Kwaneta Harris had hot flashes and lapses of memory. She didn’t feel right and didn’t know why. “It felt like my body was completely betraying me,” she wrote. “I felt like I was losing my mind.” The cause wasn’t the eight years she’d spent in solitary confinement in a Texas prison. She was going through menopause. She didn’t understand it. And Texas officials wouldn’t allow her access to books or written materials on women’s health.

Millions of people in prison are denied access to books, newsletters, texts, and other printed health information that is readily available to those of us on the outside. This censorship – too often subjective and unnecessary – harms incarcerated people and denies them the critical opportunity to be informed about their bodies and to access education.

Harris, a mother of three and former nurse who has spent the past 17 years in prison recently wrote about how other women in solitary confinement are similarly uninformed about their health, isolated from each other and unable to access health care or information as they age. They are left in the dark and expected to navigate the complex health care landscape on their own.

For the majority of people in prison, access to the internet is strictly prohibited, making printed materials the only sources of health information outside of infrequent and inadequate access to health care providers. “They [the prisons] won’t help us,” Harris says. “And they won’t let us help ourselves through education.” Something needs to change, and medical professionals are well positioned on the outside to take a stand against carceral censorship and the harm it inflicts on patients.

Why does carceral censorship exist? Supposed reasons range from concerns about inciting violence to promoting subversive behavior and providing sexual gratification. Over the years, Harris has repeatedly asked for access to anatomy, physiology, and women’s health resources in her prison, including the Menopause Manifesto, a New York Times Best Seller touted as an essential guide to menopause. Her requests have been denied due to the “sexually explicit images” featured in these texts.

The censorship of health literature in prisons is a longstanding and growing nationwide problem, resulting from inconsistent and poorly defined policies surrounding what is considered “appropriate” versus “inappropriate” content. Kansas’ banned literature list includes The Pill Book, which provides FDA-approved information on more than 1,800 commonly prescribed medications. Connecticut bans the book Trans Bodies Trans Selves, a resource guide for transgender, nonbinary, and gender-expansive populations.

We are doctors and bioethicists in Philadelphia, passionate about this topic because we have seen how censorship harms patients in prison through our work with Prison Health News (PHN), a non-profit, health information network that provides a quarterly free health newsletter distributed to more than 5,000 subscribers who are incarcerated. PHN is the only organization that responds to requests for health information from people in prisons and jails everywhere in the United States.

Over recent years, PHN’s newsletters have been censored across multiple states. Their Spring 2023 newsletter issue included articles about COVID-19 testing, mental health, and prostate health. It was impounded by the Florida Department of Corrections because a diagram depicting the anatomy of a prostate was considered “nudity.” The diagram was included to accompany a Q&A article about causes and treatments for an enlarged prostate, including prostate cancer, a common and potentially life-threatening disease that may go undiagnosed if patients do not recognize the symptoms.

Suzy Subways, an organizer with PHN, says, “People in prison are hidden away, and people outside don’t know what happens to people inside. The censorship of PHN makes this segregation even more extreme. If there is a mail slot in someone’s cell door, that is the only way for them to get information and communication from the outside world.”

Restricting access to health information robs patients of their autonomy. People in prison have the same rights as those on the outside to access health care and make informed decisions about their bodies. Censorship violates these rights and perpetuates the disparities and poorer health outcomes associated with incarceration. Without intervention, they will continue to suffer.

We urge medical professionals to raise their voices and join the fight to end carceral censorship. Form state or national committees with medical representation to help assess what is appropriate versus inappropriate health information. Send an email to your state elected officials calling for them to enact laws that make carceral censorship illegal. Share this information through your networks to raise awareness and expand these advocacy efforts. It could mean the difference between life and death for people in prison.

Hannah Calvelli and Olivia Duffield are medical students. Brian Tuohy is an assistant professor of bioethics.