Despite initial reports that Chelsea Manning would be provided with basic transition services while serving at Leavenworth Prison, she has revealed that the military has declined to meet her medical needs, leaving her struggling with gender dysphoria. This comes over requests from attorney and recommendations from her doctor that she receive transition treatments immediately, along with any other health care services she may need.
The situation highlights a plight experienced by many transgender prisoners, who often experience a denial of access to care while in the prison system, in addition to systemic discrimination like being housed with people of the wrong gender, referred to by the wrong name, and deliberately misgendered by prison guards and staff.
Caselaw and individual precedent on the provision of transgender services to individual prisoners varies. Some prisons will continue to provide hormone therapy at the dose used prior to incarceration, reflecting a policy that maintains a baseline for prisoners — but may not reflect the need to adjust or slowly ramp up hormones over the course of transition. Furthermore, prisons generally don’t offer gender confirmation surgery even when there is a clearly demonstrated medical, psychiatric and personal need. Prisons typically don’t offer ongoing psychotherapy, sessions with an endocrinologist to monitor hormone levels, and other procedures like laser hair removal as well as voice training and other therapeutic options used by some members of the trans community during transition.
This falls into a larger framework of denying health care to prisoners, a historically highly marginalized group when it comes to accessing both physical and mental health services. Despite the fact that prison can be a highly dangerous environment, prisoners have trouble getting care to help them manage chronic conditions like HIV/AIDS, diabetes and asthma that were preexisting before they arrived in prison. Prisoners who contract new chronic illnesses or develop health care problems are also typically underserved. Mental health services across the prison system are notoriously bad — even though prison can exacerbate mental health conditions or trigger episodes of depression, psychosis and other mental health emergencies.
At times, access to health care is used as a tool of control, with prisoners having care withheld if they fail to “behave.” This creates a dangerous precedent for prisoners who need stable and consistent access to care in order to control chronic conditions or address immediate medical crises, like Sarah Tibbets, a diabetic prisoner who died after officials refused to provide her with insulin.
When Manning requested hormone therapy and other transition services, they were initially denied. Trapped at Leavenworth, an all-male prison, she was in an uncomfortable and potentially dangerous position both physically and mentally, as she wasn’t able to get the care she needed and she was placed with prisoners of the wrong gender. Manning reports that during her time at Leavenworth, she has been treated disrespectfully and staff refuse to acknowledge her gender identity:
“In my daily life I am reminded of this when I look at the name on my badge, the first initial sewed onto my clothing, the hair and grooming standards that I adhere to and the titles and courtesies used by the staff,” Manning says, according to the BBC. Despite pressure from the ACLU as well as her own attorney, the military has remained vague on what kind of treatment it will provide, if any, and hasn’t committed to offering consistent treatment to Manning during her prison term. The ACLU argues that this is a case of cruel and unusual punishment, and Leavenworth could potentially be on the hook for violating Manning’s constitutional rights.
While public opinion may be split on Manning as hero or traitor, one thing is for certain: Prisoners deserve access to health care, no matter why they’re in prison. The continued denial of transition services to Manning is a blotch on America’s civil rights record — and a stark testimony to the abuse transgender prisoners endure.
Photo credit: Timothy Krause.