Addressing Period Poverty in Our Communities
Many of us have had a moment when we realize it is “that time of the month” while at work or in class, and we feel relieved to find a spare pad or tampon at the bottom of our bags. We may even have had a situation where we couldn’t find that spare and there was no way to access any pad or tampon within close proximity for the day. Unfortunately, that is too often the reality for many people who experience menstruation. For many of these individuals, the undersupply of period products is not a fault of their own but a systematic failure to provide adequate accessibility and distribution of these necessary products.
According to Bernadette Hensen, PhD., the term “period poverty” is often used to describe the difficulty surrounding access to menstrual health products, particularly for low- and middle-class-income areas. An article in The Lancet Regional Health–Americas reports that on a global scale, over 500 million individuals are forced to experience their menstrual cycle without suitable access to menstrual hygiene management. These numbers have most likely increased after the onset of the COVID-19 pandemic, in which resources shifted toward mitigation of the infectious disease rather than menstrual health services.
Period poverty is a national and global issue, and it can be more than the lack of access to menstrual health products. It also involves insufficient education and awareness of proper hygiene methods and the natural biological occurrence itself. For example, a cross-sectional survey in Ethiopia that was implemented by Dr. Hensen found that “28% of adolescents aged 10 through 19 did not have information on menstruation and menstrual hygiene before menarche; 60% had poor menstrual hygiene practices, with only 42% using commercially made pads.” Many individuals who experience period poverty must revert to unhygienic methods, which can increase the risk of urogenital infections. Sustainable products such as reusable period pads or washable period cups have been made more available to the public in stores; however, these products require other resources like clean water or electricity that may not be obtainable and leave individuals back to square one.
The Lancet Regional Health–Americas also states that widening gaps in care, access, and education also impact menstruating individuals’ mental health as “menstruation is directly related to human dignity.” Negative sentiments towards menstruation can be perceived and internalized by menstruating individuals as a shameful topic early in life, which may lead to insecurity and low self-esteem. Differing cultural beliefs or traditions that may hold negative beliefs about menstruation can also significantly impact an individual’s perception of themselves. Circulating misinformation and the scarcity of discussions within the family only exacerbate the vulnerability of menstruating individuals with no resources or trusted individuals to turn to, leaving them to bear the burden alone. With the significant physical and mental health impact menstruation may present for an individual without necessary resources, it’s essential to focus on this long-ignored community to achieve health equity for all.
The shortage of menstrual product access is one of great concern in Massachusetts and in the US as a whole. As of August 2023, only 20 states require free feminine hygiene products in school, and unfortunately, Massachusetts is not one of them. Fortunately, advocates all around the world are striving to reduce period poverty by making significant reforms to change the current situation. Organizations aspiring to cultivate supportive and engaging environments to address these issues outside of the US include Small Acts for Sustainability, The Pad Project, Dignity Period, and Project Dignity.
- As of 2019, Brookline is the first municipality in Massachusetts to offer free tampons and pads in all its town-owned restrooms.
- As of October 26th, the I AM Bill (S.1381) has unanimously passed in the Senate which provides free menstrual products to all menstruating individuals in schools, homeless shelters, and correctional institutions in Massachusetts. The language of the bill emphasizes convenient access to these critical products without any stigma being imposed on individuals.
- In a news story for CBS News Boston, Courtney Cole reports on a Somerville-based company called Egal that is uniquely tackling period poverty by designing a product that provides free sanitary products as simply “as refilling a roll of toilet paper.” The company’s solution is to have pads on a roll with perforated plastic covers, so each pad can easily be separated. That prevents individuals from needing vending machines or coins to access menstrual products. As of August 2023, Egal’s product is available at the University of New Hampshire, and the Cambridge Public Schools are testing out a pilot program. The company hopes the product will ultimately expand to every public space.
- In accordance with Boston Mayor Michelle Wu’s mission to de-stigmatize periods, the Office of Women’s Advancement recently launched an initiative offering free menstrual pads and tampons in bathroom dispensers at six of the Boston Public Library branches (Costa-Klipa, 2023). The goal is to make menstrual products part of everyday life, as stated by Alexandra Valdez, the director of the Office of Women’s Advancement, “The same way that we see toilet paper, the same way that we see hand sanitizers everywhere, we should be thinking around the same way how we see menstrual products in our own cities.” The program’s next step is to expand to all 26 library branches and city-owned buildings. The program also partners with monthly informational workshops at each participating library branch.
While it’s important to talk about menstrual health on a larger scale, there are subsections within this topic that are important to address, such as individuals who experience reproductive conditions like uterine fibroids and endometriosis. These are two diseases that can often lead to prolonged and heavy bleeding and therefore require the purchase and use of much more menstrual products.
Uterine Fibroids
What are uterine fibroids?
Fibroids are muscular tumors that grow in the uterus wall and are almost always benign, meaning not cancerous. According to Steve Eisinger, M.D., some women don’t experience symptoms while having fibroids, but those who do tend to experience pain and heavy menstrual bleeding. They can be located on the surface of the uterus (submucosal), in the wall of the uterus (myometrial), just outside the covering of the uterus (subseroal), or in the uterine cavity (penduculated). Impacting millions of individuals worldwide, uterine fibroids affect about 75% of reproductive-aged women. Outi Uimari, MD. PhD., examined this impact by conducting a study of 1,346 randomly selected women between the ages of 35 and 49. The results display uterine fibroids to affect an estimated 60% of African American women by age 30. The percentage of African American women who were affected by fibroids by age 35 increased to over 80% compared to Caucasian women with 40%. Unfortunately, comprehensive treatment plans are not always offered as many prescribed solutions focus only on the control of symptoms. For further information regarding this disease, please check out RSP’s webpage on uterine fibroids. It’s important to note that the symptoms of uterine fibroids can be very similar to the symptoms of endometriosis.
- excessive or painful bleeding during period
- bleeding between periods
- a feeling of fullness in lower belly (abdomen)/bloating
- frequent urination
- pain during sex
- lower back pain
- constipation or feeling pressure on your rectum
- long-term vaginal discharge
- inability to pee or completely empty your bladder
- increased abdominal enlargement
Endometriosis
What is endometriosis?
Affecting over 176 million individuals worldwide, endometriosis is a disease in which tissue normally found in the uterus is found outside the uterus. These patches of tissue can be located on or under the ovaries, on the fallopian tubes, behind the uterus, on the tissues that hold the uterus in place, on the bowels, or bladder. Contrary to tissue inside the uterus which sheds during a menstrual cycle, the tissue outside the uterus does not, and it produces a buildup of abnormal tissue. The buildup of this tissue outside the uterus can provoke a constant inflammatory response that may bring scarring, angiogenesis, adhesions, fibrosis, and other conditions.
- Angiogenesis is the process through which new blood vessels form from pre-existing vessels. It can support the growth and spread of tumors within people who have cancer or exacerbate endometriosis.
- Adhesions are bands of scar tissue that form inside the abdomen, which “stick” organs and tissues together that are not usually connected.
- Fibrosis is the development of fibrous connective tissue as the body responds to injury or damage. For individuals experiencing endometriosis, the buildup of abnormal tissue outside the uterus can prompt the buildup of fibrous tissues between reproductive organs which also makes them “stick” together.
Heather Guidone, a Board Certified Patient Advocate, describes endometriosis as “a riddle wrapped in a mystery inside an enigma” because of its complexity and our little progress thus far in understanding the disease. Endometriosis can be found at the root of painful menstrual cycles for some individuals. The wide-ranging symptoms have brought dismissals by practitioners due to an absence of disease literacy and awareness. These diagnosis delays can negatively impact women suffering with endometriosis. Along with the general stigma of menstrual health, endometriosis comes with its own set of stigmas for women with the disease. The classic symptoms of endometriosis can make it difficult for menstruating individuals to question if their menstrual pain is “normal.”
Endometriosis also remains an underdiagnosed disease due to the unavailability of public education concerning pelvic pain and menstrual-related disorders. Misinformation affects these diagnoses as many healthcare workers transform this pain into “imaginary” situations that can impact a woman’s sense of reality and identity. Healthcare encounters should be safe settings for patients to advocate for their health, yet according to Guidone many women end up “question[ing] their perception of the severity of the symptoms and ultimately their own sanity; mainly due to not being believed by medical practitioners and other lay people.” The average diagnostic delay for endometriosis is around 7.5 years with seeing multiple health practitioners, and that is too long for women to face these symptoms without proper acknowledgment and treatment. For further information, visit RSP’s endometriosis webpage.
- Painful menstrual cramps
- Infertility
- Diarrhea or constipation during a menstrual period
- Fatigue or low energy
- Heavy or irregular periods
- Pain with urination or bowel movements during a menstrual period
- Spotting or bleeding between menstrual periods
Tackling Period Poverty
An individual’s menstrual health experience should not be a burden due to a lack of information or resources. Rather, menstrual health should have the same significance as other areas of health when it comes to the amount of time and funding dedicated to research. Menstruating individuals have been silenced for too long. Endometriosis and uterine fibroids, among many other reproductive diseases and conditions, may already prohibit individuals from participating in everyday activities. Striving toward a better understanding and increased awareness can help end period poverty. Because menstrual health issues can arise in individuals from a young age, timely education and resources should be prepared ahead of time.
Based on my research, I believe community effort is one of the best methods to combat period poverty and disproportionate access to menstrual health resources. Using the social networks of community centers and schools could enable individuals of all ages and backgrounds to access the same level of reliable information and sufficient resources. Just as many of us are required to do scoliosis screenings or eye exams, there should be those same screenings for menstruating individuals to check for any issues that may arise and to provide guidance through their journey. Community-based hubs can also offer support for adolescents who may have less agency and financial autonomy to access menstrual health products. Dr. Hensen suggests that placing interventions in these kinds of settings can aid in reducing economic barriers by offering period products at lower prices or free of charge.
Additionally, I believe corporations that make menstrual products could make a difference in increasing the accessibility of their products, lowering their prices, and evaluating how their reach can be broadened. That could include hosting giveaways of menstrual health products in disproportionately underserved communities or having coupons accessible to individuals with lower socioeconomic levels.
What else can we do?
- A three-pronged approach was developed by the Young Female Health Initiative and Safe-D studies which collected data from women aged 16-25 through clinical and self-reported data to evaluate the prevalence and severity of dysmenorrhoea—the medical term used to describe painful menstrual periods. According to Guidon, the model consists of having a school nurse provide educational leaflets to increase awareness, encourage health professionals to be proactive about any painful symptoms, and facilitate collaboration between health professionals and reliable authoritative websites for additional guidance.
- Another idea brought up by Guidone is to have school health teams provide students with screenings for menstrual disorders. This is accompanied by extending educational programs to help parents and school leaders gain knowledge.
- A documentary called “Endo What” is a school nurse initiative founded by Shannon Cohn, a documentary producer and activist, that aims to provide a tool for women and healthcare providers to raise awareness of endometriosis education and discard social stigma.
- For challenges faced by low-resource and medically-underserved communities, local governmental agencies and healthcare institutions can use community-based efforts such as integrating secure messaging applications into clinical visits or acquiring IT or digital health tools to enhance patient knowledge and self-management.
- For states that maintain a “tampon tax” so that period products are taxed as luxury goods, removing these taxes recognizes these products as basic necessities and broadens accessibility.
- Engage in individual or group advocacy efforts to spread awareness of period poverty and urge local governments or authority figures to cultivate conversations on how to increase accessibility to menstrual hygienic products and promote education.
Let’s create a society where menstruating individuals have one less thing to worry about each month. Let’s bring forth critical conversations around menstrual communication and shine a spotlight on those affected by period poverty.