In July, Sens. Cory Booker (D-NJ) and Elizabeth Warren (D-MA) introduced the Dignity for Incarcerated Women Act, requiring the Bureau of Prisons (which operates federal prisons) provide hygiene products, including tampons, sanitary napkins, soap, shampoo, toothpaste, and toothbrushes, for free.

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“Pads have always been free since I’ve been here,” said Lisa, who has been incarcerated at the federal prison in Waseca, Minnesota, since 2011. “If I had to buy them, I wouldn’t be able to afford them.” There, Lisa—who asked to be referred to by a pseudonym—and other women simply need to walk up to the officer’s desk where pads are available for the taking. “You can take as many as you want, but some guards frown because they have to keep getting them out,” she described in an e-message to Rewire.

But in many prisons across the country, frowns are the least of women’s worries. There, limits are placed on the number of feminine hygiene products women are given; if they need more, they must buy them at the commissary—or prison store—often at prices that are exorbitant for those making pennies-per-hour at prison jobs.

In July, Sens. Cory Booker (D-NJ) and Elizabeth Warren (D-MA) introduced the Dignity for Incarcerated Women Act, requiring the Bureau of Prisons (which operates federal prisons) provide hygiene products, including tampons, sanitary napkins, soap, shampoo, toothpaste, and toothbrushes, for free. It also prohibits both shackling and solitary confinement for pregnant women, increases visitation rights, and mandates free telephone and video conference calls.

Approximately two weeks after senators introduced the Dignity for Incarcerated Women Act, the Bureau of Prisons (BOP) grabbed headlines with its own announcement—starting on August 1, 2017, federal prisons must provide feminine hygiene items. The memo’s orders last only one year.

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Both the memo and the act, if passed, affect only those in federal prisons, including private ones with federal contracts—or nearly 13,000 of the 111,500 women in prisons across the United States. (This figure does not include the 99,100 women in local jails, the unknown number of trans women held in male facilities, or those held in immigration detention.) But providing even 13,000 women with feminine hygiene products is a start.

Tynice, who has spent the past 12 years at the federal prison in Bryan, Texas—often choosing to forgo buying shampoo to afford pads—said in an e-message the memo is “a blessing.”

“I have been incarcerated for the past 12 years and this is the first time that I don’t have to set money aside to get $10 maxi pads, $8 tampons or $5 toilet paper on a [Bureau of Prisons] income,” Tynice, who asked that her last name not be used, wrote in a message to Rewire. The monthly wages at that prison range from $5.45 to $60. “It is saving me money and I don’t have to worry about, ‘Will I get in trouble for stocking up on feminine products throughout the month.?'” In many prisons, if a person is caught with more toilet paper or tampons than are allowed, they can be issued a disciplinary ticket. Getting a disciplinary ticket comes with consequences ranging from losing commissary (or ability to shop at the prison’s store), phone, or e-message access, to even losing in-person visits for 15 to 30 days.

According to the Bureau of Prisons’ Information, Policy, and Public Affairs Division, the orders in the memo are being followed. In an email to Rewire, an unnamed official wrote, “The Bureau of Prisons provides feminine products free of charge to inmates. However, the type of products provided [varies] by institution. The issuance of the recent operations memorandum ensures that female inmates will be able to choose from a larger variety of feminine hygiene products, including two sizes of tampons, two sizes of pads, and panty liners. They are generally placed in a common area and women may have as many item as they need. When they have a preference for a specific brand, they may purchase these items from the inmate commissary. The cost of feminine hygiene products sold in the commissary varies based on the product brand.”

In separate emails to Rewire, the executive assistant for Federal Correctional Institution (FCI) in Danbury and the public information officer at the federal prison in Bryan stated that tampons, sanitary pads, and toilet paper are provided free of charge and without limit.

But inside many other federal prisons, women aren’t seeing these promises fulfilled. Families for Justice as Healing and CAN-DO Foundation, advocacy organizations formed and led by formerly incarcerated women, surveyed women in federal prisons to determine whether those prisons were following the August memo. Women from 14 of the 28 federal prisons that house women responded. According to those replies—which can vary from other sources based on individual experience—despite promises made on paper, many prisons are still not providing tampons, panty liners, or pads for free as needed.

At the federal prison in Alderson, West Virginia, women say tampons continue to cost five dollars per box. For Karen, who earns $5.25 each month at her prison job, the price means that she goes without many other necessities. Twenty tampons come in a box; women who have heavier menstrual cycles need more than one box each month. The prison does issue sanitary pads free of charge, but, she said to Rewire via e-message, “they are so cheap that you have to wear about three to four at a time to not make a big mess of yourself.”

Karen wasn’t alone: Women in various prisons have reported that prison-issued pads are typically so thin that they had to wear two or three. At Dublin, women are issued 30 pads at the beginning of each month. While that number might seem sufficient, Letitia, who was released from Dublin after the BOP memo, told Rewire via phone that the pads are so thin that many women wear four at a time. If a woman runs out of pads, she must ask others if they have any to spare. “It’s embarrassing to wake up and run around looking for pads so that I don’t bleed through my clothes,” Letitia (a pseudonym) said. “They only issue us three pairs of khakis and we can only wash our clothes every four days.” She noted that, at a federal prison operated by private prison company CoreCivic, formerly called the Corrections Corporation of America, women were given as many pads and tampons as they needed during their menstrual cycle.

In Waseca, Minnesota, pads and toilet paper are free, but it wasn’t until mid-October, nearly three months after the BOP memo went into effect, that women reported being provided with tampons. Until then, they still had to buy them. A box of 20 tampons costs $5.40, but the hourly wage ranges between 12 and 55 cents. The pay scale for prisoners in federal correctional institutions is from 12 to 40 cents per hour.

“With the money we make, and what it costs to stay in touch with our family, there just isn’t enough money,” Lisa explained. “Phone calls are 21 cents a minute so a five-minute phone call is $1.05, a 10-minute call is $2.10 and a 15-minute call is $3.15.” The costs—coupled with the low wages—means that women are often forced to choose between buying tampons or calling their loved ones. In at least one prison, according to family members, women often take the sanitary pads apart and roll them into makeshift tampons.

One family member, a veteran and nurse who asked not to be identified lest her relative inside face consequences, noted that withholding tampons is not only degrading, but can lead to health risks. “It is not acceptable that menstruating women in 21st-century America have to roll up maxi pads and insert them vaginally to attend to their feminine hygiene needs,” she told Rewire via phone. “The risks associated with this practice of desperation are dangerous. What if a ‘tampon’ gets lodged so high in the vagina that the woman cannot remove it? There is no string to pull on to remove it. She’s then at risk for toxic shock syndrome.” She also noted that prison rules prohibit re-purposing items for other uses, meaning that women could get into trouble for rolling a sanitary pad into a tampon. That threat could prevent her from seeking medical attention. But, she added, “If she does not do so, absolutely she is at risk for toxic shock syndrome, sepsis, and death.”

Some prisons even limit toilet paper. In 11 of the 14 women’s prisons surveyed, women reported that toilet paper was rationed—in some places, the limit was two rolls per week. In others, it was four. Women at the federal prison in Dublin, California, told Rewire that the prison has “a very strict limit on toilet paper”—a roll and a half of single-ply toilet paper per person per week. “If you happen to conserve and end up with extra at the end of the week, they take it from you,” Susan, who asked that her real name not be used, wrote in an e-message. But not many end up with extra. “Many people have a shortage and end up going around from room to room begging for toilet paper.” She noted that, since the prison provides no rags, paper towels, or cleaning supplies, women often resort to toilet paper to clean their belongings as well.

Women behind bars at the federal medical prison in Carswell, Texas, which incarcerates women with more serious medical needs, told Rewire that tampons and panty liners were not distributed until October 20, more than two-and-a-half months after the BOP memo went into effect. Earlier that month, Allison (a pseudonym) reported in an e-message that prison officials told the women they were using too many pads and would be limited to 25 every two weeks.

“It feels like you’re degraded for having a period,” said Holli Coulman, who spent a year at the federal prison camp in Victorville, California. Even when the prison did not restrict the number of pads a woman could have, wearing multiple pads was not only uncomfortable, but also noticeable. Though the prison provided free tampons, Coulman said in a phone interview with Rewire that each unit—which housed approximately 130 women—was issued only one large box of tampons each month. “You might have gotten three tampons,” she recalled. Once the box was empty, women could either use pads or pool their pennies to buy a six-dollar box of tampons from commissary until a new box was issued the next month.

Coulman was released in January 2017, months before the introduction of the Dignity for Incarcerated Women Act or the Bureau of Prisons memo. She remains in contact with the loved ones of the women she left behind, who told her that, since the memo, each unit is now issued two large boxes of tampons each month—still not enough for everyone’s menstrual cycle. Sanitary pads are still issued, but only in one size.

Letitia was released after the memo was issued. She said that not only did staff at Dublin continue to distribute only 30 pads each month (and no tampons), but that no staff member alerted women to the memo. She and others learned about it after one woman’s family member sent her the memo; that woman passed it around.

“Women do not choose to have a period,” said Amy Povah, who spent nine years in a federal prison and is now the founder and director of the CAN-DO Foundation, in a phone interview. “If we are going to lock up women, then we must provide them with feminine hygiene products. This is not a luxury!”

Sometimes, however, withholding feminine hygiene products becomes part of a punishment. Tynice recalls being sent to the SHU (Special Housing Unit, or a form of solitary confinement) after a fight at the FCI in Danbury, Connecticut. For nearly 60 days in 2009, she was locked into her cell 23 hours a day. When her period came, she was allowed only three sanitary pads each day. “I understand that I was in trouble and being punished for something that I did but to dehumanize me and refuse me pads or tampons had me real mad,” she recalled. “I kept asking and asking for more pads ’cause I had a heavy flow. Well, long story short, I never got them. I ended up using a sock and rolled up tissue.”

In response to an email to Rewire, the executive assistant for FCI Danbury stated that the federal correctional institution does not currently have a SHU for women.

The Bureau of Prisons memo expires on August 1, 2018, and it’s not clear what will happen after that. Meanwhile, the Dignity for Incarcerated Women Act has been referred to the Senate Committee on the Judiciary.

For Tynice, requiring prisons to provide hygiene items is simply common sense. “To me it is just like feeding us. We have to eat and a woman is going to have a menstrual [period] so it is a necessity not a want,” noted Tynice. “Call it ‘three hots, a cot, and a monthly.'”