Advocacy Update

A Call to Action: Adolescent Health Experts Must Join the Fight to End Period Poverty

By Shelby Davies, MD

In spring 2020, a colleague approached me about a patient in her late teens who badly needed menstrual products and could not afford them. She was dependent on the pads she received from her school, which was now closed due to the pandemic. She often needed to use toilet paper as a replacement, which was both annoying and embarrassing. Knowing my interest in the area, my colleague asked if I had any resources to share.

 I had learned how to take a proper menstrual history on a patient, but, until recently, I focused on evaluation and treatment of menstrual disorders and not on the financial toll that periods can have on young people who menstruate. Unmet menstrual hygiene needs are an unrecognized health inequity. We know that poor menstrual hygiene can lead to physical health risks and has been linked to reproductive and urinary tract infections. Many young menstruators have limited options for affordable menstrual products, an issue known as period poverty.
 
While many societies celebrate menarche as an important rite of passage, some perceive the act of menstruation and management of menstrual blood as polluting and taboo. Much of the discourse around menstrual hygiene management has occurred primarily in low- and middle-income countries where youth who menstruate often withdraw from the public sector, including school and work, to maintain privacy and conform to cultural standards. Menstruation is the source of deep gender inequalities. Early momentum around menstrual hygiene management came from efforts to close the gender gap in education, which helped shift menstruation from an individual experience to a political problem worthy of governmental attention.
 
The experiences around menstruation for American women who live in poverty are similar to those in low- and middle-income countries. Previously published survey data indicate that low-income American youth struggle to afford menstrual products and miss class time due to lack of access to menstrual hygiene products.^1-3 Unfortunately, government benefits, such as the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), do not cover the cost of these necessary supplies.

Since the COVID-19 pandemic, one in three parents of menstruating youth worried about their ongoing ability to afford period products.⁴ While the Coronavirus Aid, Relief, and Economic Security Act, signed into law on March 27, 2020, made period products medical expenses eligible for purchase with flexible spending accounts or health savings accounts, uninsured or publicly insured individuals cannot access this benefit.
 
India, Australia, South Africa, Colombia, Malaysia, and, most recently, the United Kingdom have eliminated the tax on menstrual products.⁵ In November 2020, Scotland became the first country to make period products freely available to all who need them. In the United States, there are still 30 states that tax menstrual products as a luxury item.⁵ To put this into perspective, Hawaii has a tax on tampons, but erectile dysfunction pills are untaxed. The sales tax on menstrual products applies only to those who menstruate, and thus this is sex-based discrimination.

So far in 2021, there are almost 20 bills that have been introduced in nine states to advance menstrual equity by requiring free access to period products, eliminating the sales tax, and requiring ingredient disclosure.⁶ The White House recently announced plans for a Gender Policy Council to address issues related to women’s lives, including national security, health care and economics, and we must urge the White House to consider menstrual equity as a critical part of this conversation. 
 
While medical organizations, such as the American Medical Women’s Association, have announced public support for ending period poverty, few systemic changes have been proposed within the medical community.⁷ Adolescent health providers often support adolescents who may have an increased demand for menstrual products compared to adults due to unpredictable and irregular menses during puberty.
 
As adolescent medicine experts and advocates, we must do more to recognize and ameliorate the unwarranted financial burden of menstruation. The dismantling of systemic stigmatization, gender discrimination, and impoverization of menstruation can begin with us. We must work with institutional, local and state partners to inform existing and new policy, including sexual health education legislation and menstrual equity legislation. In doing so, our menstruating youth may be able to see menstruation as a healthy bodily function and not a source of gender shame and burden.
 
We propose the following action steps to help accomplish these goals:
 

1. Help eliminate the tampon tax. Visit Tax Free. Period. to learn more about joining the largest sales tax protest in modern history.
2. Explore the ways you can get involved at both an individual level and organizational level at Period: The Menstrual Movement.
3. Join the global movement to end menstrual stigma, expand access to educational opportunities, and create lasting change at The Pad Project.

 
The patient encounter here was previously published in a blog post for the PolicyLab at the Children’s Hospital of Philadelphia.
 
References
 

1. State of the Period: The Widespreak Impact of Period Poverty on US Students.; 2019. Accessed: April 20, 2020.
2. Wall LL. Period Poverty in Public Schools: A Neglected Issue in Adolescent Health. J Adolesc Health. 2020;67:315-316.
3. Sebert Kuhlmann A, Key R, Billingsley C, et al. Students’ menstrual hygiene needs and school attendance in an urban St. Louis, Missouri, district. J Adolesc Health. 2­­020;67:444-6.­­
4. Help Always #EndPeriodPoverty So No Period Holds Her Back. Available at: https://always.com/en-us/about-us/end-period-poverty. Accessed: 03/28/2021.
5. Tax Free. Period. Available at: https://www.taxfreeperiod.com. Accessed: 4/1/2021.
6. McConnell J. Period Health Policies: Is Your State Working to Make Menstrual Equity a Priority? Women’s Voices for the Earth. Available at: http://www.womensvoices.org/2021/01/11/period-health-policies-is-your-state-working-to-make-menstrual-equity-a-priority/. Accessed: 4/1/2021.
7. Alvarez A. Period poverty and what we can do about it. American Medical Women’s Association. Published 2019. Accessed August 18, 2020. https://www.amwa-doc.org/period-poverty/