymakers, incarcerated people, advocates, and journalists attempting to navigate the system, assess its effectiveness, and champion meaningful reforms.

To fill the gap, the Prison Policy Initiative released a new report, Parole in Perspective, designed to pull back the curtain on how discretionary parole works in 35 states (the states that still use it to release people serving a wide range of sentences). Part one of this report explores the makeup of parole boards and how they conduct hearings. Part two dives into the data on parole hearings and grant rates in these states, and the criteria that boards use in determining whether someone will be released.

If you are a journalist reporting on parole, our report can help — whether you’re just looking for an introduction to these systems or trying to investigate them in depth.

Parole in Perspective answers basic questions like:

• Which states still have discretionary parole?
• Who is making parole decisions in your state?
• How many people are granted parole in your state every year? How has this changed over time?
• How much data does your state publish about parole release, compared to other states?

Our report can also serve as a starting point for answering more complicated questions about parole, such as:

• How are parole boards making decisions? Our appendix table breaks down which criteria boards are required to take into account in each state. For instance, some boards are required to consider a person’s age — a relevant factor as prison populations get older and as a growing number of states recognize youth under 25 as less culpable for their actions. Importantly, most boards place a lot of weight on factors that the applicant has no control over, such as the original crime for which they are locked up.
• Are punitive sentencing reforms forcing people to wait longer for parole hearings? While our report does not discuss such reforms directly, we show that in almost every state, parole boards are holding significantly fewer hearings today than they did several years ago — suggesting that various factors, including “Truth in Sentencing”-style reforms, are having an impact.
• How much time is the board likely spending on each individual case? Our report shows how many people have parole hearings in an average year, by state; as well as how many members each state’s parole board has. States vary widely in the size of their parole boards and how many members are required to hold a hearing.
• Is the availability of housing and programs shaping parole grants? For example, our report shows which parole boards take someone’s reentry plan into account, which depends on housing and other services. The availability of in-prison programming also influences grant rates in states that consider someone’s accomplishments behind bars.
• How is the format of parole hearings affecting decisions? As we explain in the report, a growing number of states are transitioning to virtual hearings — and a handful do not allow applicants to be present at their hearing at all.

Questions about discretionary parole can come up on a wide range of stories: It is a key aspect of timely issues such as the aging prison population and the “tough-on-crime” creep among elected officials. We hope this report serves as a useful tool for reporters seeking to shine much-needed light on these systems. And for any questions about parole systems that the report does not answer, we’re here to help. Reporters can reach out to us through our contact page for quick assistance exploring these and other issues.

New report, Parole in Perspective, shines a light on how parole boards work and how parole decisions are made in 35 states

Despite their differences, all discretionary parole systems have serious design flaws and most are steadily releasing fewer people, a new report shows.

October 7, 2025

A new report from the Prison Policy Initiative pulls back the curtain on parole release systems, providing the most accessible and comprehensive source to date for comparing how these essential — and often dysfunctional — release mechanisms are set up in 35 states. The report, Parole in Perspective, reveals that parole releases are on the decline in nearly every state that uses discretionary parole, highlighting elements of the process that contribute to this urgent problem.

Parole in Perspective comprises two parts, each honing in on different elements of parole release. The first explores the makeup of boards and how they conduct hearings. The second dives into new data on hearings and grants, and the factors that boards consider — including their discretion — in determining whether someone will be released.

The report contains four essential data tables showing:

• How parole boards in 35 states are composed and how they hold hearings;
• The number of parole hearings and grants in every state from 2019-2024;
• How parole boards compare on the criteria they use to determine release;
• The exact statutory text guiding parole boards’ decisionmaking in every state.

Parole in Perspective coincides with the Prison Policy Initiative and MacArthur Justice Center’s release of their Principles for Parole Reform, a guiding “North Star” document designed to help activists and policymakers identify priorities for reform in their states.

Both the new report and the Principles for Parole Reform identify crucial flaws in parole systems today, including:

• Relying too heavily on factors outside of applicants’ control — such as “the severity of the offense” or a perception that release would “diminish the seriousness of the crime”;
• Making irrational parole decisions in favor of keeping applicants locked up, often flying in the face of what risk assessment tools recommend;
• Stacking boards with law enforcement professionals, while ignoring the perspective of people with experiences of incarceration;
• Increasingly holding virtual rather than face-to-face hearings, or worse, not affording parole applicants a hearing at all.

“Despite their differences, all discretionary parole systems have serious design flaws that lead to an unfair preparation and hearing process for incarcerated people,” said report author Leah Wang. “By shining a light on boards and their practices, we hope to lay a path toward making these systems real tools for decarceration.”

The full report is available at https://www.prisonpolicy.org/reports/parole.html.

In 2025, every U.S. state outranks most democratic countries in women’s incarceration, new report shows

The number of imprisoned women globally has grown 60% since 2000. The United States remains a major driver of this population, a new report shows.

September 23, 2025

Every U.S. state incarcerates more women per capita than most independent nations of the world, a new report from the Prison Policy Initiative shows. Collectively, the United States accounts for 4 percent of the world’s women, but holds one-quarter of women who are incarcerated worldwide.

States of Women’s Incarceration: The Global Context 2025 provides a comprehensive women’s incarceration rate for every U.S. state — including prisons and jails, youth confinement facilities, tribal jails, immigrant detention centers, and other types of incarceration — comparing states to each other and to countries of the world. The report offers a crucial lens through which to view the criminalization of women, who are a small minority of all incarcerated people in the U.S., but whose incarceration rates today are at near-historic highs.

The Prison Policy Initiative’s report allows viewers to observe that, for example:

• South Dakota — with the highest incarceration rate in the U.S. — as well as Montana and Idaho have higher women’s incarceration rates than any country in the world.
• Women in Kentucky face almost the same incarceration rate as women in El Salvador, a country that has been described as an authoritarian police state.
• New Jersey — which has one of the lowest women’s incarceration rates in the U.S. — is on par with the United Arab Emirates, a nation where nonmarital sex can result in a prison sentence of six months for women.

States of Women’s Incarceration homes in on some of this country’s closest international allies to show just how starkly the U.S. stands out globally. Most states, the report shows, incarcerate women at more than double the rates of these “peer” countries.

“Women’s mass incarceration is a global concern — the number of imprisoned women has grown nearly 60% since the year 2000,” said report author Emily Widra. “With this country’s war on drugs, our treatment of mental illness as a problem for police to deal with, and our criminalization of poverty, it is no wonder that the U.S. continues to drive this problem and to account for a quarter of the world’s incarcerated women.”

The full report is available at https://www.prisonpolicy.org/global/women/2025.html.

New report, Youth Confinement: The Whole Pie 2025, shows racial disparities in youth confinement worsening as total numbers go down

New report explains how many system-involved youth are confined, where they are held, under what conditions, and for what offenses.

August 25, 2025

A new Prison Policy Initiative report provides the most up-to-date picture of how many youth are detained and committed in the U.S., highlighting the persistent overincarceration of Black and Indigenous youth in a system that, in recent decades, has made great strides in reducing youth confinement overall. Youth Confinement: The Whole Pie 2025 explores the conditions facing 31,900 kids today — most of whom are held in youth prisons and jails — and offers data on youth confinement by offense type in all 50 states.

Over the past 25 years, the number of youth in confinement in the U.S. has fallen by more than 70 percent — impressive progress compared to the adult criminal legal system, whose populations have changed very little overall in that same period. Nevertheless, the U.S. still confines youth at a rate more than twice the global average, and its juvenile legal system mirrors the adult system in many alarming ways:

• Severe racial disparities. 47% of boys and 39% of girls in juvenile facilities are Black — a level of disparity that has actually worsened in recent years. And even excluding youth held in Indian country facilities, Indigenous children make up 3% of girls and 2% of boys in juvenile facilities, despite comprising less than 1% of all youth nationally.
• Large numbers of youth held pretrial or for minor offenses. Nearly 9,000 youth today are locked up before they’ve had a trial, and thousands are in detention for minor, low-level offenses. Select states — such as Indiana, which accounts for almost one-quarter of kids locked up for running away; and Texas and California, which hold 26% of kids confined for technical violations of parole — contribute heavily to this problem.
• Prison-like conditions. While the number of kids in large facilities (holding 100 youth or more) has fallen steeply in the last few years, nearly 4 out of every 5 confined kids are held in youth or adult prisons and jails — an increase since 2017, when 65% of confined youth were held in such places.

“States have made astonishing progress in the last 25 years in reducing youth incarceration, but the fact remains that prisons and jails are not places for kids,” said report author Brian Nam-Sonenstein. “Confinement is still a traumatizing experience for youth — most of whom already have histories of trauma — and one that leaves them worse off than before their incarceration.”

Youth Confinement: The Whole Pie 2025 includes a first-of-its-kind, 50-state table showing the number of youth confined for various types of offenses, shining particular light on “status offenses” (behaviors that are not law violations for adults). Other key features of the report include:

• Sidebars breaking down the different types of youth confinement facilities, and terminology around youth incarceration that differs from the adult system;
• Infographics “zooming in” on certain slices of the pie, such as youth held for low-level offenses and youth in highly restrictive facilities;
• A section highlighting some of the reforms that have led to a more than 70% drop in confined youth populations, and noting how these same reforms could be applied to the adult criminal legal system.

“Disturbingly, some states today are threatening to double down on failed policies that created the youth confinement crisis in the first place,” Nam-Sonenstein said. “Seeing the full picture of this system should remove any doubt that it casts far too wide a net, one that disproportionately ensnares Black and brown youth. State policymakers would do well to emulate the reforms that have shrunk this system and apply these lessons to adult prisons and jails.”

The full report is available here: https://www.prisonpolicy.org/reports/youth2025.html

New study finds confined neurodivergent youth of color are particularly vulnerable to physical assault by staff

A new study analyzing a national survey of youth in custody reveals stark disparities in rates of staff physical assault among Black and neurodivergent youth.

by Emily Widra, August 19, 2025

Even though the rate of youth incarceration is more than three times lower than it was twenty years ago, youth of color and youth with disabilities are still overrepresented in custody — and these disparities are getting worse.¹
These children were already among the most vulnerable to involvement in the juvenile legal system, but as the system decarcerates, their vulnerability is compounded by the fact that they are also among the most likely to suffer abuse while confined, including being violently victimized by adults.

New research underscores the extent to which staff violence against incarcerated neurodivergent youth of color is substantially worse than it is for white neurotypical youth.² Brianna Suslovic and her colleagues at the University of Chicago Crown Family School of Social Work, Policy, and Practice, identified significant disparities in the likelihood of staff physical assault between confined youth of different racial identities, and between neurodivergent and neurotypical incarcerated youth. They found that the odds of Black youth reporting staff physical assault are 79% higher than the odds of white youth reporting assault, and the odds of neurodivergent youth reporting staff assault are 59% higher than the odds of neurotypical youth reporting assault. Even more alarmingly, for neurodivergent youth of color, the odds of reporting staff physical assault are more than twice the odds of their white, neurotypical peers.

These findings, forthcoming in the Journal of the Society for Social Work and Research, are based on data collected by the federal government in the 2018 National Survey of Youth in Custody. Suslovic and her co-authors have made a useful contribution to existing research because they use self-reported data to examine how structural forces and marginalization — in this case, racism and ableism — shape experiences of youth confinement. The evidence they present underscores the need to keep those at the highest risk of abuse at the forefront of decarceration efforts, and to ensure they don’t enter youth jails and prisons in the first place.

Confined youth of color and neurodivergent youth disproportionately experience violence at the hands of facility staff

The study finds that children of color and neurodivergent children are disproportionately confined in juvenile facilities, and that neurodivergent children of color in particular are more likely to report being physically assaulted by staff than white, neurotypical children.

Among white, Black, and Hispanic confined youth, those identified as neurodivergent — meaning they’ve ever been diagnosed with ADD/ADHD, dyslexia, a learning disability, Autism or Asperger’s Syndrome — are more likely to have been physically assaulted by staff, based on self-reporting in the 2018 National Survey of Youth in Custody. Source: Suslovic, B., Shankar, S., & Gottlieb, A. (2025). Race/Ethnicity, Neurodivergence, and Odds of Staff Physical Assault in Youth Carceral Settings. Journal of the Society for Social Work and Research. https://doi.org/10.1086/734616.

Overall, more than 1 in 10 incarcerated youth report being assaulted by staff. However, among neurodivergent confined youth, a greater proportion (15%) reported being assaulted by staff. In fact, the odds of neurodivergent youth reporting violent victimization by staff were 59% higher than the odds of their neurotypical peers. In the analysis across race, the researchers found that Black youth have odds of reporting staff physical assault that are 79% higher than white youth, with almost 1 in every 6 Black youth reporting assault, compared to 1 in 9 white youth.

The researchers also found that across almost all racial categories, staff physical assault is more prevalent among neurodivergent youth.¹⁰ Neurodivergent youth of color experience a distressing 120% higher odds of reporting being assaulted by staff than their white, neurotypical peers. This is particularly alarming, as it indicates the extent to which the children most vulnerable to involvement in the juvenile system are made additionally vulnerable to violence at the hands of adults in power.

Despite great strides in youth decarceration, longstanding disparities in confinement are getting worse

The great strides made in youth decarceration over the past twenty years have not been evenly distributed. People of color and those with disabilities, who have often been primary targets for surveillance, policing, and incarceration,¹¹ still represent a greater portion of the dwindling confined youth population than their white and neurotypical peers. In fact, their overrepresentation in the system is growing, and they continue to face the very kinds of abuses that have motivated decarceration of youth jails and prisons in the first place.

The conditions in youth jails and prisons — which can include solitary confinement, physical abuse, sexual abuse, a lack of programming and services, and excessive use of force — make juvenile confinement particularly dangerous for youth with disabilities, and can exacerbate mental and behavioral health concerns.¹² Overall, confined youth face exceptional risk of victimization by facility staff: systemic maltreatment — including physical abuse and excessive use of force by staff — has been reported in juvenile facilities in 29 states since 2000, and a 2010 survey found 22% of confined youth reported that they were afraid that a staff member will physically attack them.¹³

The data from this newest study support these concerning trends, further quantifying the overrepresentation of youth of color and neurodivergent youth in confinement, and characterizing their mistreatment in a shrinking system.

Youth with disabilities are disproportionately locked up

More than two-thirds of confined youth met the study’s criteria for neurodivergence, which the researchers defined as any diagnosis by a doctor, counselor, or other professional of ADD/ADHD, dyslexia, a learning disability, Autism, or Asperger’s Syndrome. The prevalence of many of these diagnoses is much higher among children in custody than in the national youth population:¹⁴

• ADD/ADHD: 60% of youth in custody compared to 11% of youth nationally;
• Learning disabilities: 27% of youth in custody compared to 8% of youth nationally; and,
• Autism: 4% of youth in custody compared to 1.7% of youth nationally.

In addition, more than half (55%) of neurodivergent confined youth were Black, Hispanic, American Indian or Alaska Native, Asian, or Native Hawaiian or Pacific Islander.

While youth with disabilities represent 17% of national K-12 enrollment, they represent almost one quarter (24%) of confined youth.¹⁵ Children with disabilities face some of the highest rates of arrest in schools, in part because police are often called to respond to youth who have challenges with processing emotions and information, communication, and disability-related behaviors. Youth of color with disabilities are arrested at even higher rates in schools, with Native Hawaiian and Pacific Islander boys and Black boys with disabilities facing rates four to six times the average arrest rate.¹⁶

Racial disparities are increasing in youth confinement

Racial disparities have long been a feature of youth incarceration, and they’re only getting worse. In 2003, Black youth accounted for 38% of youth detained or committed, and in 2023, this increased to over 46%. In addition, youth of more than one race accounted for only 1% of confined youth in 2006 (the first year juvenile data included that race category), and that proportion has more than doubled as of 2023.

Some of these disparities can be traced back to differences in the policing of kids of different races and ethnicities. As is the case with Black adults, Black children are particularly targeted with overcharging and harsher treatment, making them far more likely to be incarcerated than white children. Black children, and especially Black girls, are also subject to an added burden of adultification: when a child is perceived as older, more culpable, and more responsible than their peers. Similar to the racist “super predator” myth that was used to rationalize harsh punishments in the 1990s by portraying Black youth as more violent and unruly than their white peers, adultification leads to harsher consequences within the juvenile legal system.

Conclusion

The findings from Brianna Suslovic and her colleagues represent important contributions to the existing research, highlighting how some of the most vulnerable children are funneled into the juvenile legal system, where they face a number of dangers, including physical assault by staff.

Violent victimization is the product of several factors in youth confinement. Almost one-third of the study sample reported physical abuse by an adult prior to confinement, and we know that prior victimization is a strong indicator of subsequent victimization while in custody. Research also shows that the quality of relationships with facility staff can influence the likelihood of victimization — and other positive and negative outcomes for incarcerated youth and adults — and the vast majority (89%) of confined youth reported that they were assigned a case manager or counselor. Educational access and engagement have been identified as protective factors against maltreatment for children as well. Despite evidence that people who achieve higher levels of education while incarcerated are more likely to experience positive outcomes after release, less than one-third of confined youth have completed high school, even though more than 60% of confined youth are over 17 years old.¹⁷ Many of the same factors that make children more vulnerable to criminal legal system involvement also make them more vulnerable to suffering abuse while confined, and this study calls particular attention to some of the youth most disproportionately at risk of violent victimization by adults.

While the number of confined youth has been declining for years, the confined population still reflects the racist and ableist trends of the nation’s criminal legal system: children with histories of abuse, lower education levels, learning disabilities, cognitive disorders, disabilities, and children of color are disproportionately locked up. Those are the children who remain in juvenile facilities where they are at heightened risk of physical assault at the hands of the people charged with their safety and wellbeing. Given the pronounced failure of youth incarceration to significantly reduce “delinquent” behaviors and the dangers they experience behind bars, the findings from this recent study signal a need to reevaluate our nation’s use of incarceration for children.

WEBINAR: Taking the Lede: How advocates can shape news coverage of the criminal legal system

How small organizations can make the most of their resources to build relationships with the media.

by Wanda Bertram, August 18, 2025

With every sheriff’s office, department of corrections, district attorney, and police department armed with its own media relations team, the news cycle is all too often stacked toward the status quo when it comes to criminal legal system issues. How can advocates for system reform have their voices amplified — and their priority issues covered — without overworking themselves to get the media’s attention? And how can advocates frame issues in ways that resonate with journalists?

On September 18th, the Prison Policy Initiative and the Center for Just Journalism hosted a webinar to help advocacy organizations home their media strategies and get attention on critical issues. Panelists Wanda Bertram of the Prison Policy Initiative and Hannah Riley of the Center for Just Journalism provided guidance on how small organizations can make the most of their limited resources and staff capacity. They covered:

• The lay of the contemporary news media landscape and basic tips for interacting with journalists;
• The strategic benefits of building relationships with reporters, and how advocates should select reporters to reach out to;
• How to have informal conversations with the media that can influence the news cycle, as well as write formal pitches that can lead to news clippings.

Watch the full webinar:

Additional resources:

• Webinar slides
• Freedom of the Press Foundation’s guide to interviewing incarcerated people
• Institute for Nonprofit News’ publications directory
• Ad Fontes’ media bias chart