Outlook: Newsletter of the Society of Behavorial Medicine

Spring 2025

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Period Politics: Policies to address Period Poverty

Grace Biermann1, MPH; Anna M. Strahm1,2, PhD - Women's Health SIG

Period poverty is defined as the lack of access to affordable, safe menstrual products.1 While several states have legislation that ensures people have access to affordable menstrual products, such policies are missing in many states and at a national level. As of September 2024, 28 states and Washington D.C. have enacted laws providing free period products in schools, while 25 states have passed policies requiring free menstrual products in correctional facilities, and 3 states require free products be made available in homeless shelters.2 At the federal level, all federal correctional facilities are required to provide free menstrual products.2 Additionally, with the passing of the Coronavirus Aid, Relief, and Economic Security (CARES) Act in 2020, period products can be paid for using a Flexible Savings Account or Health Savings Account.2

Barriers to Period Products

  • Physical availability3
  • Affordability4
  • Education/Attitudes5

Period Poverty is a Public Health Issue

  • Physical health consequences of period poverty include increased risk of infections, endometriosis, polycystic ovarian syndrome, and infertility.6
  • Research suggests an association between period poverty and feelings of shame/embarrassment7 and depression.8
  • Period poverty also affects social wellbeing. It may cause individuals to miss work or school, thereby affecting educational attainment and financial stability/socioeconomic status.9

Policy Examples

  1. Free Period Products in Schools: Studies show period poverty negatively affects school attendance and academic performance.10 On the Pine Ridge Reservation in western South Dakota, many Indigenous students experience chronic period poverty because of a lack of financial resources.11 Utah passed a law requiring the provision of free menstrual products in all school restrooms.12  Free menstrual products in school bathrooms could improve menstruating students’ ability to attend classes and learn. It would be moderately feasible to add school-based menstrual products to the state budget, as it costs about five to seven dollars per year per student to provide free tampons and pads.13
  2.  Free Period Products in Prisons: As of 2021, Mississippi requires correctional facilities to provide inmates with free tampons and sanitary napkins.14 Many female inmates across the country report that menstrual products are often withheld as a form of control or coercion.15By enforcing policies that require prisons to provide sufficient free tampons and pads, menstrual products can no longer be used as a weapon. Increasing access to menstrual products in correctional facilities can decrease the incidence of vaginal infections and toxic shock syndrome, thereby improving the health of female inmates.
  3. Eliminate Sales Tax on Menstrual Products: Menstrual products have been exempt from sales tax in Nebraska since 2022.16 Repealing sales tax on period products may improve menstrual health and equity by increasing access to necessary products. This policy is economically feasible in some states. For example,economists predicted that South Carolina would only lose 5.9 million dollars of their 4.1-billion-dollar annual sales tax revenue if they eliminated the tampon tax.17 However, a policy like this may be less feasible in states such as South Dakota, which relies so heavily on sales tax for revenue.

Conclusion

Period poverty is a neglected public health issue that is on the rise in the United States.1 Increasing access to period products may decrease menstruating people’s risk of urogynecological infections, improve school/work attendance and performance, and decrease feelings of stress, shame, or embarrassment.1 Policies that provide free menstrual products in schools and prisons are potential solutions to fill the gap in period poverty policy.

Affiliations:

  1. Behavioral Sciences, Sanford Research, Sioux Falls, SD, USA
  2. Department of Obstetrics & Gynecology; Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, USA

References:

  1. Mann, S. & Byrne, S. K. (2023). Period Poverty from a Public Health and Legislative Perspective. International Journal of Environmental Research and Public Health, 20.
  2. American College of Physicians. (2024). Advocacy Toolkit: Period Poverty. American College of Physicians. https://www.acponline.org/advocacy/state-health-policy/advocacy-toolkit-period- poverty#:~:text=Currently%2C%2028%20states%20and%20DC,no%20costs%20in %20homeless%20shelters.
  3. Hunter, E., Palovick, K., Teni, M. T., & Kuhlmann, A. S. (2022). COVID-19 made it harder to    access period products: The effects of a pandemic on period poverty. Front Reprod Health, 10(4).
  4. UN Women. (2024). Period Poverty – why millions of girls and women cannot afford their periods. UN Women. https://www.unwomen.org/en/news-  stories/explainer/2024/05/period-poverty-why-millions-of-girls-and-women-cannot-afford-their-periods
  5. Garg, S. & Anand, T. (2015). Menstruation related myths in India: strategies for   combating it. J Family Med Prim Care, 4(2), 184 – 186.
  6. Jaafar, H., Ismail, S. Y., & Azzeri, A. (2023). Period Poverty: A Neglected Public Health Issue. Korean Journal of Family Medicine, 44, 183-188.
  7. Henry, J. E. (2022). Period Stigma and the Unacknowledged System of Oppression. Stanford University. https://digitaleducation.stanford.edu/period-stigma-and-unacknowledged-system-oppression
  8. Cardoso, L. F., Scolese, A. M., Hamidaddin, A., & Gupta, J. (2021). Period poverty and mental health implications among college-aged women in the United States. BMC Women’s Health, 21.
  9. Hennegan, J., OlaOlorun, G. M., Oumarou, S., Alzouma, S., Guiella, G., Omoluabi, E., & Schwab, K. J. (2021). School and work absenteeism due to menstruation in three West African countries: findings from PMA2020 surveys. Sexual and Reproductive Health Matters, 29(1).
  10. Great Plains Tribal Leaders’ Health Board. (2019). What is period poverty? Native American women work to address issue. Great Plains Tribal Leaders’ Health Board. https://www.greatplainstribalhealth.org/native-american-healthcare-scholars-program-news/what-is-period-poverty-native-american-women-work-to-address-issue-129.html
  11. Cotropia, C. A. (2019). Menstruation Management in United States Schools and Implications for Attendance, Academic Performance, and Health. Women’s Reproductive Health, 6(4).
  12. Khurana, M. (2021). The case for free tampons and pads in schools. National Public Radio. https://www.npr.org/2021/12/02/1056830306/free-tampons-public-schools
  13. Utah State Legislature. (2022). H.B. 162 Period Products in Schools. Utah State Legislature. https://le.utah.gov/~2022/bills/static/HB0162.html
  14. Mississippi Legislature. (2021). House Bill 196. Mississippi Legislature. https://billstatus.ls.state.ms.us/2021/pdf/history/HB/HB0196.xml
  15. Tapp, K. & Henson, A. (2024). “For men, by men”: Menstrual victimization and the weaponization of period products in carceral settings. Womens Health, 20.
  16. Nebraska Legislature. (2022). LB984 – Change sales and use tax collection fees, provide a sales and use tax exemption for net wrap and feminine hygiene products, and require detention facilities to provide feminine hygiene products to female prisoners free of charge. Nebraska Legislature. https://nebraskalegislature.gov/bills/view_bill.php?DocumentID=47455
  17. Elsesser, K. (2023). States and Retailers Take A Stand Against The ‘Tampon Tax.’ Forbes. https://www.forbes.com/sites/kimelsesser/2023/05/18/states-and- retailers-take-a-stand-against-the-tampon-tax/