Get Real! Unpacking Cultural Myths and Biases About Women’s Bodies & Sex

Heather Corinna

I often get questions from women in South Asia or the Middle East concerning virginity "status" in relation to their culture. Here are a number of such questions and the answers to them.

This column is published in partnership with Scarleteen.

rheashah5 asks:

When a woman has sex for the first time her hymen breaks. How is it possible to differentiate between a virgin female and not a virgin except for the hymen concept? How can one say that the girl is not a virgin on the face of it? 

Heather Corinna replies:

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Here are some other questions we’ve had like this one recently:

I’m a newly married man. I was suspecting my wife was a virgin but the result came opposite then what I was suspecting. When we had sex for the first time there was no bleeding and I did not feel the vagina is so tight. It means is my wife had sex previously? Or are there are some other reasons for being like this?

I was married five months ago. When we sex first time she did not feel pain and not bleeding too. We had done enough emotional activities before the sex. May be this the reason for that or has she done sex before?

my wife breast was very soft. i heard the lady who has not had their breast touched should have tight breasts. so i am confusing. we married one month ago. she had done sexual activites before?

We get questions and emails like this often. They are usually coming from people slightly older than our typical our age range, and also most often from South Asia or the Middle East. While these questions are often coming from older people, the issues are certainly pertinent to people of all ages. They are also still held by some Westerners.

I’ll say some more in depth after I walk through the basic answers. Because we get so many questions on some of these issues, there are hyperlinks added to each of the items below for those who want more information.

Here are the bare basics:

1) Unless a woman becomes pregnant (or gives birth and/or breastfeeds, both things which usually happen through sex), contracts a sexually transmitted infection or is seriously injured during sex, her body is rarely, if ever, permanently changed by sexual activity. Previous or current sexual activity does not make a woman’s vagina “loose.” It does not make her external vulva look different. It does not cause her breasts or any other body part to have a different appearance or to feel different to a partner. The exception to that can be the hymen/corona to some degree, which I explain below.

Most of the physical changes a woman will have in her life, when not due to pregnancy or birth, will be due to her own genetics, to change in body composition (like losing or gaining muscle or fat), to the hormonal changes that are part of our lives just like they are part of men’s lives, to the changes of puberty, to any injuries, serious illness or to aging. Very few, if any, are due to sex all by itself, of any kind. Just like a woman’s vagina or hands don’t tend to have the power to change male bodies via sex, a man’s penis or hands do not generally have that ability with women. Most permanent changes to the vulva or vagina are due to puberty, aging or birth. Most temporary changes to the vulva or vagina are due to emotional and sexual feelings.

For more on this, see:

2) Based on what we know from the study we have to reference and from what women self-report, most women do not bleed with first-time intercourse. Some do, but many do not. Whether or not a woman has vaginal bleeding should not be seen as any kind of proof of whether or not she has had sexual partners in the past. A woman can have vaginal bleeding with sex who has had 70 partners; a woman who has had no partners may not have any.

For more on this, see:

3) If and when bleeding does happen, it’s an error to assume it must be about a woman’s vulva, vagina or hymen (corona) being a certain way because she has not had sex before. It is also incorrect that the first time a woman has intercourse, her hymen breaks.

The hymen (now also called the corona) is usually very thin, stretchy tissue just inside the opening of the vagina. For most women, most of it wears away on its own over a woman’s lifetime, with or without intercourse. It is not a seal that “breaks” or “pops” with first intercourse, though first intercourse, and any vaginal sex thereafter, will often play one part in that tissue gradually wearing away. One round of intercourse will not remove the hymen or cause it to be all gone.

If a woman has menstrual periods, you can be sure that the hymen/corona has already begun wearing away, otherwise that fluid could not leave a woman’s body. When that tissue wears away further or is stretched, it may not not cause bleeding, especially if a woman was fully aroused, emotionally comfortable, well-lubricated during sex and had a partner who was also responsive to what felt good for her (or didn’t).

A minority of women have what are called “resilient hymens.” For those women, intercourse or other vaginal entry will tend to be painful, and for the most part, impossible without causing that woman injury. (The women and their partners I have known with this condition have expressed attempts at intercourse as feeling like someone was trying to jump through a trampoline.) Women with resilient hymens may need a minor, outpatient surgery called a hymenectomy; a doctor makes an incision in the hymen so that it can begin to wear away over time as it should. Those women may also find they do not menstruate, because a hymen/corona which has not worn away at all will not be able to release menstrual flow.

At best, the only thing anyone could tell about a woman’s sexual history by looking around her vaginal opening with a trained eye is if she has NEVER had any kind of vaginal intercourse or other entry. A doctor or someone who knew what a fully intact hymen looked like could tell that because the hymen was fully intact.

But. Many women who have not had any kind of sex do not have fully intact hymens, so that kind of examination is primarily useful with very young girls, who have also not started puberty or menses, both things which contribute to the hymen wearing away all by themselves. If a woman is pregnant or has a genital sexually transmitted infection, that is another way a doctor could be sure a woman has had sex before. On the whole, the idea or practice of a physical examination to “prove” virginity is deeply flawed and often inaccurate. For women who are put through that experience, it is also often an experience that feels degrading and humiliating. As well, some of the doctors engaging in this practice know how unreliable it is and are purposefully dishonest about that.

Virginity is not anatomical or medical: there is no such term in medical practice, even if you hear a doctor use it. Virginity is a social, cultural or individual idea or concept about people’s sexual behavior. The hymen is not virginity: it is one body part which some people have made part of their ideas about virginity, and which historically was often part about ideas of virginity from times in the past when female anatomy was less understood.

For more on this, see:

4) Pain and/or bleeding are often signs of injury, not of well-being. If we love someone, we’ll tend to do all we can to help them avoid injury and pain, rather than wanting to purposefully cause them injury or pain.

Sometimes people will get injuries due to sex accidentally, so if and when it does happen, it doesn’t mean anyone involved is a bad person or has done something wrong. Genitals can be delicate and just like they can happen with sports, injuries can happen with sex. A woman may have vaginal bleeding because someone didn’t trim their nails, was accidentally too rough or there wasn’t enough lubricant used as was needed. Some health conditions can cause vaginal bleeding, like some sexually transmitted infections; vaginal bleeding can also happen because of spotting with ovulation or a birth control method, and certainly during menstruation. There are some health conditions which make vaginal sex painful for women, conditions which usually need treatment. Sometimes women experience pain with intercourse simply because they do not want to have intercourse.

If someone of any gender is having a lot of pain with sex, that’s not ideal: it’s something we want to try to avoid. Would you want to be in pain with sex yourself? Probably not. If someone is having bleeding, even if no one meant to cause any kind of injury, it means something likely went wrong, not right. Unless you are a sadist and pain is something a partner also wants, your aim as a caring partner should be to do all you can to help a partner to avoid pain, not to idealize them being in pain.

For more on this, see:

5) During intercourse, the vagina may not feel “tight” to a partner or a woman for a few reasons. When a woman is not scared and is sexually excited, the muscles around and of the vagina will temporarily become more flexible and open. Vaginal lubrication that also often happens at those times adds to the vagina not feeling tight. Contrary as it may sound, when women feel very sexually aroused (excited) and are active sexual partners, the vagina may also feel tighter because of the muscles being more active and because of certain areas of the vulva being more erect and because of more blood circulating to the pelvic area.

For men and women alike, the feeling of intercourse can sometimes or always feel more general than specific. It’s not everyone’s favorite sexual activity, and may not be the one where one or both partners feel the strongest or most specific sensations. Sometimes people’s expectations of what intercourse or a vagina is “supposed to” feel like are not realistic or true to their actual experiences.

For more on this, see:

6) People are not property. Women and women’s bodies are not objects. Despite whatever someone’s marriage arrangement may be, whatever a person’s culture is or traditions are or say, if in any way women or some part of women’s bodies or selves are presented as something to be bought or owned by another person or family in any way, that is a false construction. People, which women are, in actuality are still are not, nor can be, property.

In colonial American history, many people once kept slaves. They usually purchased or traded for these slaves with another white person and considered the people they “bought” to be their property; treated them as if they were property, including sexually. However, no matter what was paid for them, no matter that our culture called them slaves, that never made people anyone’s actual property because people are not objects. This is why slavery is globally considered a human rights violation: because the idea or practice of slavery presents and treats certain people as less than human. The same is true of women who are either treated like slaves or like property in any respect.

With men who believe that women are whole human beings, equal to them and absolutely not property, but who worry about things like this, it often seems to stem from insecurity and feelings of vulnerability. It can stem from a need to validate oneself or one’s masculinity by having a sexual partner who only knows you as a sexual partner and who has and can make no other basis of comparison; who has not “belonged to” or “been marked by” some other man. Sometimes some of these ideas are rooted in notions that suggest or state women’s sexuality to only exist or be complete in relationship to men or a given man, like the idea that our sexuality is given to us by men (it is not: it’s part of who we are, all by ourselves, from before we were born), or that sharing our sexuality with a male partner is giving him that sexuality entire, or allowing him to “take” it from us. In short, otherwise fair-minded men, hanging unto ideas like the myths I’ve addressed here can be about men needing to do their own growing and developing, intellectually and emotionally.

For more on this, see:

Please understand that many horrible things have been done to women historically because of “traditional” ideas about virginity and its value (and the lack of value ascribed to women who are not virgins, or who are seen as not being virgins even when they are, including women who have been raped) and because of uneducated ideas about women’s bodies and what they are seen as representing about women or their male spouses or partners. Things like stoning and other forums of torture or murder, public “virginity testing”, rape, exile and female genital mutilation are and have been and are some of the atrocities done to women based in whole or in part on people’s ideas about virgins and how “virgin bodies” are supposed to be.

I’d encourage you to ask yourself why you would find it ideal to have a person you are supposed to love be bleeding or in pain in order to support your subjective ideas, feelings and individual identity. I think it is important to ask yourself why it is important or essential a wife is a virgin, important enough to distrust her, to be trying to divine her sexual history through her body parts, and to be doing things, asking things or even thinking things which are likely to create problems in your relationship and to keep the two of you from earnestly and mutually loving and respecting one another.

If someone tells me they love and respect someone, I assume they believe what that person says; that they have faith in and trust that person, as we can’t love or respect without faith and trust. The only way to know what someone’s sexual history has been is to ask them and then put stock in their words. If a woman tells you she has not had sex with anyone before, that is the only reliable and respectful way to know she has not. If her words are not enough for you, or you don’t believe them, it may be you need to reconsider if a marriage or other relationship with them is right for you. In other words, your disbelief in, or suspicion of, a partner isn’t about her body, it’s about your own mind and heart.

By all means, some people don’t feel able to be honest about having sexual partners before, especially in situations or areas where being honest may put them in danger from family, a spouse or others or at risk of losing a roof over their head and food on their table. These ideas in and of themselves make honesty difficult. All the same, someone’s own words and answers are what you have to work with. If you want to be sure that person feels they can be truthful with you, you need to be someone they find trustworthy, and who they have faith will treat them with love, kindness and respect no matter what their answers to questions about their history are. It’s very hard to tel the truth when you know your own truth will be seen or treated as the wrong answer.

I’d suggest you consider why it’s so important that someone has not had any previous sexual partners. If when they did, they used latex barriers (like condoms), chances are good that their sexual health is just as good as your own (if you, yourself, have not had any previous sexual partners, and if you did, you yourself used barriers when you did). A person who has had previous sexual partners is no more or less likely to be satisfied with you as a sexual partner; no more or less likely to be a good overall partner; no more or less likely to stay in your marriage or leave it. A person who has had previous sexual partners is no more or less valuable a person than someone who has not. I understand there are some strong cultural messages that say differently, but I think it’s important everyone recognize those are inhumane ideas; they are not ideas that treat people with respect. They are ideas which need to be changed if any of us wants a culture where all people are treated humanely.

If and when there is one standard about this for women and another for men, that’s a double-standard. If you don’t feel it is vitally important a male spouse had no sexual partners before marriage, it’s not fair to feel it is for women. And if you did have sexual partners previously yourself, it’s an even more inequitable — and hypocritical — standard.

Zenab Eve Ahmed at the Guardian recently wrote:

Typically in Muslim families, with a strict ban on sex before marriage, girls still experience the patriarchal side of Islam in ways their brothers do not. The supporters of Islam tell me the west does not do things any better. They point out to the exploitation here of women by the men who run our pornographic and sex industries. They ask: is it better for girls to have the freedom to dress like sluts and to drink and fornicate like men do? My answer is that we are all, as women, struggling for self-determination in a world run by men, be they Muslim or Christian.

Sajad Ahmed Rana, fighting over the intact state of his daughter’s hymen, has sought to portray a dispute with his ex-wife over custody as a battle between cultures. For the likes of Mr Rana, the West is full of “repugnant” temptations that lead an obedient girl astray. I view his battle as nothing more than the age-old story of a male determined to dictate how a female lives her life. It felt like an old-fashioned war when it raged over my head 30 years ago and I can only hope the Muslim girls coming to terms with their own east/west dilemma today find their subsequent path through life smoother than I did.

I want to share a couple other recent questions with you we’ve seen, questions from women dealing with these kinds of ideas:

i want my virginity back. i am from india. will u please tell me where i have to go to complete the surgery.

i’m from syria – i am a virgin but my hymen is not right please i want to know about hymenoplasty sergery and also the name of doctors to make this surgery in damascus thanks awaiting please your quick replay

Hi. I’m 19yrs n a virgin until recently i had sex. But d first time my bf fingered me, he said m not a virgin. I need to know how is it dat a hymen doesn’t exist in me bcos i really want to free myself from his allegations that i ve had sex before which isn’t true. he was telling me that my vagina hole is loose and that his ex girl friends vagina hole was really really tight. why am I so loose for a virgin? he said that his ex girl friend that he was with her for two years never got loose like me and he could barely stick his pinky in cause it would hurt her and it hurted her. I don’t understand why her vagina is tighter then mine? now my boyfriend is always telling me that he isn’t going to do anything to me no more because im not a virgin and I wanna go to those vagina doctors so I can prove him and my mom wrong is there anyway you can help me find one?

I’m going to get married this summer and i’m not a virgin. I am of very traditional background and it means a lot for a women to be a virgin until she gets married. If she’s not, it will be something that will always be a problem with her and her husband. I don’t agree to this, and i always thought that i was going to marry someone who didn’t care about that, but now life has shown me otherwise. I know many women would say tell him the truth and if he really loves you he wont care. But my relationship with him is very traditional and my mother has always told me that i am to never tell him that i’ve been with someone already. Anyways, for the past couple weeks i’ve just been worried about my wedding night and if there are things that i could do to make him think i am. What can i do to make him believe i was a virgin before i got married.

Im from a country where culture, family traditions and religion does not allow you to have sex before marrige, if you do have sex then your doomed because your husband is going to find out the night of your wedding that you’re not a virgin when he has sex with you and leave you.

I included those letters to give you an idea of how women can suffer because of some of these ideas. Those letters are not as bad as it gets. The women with the least access to tools like the internet are often suffering even more, and are probably feeling even more scared, more isolated and more desperate.

I hope you can agree that women who feel they should consider unnecessary, painful, risky and often unsuccessful surgeries, who face suspicion and disdain from the very people who are supposed to love them the most, have been put in a terrible position no one should ever be put in. Put yourself in their shoes for a minute, or the shoes of your wives. I think it’s easy to recognize those are not shoes you’d want to be in, and then hopefully recognize that they’re not shoes you’d want to put someone you loved and valued in.

I am going to assume that your hope is that during the course of your marriage, you will have a relationship where both people and any children feel loved, happy, honored, accepted and respected. I am also going to assume you want your sex life within your marriage to be one in which both people feel comfortable, safe, cared for and also enjoy themselves. I am going to assume you want to value the person who you chose to marry, or who you accepted a marriage arrangement with, and want them to value you.

If those re things you want, you will best meet those goals by working to unload or unpack any ideas you have about women’s bodies being objects, being proof of something, being anyone’s sole property. You will meet those goals best by establishing and nurturing trust, which involves believing what a partner tells you and working on any of your own trust issues or problems which may get in the way. You will meet those goals best by ditching sexual or other double-standards you have about your partner or their gender. You will meet those goals best by remembering that whatever your partners past has or has not been, it has made them who they are in the present: that person you love and cherish is a product of the life she has lived.

I know it’s easy for Westerners to be relativistic, however, the same kinds of things I’m saying have been said by those who are not western, as well. East Asian women’s organizations and projects like the Gulabi GangThe Pink Chaddi Campaign and Blank Noiseare all projects/groups begun and run by women from South Asia which address these issues or some of what can stem from them. There have also been some changes nations have been making lately, like the Supreme Court of India ruling that if a person commits rape, neither a proposal of marriage nor any other settlement between the rapist and victim can condone him of the crime to change a very disturbing tradition of a woman being forced to marry someone who raped her.

I understand and respect placing value in one’s own culture and heritage. But I don’t think there’s a culture out there, nor has there ever been, which cannot stand to do some evolving, especially when we’re given new facts and perspectives our ancestors did not have. I don’t believe there is any culture at this time which is perfect, nor any which cannot benefit from questioning some of its beliefs, tenets or history. I don’t believe there is any culture at this time which could not stand to make some improvements for its people, especially the people in it with less rights and agency than others.

By now, all of our cultures have since accepted the world is round, not flat, even though for a long time, most held to very different beliefs. Many cultures which also once enabled, condoned or enacted abuses of its people, or some of its people, have since changed their views and practices, or have begun that process of change. I think we all can, and should, do the same with issues like this, especially if we want our world to be a peaceable place that is safe and loving for everyone in it.

Roundups Sexual Health

This Week in Sex: Some Men Base Condom Use on Women’s Looks

Martha Kempner

This week, a study suggests some men are less likely to have safer sex with women whom they find attractive. There's now a study of women's pubic hair grooming habits, and a lot of couples don't have wedding-night sex.

This Week in Sex is a weekly summary of news and research related to sexual behavior, sexuality education, contraception, STIs, and more.

Men Less Likely to Have Safer Sex If Partner Is ‘Hot’

The old adage “Never judge a book by its cover” is apparently easily forgotten when it comes to judging potential sex partners. A new study in BMJ Open found that men said they were less likely to use a condom if their potential partner was hot.

In this small study, researchers showed pictures of 20 women to 51 heterosexual men. The men were asked to rank how attractive the woman was, how likely they would be to have sex with her if given the opportunity, and how likely it was they would use a condom if they did have sex with her. The results revealed that the more attractive a man found a woman, the less likely he was to intend to use a condom during sex with her.

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Men also rated how attractive they consider themselves, and the results showed that this was also related to condom use. Men who thought of themselves as more attractive were less likely to intend to use a condom.

Researchers also asked the men to estimate how many out of 100 men like themselves would have sex with each woman given the opportunity and finally, how likely they thought it was that the woman in the picture had a sexually transmitted infection (STI).

The results of these two questions turned out to be related: The men assumed that women whom other men would want to sleep with were more likely to have STIs.

This did not make the men in the study any more likely to intend to use a condom with those women. In fact, the men were most likely to intend condom use with women they found less attractive, even though they considered these women less likely to have an STI.

This was a small study with a relatively homogenous group of men ages 18 to 69 near Southhampton, England, and it measured intention rather than behavior.

Still, the results could present a challenge for public health experts if men are making condom decisions on a broader scale based on attraction rather than risk assessment.

How and Why Women Groom Their Pubic Hair

A new study published in JAMA Dermatology is the first nationally representative survey of U.S. women’s pubic hair grooming habits. The study included more than 3,300 women ages 18 to 64.

Overall, 84 percent of women had engaged in some pubic hair grooming. Pubic hair grooming was more common among younger women (ages 18 to 24); among white women; and among women who had gone to college.

Before you start thinking everyone is out getting Brazilians, however, grooming means different things to different women. Only 21 percent of women said they took all their pubic hair off more than 11 times, and 38 percent of women say they’ve never done so. Moreover, waxing lags behind the most popular hair removal methods; only 5 percent of women say they wax compared with 61 percent who shave, 18 percent who use scissors, and 12 percent who use electric razors. (Respondents could choose more than one answer in the survey.)

Most women (93) do it themselves, 8 percent have their partners help, and 6.7 percent go to a professional.

The researchers were most interested in the most common reason women groom their pubic hair. The most common reason was hygiene (59 percent), followed by “part of my routine” (46 percent), “makes my vagina look nicer” (32 percent), “partner prefers” (21 percent), and “oral sex is easier” (19 percent).

Tami Rowen, the lead author of the study and a practicing gynecologist at the University of California, San Francisco, told the New York Times, “Many women think they are dirty or unclean if they aren’t groomed.”

But while people may think that, it’s not true. Pubic hair actually exists to help protect the delicate skin around the genitals. Rowen and other doctors who spoke to the Times believe that women, especially teenagers, are taking up grooming practices in response to external pressures and societal norms as reflected in images of hairless genitals in pornography and other media. They want young people to know the potential risks of grooming and say they’ve seen an increase in grooming-related health issues such as folliculitis, abscesses, cuts, burns, and allergic reactions. As some may remember, This Week in Sex reported a few years ago that emergency-room visits related to pubic hair grooming were way up among both women and men.

This Week in Sex believes that women should be happy with their genitals. Keeping the hair that grows does not make you dirty—in fact, it is there for a reason. But if shaving or waxing makes you happy, that’s fine. Do be careful, however, because the doctors are right: Vulvas are very sensitive and many methods of hair removal are very harsh.

Wedding-Night Sex May Be Delayed, But That’s OK With Most Couples

Summer is a popular wedding season, with couples walking down the aisle, exchanging vows, and then dancing the night away with friends and families. But how many of them actually have sex after the caterer packs up and the guests head home?

According to lingerie company Bluebella—about half. The company surveyed 1,000 couples about their postnuptial sex lives and found that 48 percent of them said they did “it” on their wedding night. Most women in those couples who did not get it on that night said they were just too tired. The men, on the other hand, said they were too drunk or wanted to keep partying with their friends. (It is unclear whether the survey included same-sex couples.)

By the next morning, another 33 percent of couples had consummated their marriage, but about 10 percent said it took 48 hours to get around to it.

But whenever couples did have that post-wedding sex, the overwhelming majority (84 percent) said it lived up to their expectations.

Analysis Maternity and Birthing

Pregnant Women Are Being Shackled in Massachusetts—Even Though It’s Been Illegal for Years

Victoria Law

According to a new report, not a single jail or prison facility in the state has written policies that are fully compliant with the law against restraining pregnant women behind bars.

Korianne Gamble was six months pregnant in November 2014 when she arrived at the Bristol County Sheriff’s Office Women’s Center, a jail in North Dartmouth, Massachusetts. Six months prior, the state had passed “An Act to Prevent Shackling and Promote Safe Pregnancies for Female Inmates.”

According to the new law, the jail should have been prohibited from using any type of restraint on Gamble during labor, and using of leg and waist restraints on her during and immediately after her pregnancy. It also guaranteed her minimum standards of pregnancy care and required—as with everyone incarcerated while in their second or third trimesters—that she be transported in the jail’s vehicles with seat belts whenever she was taken to court, medical appointments, or anywhere outside the jail.

But that wasn’t the case for Gamble. Instead, she says, when it came time for her to give birth, she was left to labor in a cell for eight hours before finally being handcuffed, placed in the back of a police cruiser without a seatbelt, and driven to a hospital, where she was shackled to the bed with a leg iron after delivering.

According to a new report, Gamble isn’t alone. Advocates have been monitoring pregnancy-related care since the law’s passage. After obtaining and analyzing the policies of the state’s prison and jail system, they found that no facility has policies that are fully compliant with the 2014 law. They issued their findings in a new report, Breaking Promises: Violations of the Massachusetts Pregnancy Standards and Anti-Shackling Lawco-authored by Marianne Bullock of the Prison Birth Project, Lauren Petit of Prisoners’ Legal Services of Massachusetts, and Rachel Roth, a reproductive-justice expert.

In addition to analyzing policies, they spoke with women who were pregnant while in custody and learned that women continue to be handcuffed during labor, restrained to the bed postpartum, and placed in full restraints—including leg irons and waist chains—after giving birth.

“The promise to respect the human rights of pregnant women in prison and jail has been broken,” the report’s authors concluded.

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Medical experts, including the American Congress of Obstetricians and Gynecologists, the American Medical Association and the American College of Nurse-Midwives, have all agreed that shackling during pregnancy is unnecessary, inhumane, and dangerous. Shackling increases the risk of falling and injury to both mother and fetus while also preventing medical staff from assessing and assisting during labor and delivery. In 2014, both the Massachusetts legislature and then-Gov. Deval Patrick (D) agreed, passing the law against it.

“The Massachusetts law is part of a national trend and is one of the most comprehensive in protecting pregnant and postpartum women from the risks of restraints,” said Roth in an interview with Rewire. “However, like most other states, the Massachusetts law doesn’t have any oversight built in. This report clearly shows the need for staff training and enforcement so that women who are incarcerated will be treated the way the legislature intended.”

Gamble learned all of this firsthand. In the month before her arrest, Gamble had undergone a cervical cerclage, in which a doctor temporarily stitches up the cervix to prevent premature labor. She had weekly visits to a gynecologist to monitor the development of her fetus. The cerclage was scheduled to be removed at 37 weeks. But then she was arrested and sent to jail.

Gamble told jail medical staff that hers was a high-risk pregnancy, that she had had a cerclage, and that her first child had been born six weeks prematurely. Still, she says she waited two months before seeing an obstetrician.

As her due date drew closer, the doctor, concerned about the lack of amniotic fluid, scheduled Gamble for an induction on Feb. 19, 2015. But, she says, jail staff cancelled her induction without telling her why.

That same evening, around 5 p.m., Gamble went into labor. Jail staff took her to the medical unit. There, according to Gamble, the jail’s nurses took her blood pressure and did a quick exam, but did not send her to the hospital. “They [the nurses] thought I was ‘acting up’ because my induction was canceled,” she told Rewire.

She was placed in a see-through cell where, as the hours progressed, her labor pains grew worse. “I kept calling to get the [correctional officers] to get the nurse,” Gamble recalled. By the time a nurse came, Gamble was bleeding. “The nurse made me pull down my pants to show her the blood—in front of a male [correctional officer]!” Gamble stated. Still, she says, no one called for an ambulance or made arrangements to drive her to the hospital.

At 1:45 in the morning, over eight hours after she first went into labor, the jail’s captain learned that Gamble was in labor. “[He] must have heard all the commotion, and he called to find out what was going on,” she said. He ordered his staff to call an ambulance and bring her to the hospital.

But instead of calling an ambulance, Gamble says jail staff handcuffed her, placed her in the back of a police cruiser without a seatbelt—in violation of the law—and drove her to Charlton Memorial Hospital. “My body was already starting to push the baby out,” she said. She recalled that the officers driving the car worried that they would have to pull over and she would give birth by the side of the road.

Gamble made it to the hospital, but just barely. Nine minutes after arriving, she gave birth: “I didn’t even make it to Labor and Delivery,” she remembered.

But her ordeal wasn’t over. Gamble’s mother, who had contacted Prisoners’ Legal Services and Prison Birth Project weeks earlier, knew that the law prohibited postpartum restraints. So did Gamble, who had received a packet in jail outlining the law and her rights from Prisoners’ Legal Services. When an officer approached her bed with a leg iron and chain, she told him that, by law, she should not be restrained and asked him to call the jail to confirm. He called, then told her that she was indeed supposed to be shackled. Gamble says she spent the night with her left leg shackled to the bed.

When the female officer working the morning shift arrived, she was outraged. “Why is she shackled to the bed?” Gamble recalled the officer demanding. “Every day in roll call they go over the fact that a pregnant woman is not to be shackled to anything after having a baby.” The officer removed the restraint, allowing Gamble to move around.

According to advocates, it’s not unusual for staff at the same jail to have different understandings of the law. For Gamble, that meant that when the shift changed, so did her ability to move. When the morning shift was over, she says, the next officer once again shackled Gamble’s leg to the bed. “I was so tired, I just went along with it,” Gamble recounted.

Two days after she had given birth, it was time for Gamble to return to the jail. Despite Massachusetts’ prohibition on leg and waist restraints for women postpartum, Gamble says she was fully shackled. That meant handcuffs around her wrists, leg irons around her ankles, a chain around her waist,g and a black box that pulled her handcuffs tightly to the waist chain. That was how she endured the 20-minute drive back to the jail.

Gamble’s jail records do not discuss restraints. According to Petit, who reviewed the records, that’s not unusual. “Because correctional officers don’t see it as out of the ordinary to [shackle], they do not record it,” she explained. “It’s not so much a misapplication of the extraordinary circumstances requirement as failure to apply it at all, whether because they don’t know or they intentionally ignore it.”

While Bristol County Sheriff’s Office Women’s Center’s policies ban shackling during labor, they currently do not prohibit restraints during postpartum recovery in the hospital or on the drive back to the jail. They also do not ban leg and waist restraints during pregnancy. Jonathan Darling, the public information officer for the Bristol County Sheriff’s Office, told Rewire that the jail is currently reviewing and updating policies to reflect the 2014 law. Meanwhile, administrators provide updates and new information about policy and law changes at its daily roll call. For staff not present during roll call, the jail makes these updates, including hospital details, available on its east post. (Roll call announcements are not available to the public.)

“Part of the problem is the difference in interpretation between us and the jurisdictions, particularly in postpartum coverage,” explained Petit to Rewire. Massachusetts has 14 county jails, but only four (and the state prison at Framingham) hold women awaiting trial. As Breaking Promises noted: “Whether or not counties incarcerate women in their jails, every county sheriff is, at minimum, responsible for driving women who were arrested in their county to court and medical appointments. Because of this responsibility, they are all required to have a written policy that spells out how employees should comply with the 2014 law’s restrictions on the use of restraints.”

Four jurisdictions, including the state Department of Correction, have policies that expressly prohibit leg and waist restraints during the postpartum period, but limit that postpartum period to the time before a woman is taken from the hospital back to the jail or prison, rather than the medical standard of six weeks following birth. Jails in 11 other counties, however, have written policies that violate the prohibition on leg and waist shackles during pregnancy, and the postpartum prohibition on restraints when being driven back to the jail or prison.

Even institutions with policies that correctly reflected the law in this regard sometimes failed to follow them: Advocates found that in some counties, women reported being restrained to the bed after giving birth in conflict with the jail’s own policies.

“When the nurse left, the officer stood up and said that since I was not confirmed to be in ‘active labor,’ she would need to restrain me and that she was sorry, but those were the rules,” one woman reported, even though the law prohibits restraining women in any stage of labor.

But shackling pregnant women during and after labor is only one part of the law that falls short. The law requires that pregnant women be provided with regular prenatal and postpartum medical care, including periodic monitoring and evaluation; a diet with the nutrients necessary to maintain a healthy pregnancy; written information about prenatal nutrition; appropriate clothing; and a postpartum screening for depression. Long waits before transporting women in labor to the hospital are another recurring complaint. So are routinely being given meals without fruits and vegetables, not receiving a postpartum obstetrician visit, and waiting long stretches for postpartum care.

That was also the case with Gamble. It was the middle of the night one week after her son’s birth when Gamble felt as if a rock was coming through her brain. That was all she remembered. One hour later, she woke to find herself back at the hospital, this time in the Critical Care Unit, where staff told her she had suffered a seizure. She later learned that her cellmate, a certified nursing assistant, immediately got help when Gamble’s seizure began. (The cell doors at the jail are not locked.)

Hospital staff told her that she had preeclampsia, a pregnancy complication characterized by high blood pressure. Postpartum preeclampsia is rare, but can occur when a woman has high blood pressure and excess protein in her urine soon after childbirth. She was prescribed medications for preeclampsia; she never had another seizure, but continued to suffer multiple headaches each day.

Dr. Carolyn Sufrin is an assistant professor of gynecology and obstetrics at Johns Hopkins Medicine. She has also provided pregnancy-related care for women at the San Francisco County Jail. “Preeclampsia is a leading cause of maternal mortality,” she told Rewire. Delayed preeclampsia, or postpartum preeclampsia, which develops within one to two weeks after labor and delivery, is a very rare condition. The patient suffering seizures as a result of the postpartum preeclampsia is even more rare.

Postpartum preeclampsia not only needs to be treated immediately, Sufrin said, but follow-up care within a week at most is urgent. If no follow-up is provided, the patient risks having uncontrolled high blood pressure, stroke, and heart failure. Another risk, though much rarer, is the development of abnormal kidney functions.

While Sufrin has never had to treat postpartum preeclampsia in a jail setting, she stated that “the protocol if someone needs obstetrical follow-up, is to give them that follow-up. Follow through. Have continuity with the hospital. Follow their instructions.”

But that didn’t happen for Gamble, who was scheduled for a two-week follow-up visit. She says she was not brought to that appointment. It was only two months later that she finally saw a doctor, shortly before she was paroled.

As they gathered stories like Gamble’s and information for their report, advocates with the Prison Birth Project and Prisoners’ Legal Services of Massachusetts met with Rep. Kay Khan (D-Newton), to bring her attention to the lack of compliance by both county jails and the state prison system. In June 2015, Khan introduced An Act to Ensure Compliance With the Anti-Shackling Law for Pregnant Incarcerated Women (Bill H 3679) to address the concerns raised by both organizations.

The act defines the postpartum period in which a woman cannot be restrained as six weeks. It also requires annual staff trainings about the law and that, if restraints are used, that the jail or prison administration report it to the Secretary of Public Safety and Security within 48 hours. To monitor compliance, the act also includes the requirement that an annual report about all use of restraints be made to the legislature; the report will be public record. Like other statutes and bills across the country, the act does not have specific penalties for noncompliance.

In December 2015, Gamble’s son was 9 months old and Gamble had been out of jail for several months. Nonetheless, both Gamble and her mother drove to Boston to testify at a Public Safety Committee hearing, urging them to pass the bill. “I am angered, appalled, and saddened that they shackled her,” Gamble’s mother told legislators. “What my daughter faced is cruel and unusual punishment. It endangered my daughter’s life, as well as her baby.”

Since then, both the Public Safety Committee and Health Care Financing Committee approved the bill. It is now before the House Committee for Bills in the Third Reading, which means it is now at the stage where it can be taken up by the House for a vote.

Though she has left the jail behind, Gamble wants to ensure that the law is followed. “Because of the pain I went through, I don’t ever want anyone to go through what I did,” she explained to Rewire. “Even though you’re in jail and you’re being punished, you still have rights. You’re a human being.”


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