Period Poverty in the United States

womenpovertysexual health/violence

Feb 10

Written By Katie Krumperman

A group of women sitting on an orange couch

By Katie Krumperman

Published Winter 2023

Special thanks to Alyssa Augustus for editing and research contributions.

Summary+

Period poverty is the lack of access to menstrual products and inadequate education surrounding menstruation. Period poverty affects menstruators worldwide, including those in the United States. In a 2019 study, 64% of menstruators noted that they struggled to afford menstrual products within the last year. ¹ Stemming from the cost of products, stigmas, education, and the world pandemic, those who menstruate struggle to afford menstruation products and have adequate education on the subject. The effects of period poverty include effects on menstruators’ physical and mental health as well as their productivity at work. Lawmakers are fighting to end period poverty with the Menstrual Equity Law. Reusable products are also becoming popular and affordable for menstruators to use, which is helping end period poverty in the United States.

Key Takeaways+

Period poverty, or the lack of information and education about menstruation as well as access to menstrual products, in the US affects all menstruators but especially those who are low-income, homeless, in college, imprisoned, or transgender. ¹⁰⁰
With the recent inflation problems, Bloomberg reported that prices for pads rose 8.3% and tampons prices rose 9.8% in 2021. ¹⁰¹
A study done by St. Louis University on period poverty found that 36% of those surveyed who were full-time or part-time employed had to miss one or more days of work a month because of a lack of menstrual products during their periods. ¹⁰²
Research done on the financial benefit of using menstrual cups estimates over 10 years found that a reusable cup would be 5% of the purchase of pads and 7% of the purchase cost of tampons. A reusable cup would also produce 0.4% of the plastic waste used for pads and 6% of the plastic waste used for tampons. ¹⁰³

Key Terms+

Bacterial Vaginosis (BV)—“Common vaginal infection that happens when some normal bacteria that lives in the vagina overgrows, causing a bacterial imbalance. Symptoms include an off-white or gray vaginal discharge that smells fishy.” ²

Menstruator—Term used to describe those who menstruate.

Menstrual products—Products that are used during the menstrual cycle, such as pads and tampons.

Period poverty—“Inadequate access to menstrual tools and education, including but not limited to sanitary products, washing facilities, and waste management.” ³

Reusable menstrual cup—A small, flexible funnel-shaped cup made of rubber or silicone that you insert into your vagina to catch and collect period fluid. ⁴

Stigma—A set of negative and often unfair beliefs that a society or group of people have about something. ⁵

Tampon tax—“a charge on menstrual products meaning they have a value-added tax or sales tax.” ⁶

Toxic Shock Syndrome (TSS)—A rare but potentially life-threatening condition caused by certain strains of bacteria that produce poisons (toxins). These toxins get into your bloodstream and can affect organs such as your heart, liver, or kidneys. ⁷

Context

Q: What are periods?

A: Periods occur when the female body prepares itself for pregnancy, and the egg is not fertilized, causing the lining of the uterus to shed through the vagina, resulting in blood flowing out of the vagina.⁸ Many menstruators experience cramps, lower back pain, bloating, and other symptoms during menstruation.⁹ Most people start at the age of 12 but can start as early as 8 years old.¹⁰ Periods usually come every 21 to 35 days and last from 2 to 7 days. However, everybody is different, and these numbers can vary.¹⁰ Menstrual products include tampons, pads, and reusable cups, which are used to catch menstrual flow. Seventy percent of people who menstruate use tampons and will go through an average of 20 tampons per cycle.¹² Reusable products are a recent development in the world of menstrual products and will be discussed later in the brief as a way to help decrease period poverty.

Q: What is Period Poverty?

A: Period poverty is the lack of access to menstrual products (MP) and improper education about menstrual hygiene. It also includes a lack of access to washing facilities and waste management, but for this brief, we focus only on the lack of access to products and education.¹³

Q: Who is affected by Period Poverty in the United States?

A: While everyone who menstruates is affected by the inequalities of high prices, lack of access, and education that come from menstruating, those that struggle the most from period poverty in the US are women in low-income households, that are homeless, in college, who are imprisoned, and who are transgender or nonbinary.¹⁴ In a 2019 study done on low-income women, two-thirds stated they had trouble affording products. Those who are homeless struggle to have resources due to the lack of donations from the public.¹⁵ A study about period poverty and college students found that 14.2% of participants struggled within the last year to afford products.¹⁶ A review of correctional facilities in New York found that 54% of women in the facility said that they did not have enough sanitary napkins (pads) each month.¹⁷ A study surrounding Trans menstruators found that 66% felt unsafe and 68% felt uncomfortable using the men’s restroom while on their periods.¹⁸ The lack of access and difficulty affording menstrual products at times leads to menstruators using other tools such as rags, cardboard, and paper towels.¹⁹ The impact of not using proper menstrual products will be discussed later in this brief.

In a 2019 study done on low-income women, two-thirds stated they had trouble affording products

  Q: How many women are affected by Period Poverty in the United States compared
  to other countries?

A: In a study surrounding menstrual products and women in the United States done by a tampon company, 42% of the participants said they had experienced struggles to afford menstrual products before.²⁰ The study also included that those who are Black (35%) or Hispanic (36%) are more likely to struggle with period poverty compared to those who are White (23%).²¹ Taxes on menstrual products increase the prices causing menstruators to not afford products. In the United States, states that heavily tax period products include Mississippi, Tennessee, and Indiana at 7%. Other states like Arkansas, Texas, Kansas, Idaho, Kentucky, West Virginia, and South Carolina tax products between 6–6.5%.²² Around 16.9 million people who menstruate live in poverty in the United States.²³ Among those women, two-thirds said they struggled with affording menstrual products in the last year, and 14% of college girls in a study surveyed said they struggled to afford period products.^{24, 25} Period poverty can also be seen throughout the world. One study in the UK found that of the women interviewed, 50% reported that they struggled to afford period products in the last year.²⁶ In Sub-Saharan Africa, on the other hand, 1 in 10 girls is likely to miss school monthly because of their period, leading to them missing 20% of the school year on period products.²⁷ In China, a study showed that women spend around 1,040 yuan ($160.00) a year, including a 13% sales tax.²⁸ In Mexico, 43% of girls surveyed do not like to go to school while on their periods.²⁹

Q: When did period poverty become an issue?

A: In March 2019, stakeholders across sectors engaged in menstrual health met in Geneva to establish a global plan to fight menstruation health and hygiene. In this meeting, it was concluded that the lack of research done on this topic was something that needed to be changed which has influenced the increase in research being done and advocacy that is happening around the world surrounding menstruation.³⁰

Contributing Factors

Cost

The high cost of menstrual products affects the ability of women to afford them and increases period poverty. The Tampon Tax contributes to this problem. While not an official tax, the Tampon Tax refers to the fact that many states across the country classify tampons and other period products as luxury items, which means sales tax applies to them. States that have a sales tax do not tax items like food and medical supplies because they are viewed as essential, while menstrual products are viewed as non-medical or non-essential items.³¹ A study in 2019 on the menstrual product tax conducted by John Hopkins University found that 35 states tax menstrual products at 7.41% on average (between 4.70–9.90%).³² While these percentages may not seem that large, the tax adds to the already high price of menstrual products. In the 40 years on average that a person menstruates, they will spend $13.25 a month and $6,000.00 total in those years on menstrual products before tax.³³ As of September 20, 2022, 22 states still tax tampons, but there are still issues with cities and counties having their own sales tax.³⁴ With the recent inflation problems, Bloomberg reported that prices for pads rose 8.3% and tampons prices rose 9.8% in 2021.³⁵ Thus, the cost of menstrual products is increasing to unaffordable prices.

Although menstrual products are a necessity, studies show that many women are unable to afford them, especially low-income women. In a 2019 study of low-income women in St Louis Missouri, researchers found that 64% of participants could not afford pads or tampons the previous year, 21% said they struggled monthly the previous year to purchase menstrual products, and 46% said they could not afford to pay for both food and menstrual products throughout the previous year.³⁶ Around 38 million people in the US, or 12% of the population, benefit from food stamps, according to a study done in 2019.³⁷ These help purchase groceries and other products. Because menstrual products are non-food items, they are not covered by food stamps.³⁸ Most women who use food stamps do not have enough money to buy basic necessities. One woman, Eva Hernandez, shared her experience of selling her food stamps to have money to buy tampons because they are not covered by food stamps.³⁹ She said, “If I need pads, we sell food stamps. Everybody does.”⁴⁰ Because low-income women are not able to afford period products, they may have to give up other resources to afford them.

The Stigma of Menstruation

The stigma surrounding menstruation also has a great effect on period poverty because it often leads to less knowledge and discussion of periods, an important part of period poverty that occurs here in the United States. It is important to note that there is limited research surrounding this topic, so anecdotal evidence will be used throughout this section.⁴¹ Stigmas that come from menstruation include menstruation being gross and undiscussable and women being emotional, weak, mentally unstable, and hysterical when on their periods.⁴²

One study done by Thinx, a period product company, highlighted the stigma that is prevalent throughout the United States. When asking women across the country, 58% of the 1,500 women polled said they personally felt embarrassed, and 42% felt shame while on their periods.⁴³ The feeling of shame and embarrassment women feel towards menstruation results in them not wanting to discuss other aspects of menstruation.⁴⁴ Women then do not talk about the lack of access they may have, resulting in them not getting the resources needed to help with menstruation.⁴⁵ The stigma surrounding menstruation leads to women not discussing menstruation and not receiving the resources necessary.

The stigma of menstruation affects the way menstruation is discussed among menstruators. One stigma that occurs is the idea that menstruation is a private matter and should not be discussed with anyone.⁴⁶ Since most people who menstruate learn from their mothers and peers about menstruation, this stigma causes little information to be shared and sometimes causes the little information that is shared not to be accurate.⁴⁷ An example of stigma can be found in an article called “I thought I was dying,” when an unnamed young woman shared her experience with menstruation. Both mother and daughter were unable to communicate about the daughter’s knowledge of menstruation, leading to the girl spending months worrying about getting a period and being confused about what it was.⁴⁸ Without good menstrual health education and discussion, situations like this have the possibility to continue, and menstruators do not have the information needed to educate their own children on menstruation.⁴⁹

Education in School

The lack of education surrounding menstruation contributes to period poverty here in the United States. The World Health Organization states that adequate menstruation knowledge includes timely, appropriate education at different ages, education for both boys and girls in school as well as having support from the teachers in helping the students understand menstruation.⁵⁰ Research on education surrounding menstruation in school systems is limited but is included under sexual health education, which differs from state to state, and even from school to school. Many states follow the National Sexuality Education Standards, but these standards do not include all the information needed. The standards mention the physiological parts of menstruation but not specifically how to manage menstruation and personally care for it.⁵¹ In a study done about all 50 states’ health education standards for elementary and secondary schools, researchers found that only 3 states clearly cover what personal hygiene products are available with menstruation, and 3 other states have menstruation management, how to manage your physical, emotional, and mental well-being during menstruation, in their school health standards.⁵² A study published in June 2022 noted the impact of the lack of education on adolescent girls’ feelings toward menstruation. Though the exact number was not provided, of those interviewed, many reported that they felt they received inadequate education about menstruation before starting their periods. One girl noted, “I was in the bathroom doing my business and I saw blood and I was scared. I was crying because I didn’t know if I was dying or not.”⁵³ Others expressed similar feelings toward starting their periods. Another article noted that 4 out of 5 teenagers felt they learned more about the biology of frogs than the female body, leaving them unprepared for menstruation.⁵⁴ The absence of education in the United States on menstruation leads to menstruators lacking knowledge, a key aspect of period poverty.

Covid-19

The recent COVID-19 pandemic affected the ability of menstruators to access menstrual products and resources needed because of the impacts covid had on the supply and demand of menstrual products. It is important to note that this is a recent topic with few studies done to see the full effect. A study done on income loss globally found that 34% of US participants said they were earning less than before the pandemic, and 39% said they stopped working temporarily.⁵⁵ In a study done on the effects of Covid on period poverty, research showed that those with income loss during the pandemic were 3.5 times as likely to experience period poverty as those with no income loss from March–October 2020.⁵⁶ The study also found that income loss participants also had 3 times the likelihood of changing products less often or using makeshift menstrual products to manage and also 2 times the likelihood of feeling stressed when purchasing products.⁵⁷ The recent supply chain problems and price increases of raw materials have also contributed to the decreasing number of menstrual products being produced.⁵⁸ This problem has led to a 7% decrease in the production of menstrual products, with customers noting that their preferred products are not as available.⁵⁹ However, as a result, companies like P&G, which produces around 60% of menstrual products in the United States, are working their plants twenty-four-seven to ensure their products are available.⁶⁰ Though there has not been extensive research done on the effects COVID will have on period poverty in the future, the research that has been done shows that the shortage and its effect are current. Without enough menstrual products, those who menstruate have to use unsafe products or keep their products in for longer than recommended.⁶¹

Consequences

Physical Health

One of the main consequences of period poverty in the United States is its effect on physical health. People experiencing period poverty find themselves without the financial resources to access suitable menstrual products.⁶² This lack of resources forces menstruators to use other options, such as rags, paper towels, or cardboard.⁶³ Using these options can lead to infection, which menstruators struggle to care for.⁶⁴ An article that discussed the impacts of period poverty stated that using unclean materials and not taking care of menstrual hygiene can cause urinary tract infections and vulvar contact dermatitis.⁶⁵ These hygiene habits can lead to a lower quality of life because of the lack of hygienic care.⁶⁶ Additionally, when women cannot access the proper amount of menstrual products, they leave the product in for over the recommended 8 hours, causing bacteria to build up in the vagina. This buildup puts women at risk of infection and other problems.⁶⁷ By not having the right resources, women are putting their own health at risk monthly.

Bacterial Vaginosis

One infection that can occur from leaving menstrual products in the body for too long is Bacterial Vaginosis (BV).⁶⁸ An estimated 1 in 3 American women will get BV.⁶⁹ While there are other causes for BV, like being sexually active and pregnant, leaving a tampon in for an extended period of time increases the likelihood of BV.⁷⁰ There are not any serious effects from BV. One-third of BV cases clear up on their own, and the other two-thirds of cases require antibiotics to treat it.⁷¹ However, it is important to remember that BV is preventable by following the instructions for changing the tampon. Those who struggle with period poverty are unable to follow those instructions at times because they do not have enough products to last their entire period. Using a tampon longer than the recommended time can lead to them having a higher possibility of bacteria building up and causing BV.⁷²

Toxic Shock Syndrome

For some menstruators, having enough products to last their whole cycle is a challenge, causing them to use the same product for an extended amount of time.⁷³ When using the same tampon for long hours, there is a higher chance that bacteria will build up, which can cause Toxic Shock Syndrome (TSS). For this reason, it is recommended to change the tampon every 4 hours.⁷⁴ Tampons are not the only reason TSS occurs. Other causes are open wounds, surgery, and childbirth.⁷⁵ In fact, half the time, TSS is caused by something other than tampons.⁷⁶ However, most people know TSS from tampon usage.⁷⁷ While TSS is rare, 1 in 100,000 women get it, there is a 30–70% mortality rate for those who suffer from it because the bacteria buildup can cause toxins to enter and shut down a person’s organs.^78,79 Though TSS is a medical condition that can be easily avoided with appropriate menstrual products, it continues to occur. To avoid TSS, doctors advise that people who menstruate change their tampons regularly, but many menstruators who do not have access to a suitable amount of products to last their whole cycle keep them in for longer.^{80, 81}

Mental Health

Those who are affected by period poverty struggle with their mental health due to the stress they feel to afford products. In a study done by BMC Women about the struggles of Period Poverty among college-age women, it was discovered that young women who experienced period poverty within the last year were more likely to report having moderate to severe depression compared to those who have not experienced period poverty.⁸² The study found that of the women surveyed who experienced period poverty monthly, 68.1% reported symptoms of moderate or severe depression, 61.2% of those who had experienced period poverty at any point experienced depression, and 43.4% who had never experienced period poverty experienced depression.⁸³ While there may be other factors that contribute to the mental state of these college-age women, the study found enough evidence to show that Period Poverty does affect the mental health of women who struggle to afford menstrual products monthly.

Women who experience period poverty report symptoms of depression

There are also feelings of anxiety that come from period poverty. Menstruators worry about whether they will be able to afford menstrual products that month and what other purchases to cut down to afford them. A recent study conducted by Always, a menstrual product brand, found that, especially with the economic problems that have occurred because of the pandemic, 1 in 3 parents is worried about the ongoing ability to afford menstrual products.⁸⁴ Low-income families already have worries when it comes to their livelihood, so the added cost of menstrual products, an essential product in the lives of those who menstruate, is added stress.

Decreased Productivity at Work

Period poverty also impacts menstruators in the workplace due to not having enough menstruation products to complete a full day at work. Lack of access to menstrual products can impact the number of days women miss work monthly. A study done by St. Louis University on period poverty found that 36% of those surveyed who were full-time or part-time employed had to miss one or more days of work a month because of a lack of menstrual products during their periods.⁸⁵ While there is limited information on workplace productivity in the United States, a study done in the UK found the impacts of period pains on menstruators in the workplace. The article noted that because of the lack of education and stigmas surrounding menstruation, people who menstruate do not understand their periods, including their symptoms. Because of the inadequate knowledge these women had surrounding menstruation, 14% of women took off days at least once because of their symptoms from menstruation, with 3.4% reporting absenteeism almost every period. It also reported that 80% of the participants felt less productive at work during their periods.⁸⁶ The lack of access to menstrual products and the lack of knowledge surrounding menstruation have affected menstruators’ ability to do work during their cycle.

36% of those surveyed who were full-time or part-time employed had to miss one or more days of work a month because of a lack of menstrual products during their periods

Practices

Menstrual Equity Law

On May 28, 2021, a federal bill called the Menstrual Equity For All Act of 2021 was introduced into the house. The purpose of this bill is to increase access and affordability for menstrual products for those who do not have proper access and other important aspects of menstruation.⁸⁷

Impact

While the law is in the works currently, if the Menstrual Equity Law was passed, it would require schools, public government places, and correctional facilities to provide free menstrual products. The bill also would have companies with larger than 100 employees provide free menstrual products at work. This law would allow menstruators easier access to products while using public facilities. The bill would also require Medicaid to cover menstrual products for its clients, so products such as pads and tampons would be paid for by Medicaid.⁸⁸

Gaps

In an article discussing the impacts of a bill being passed like the Menstrual Equity Law, the author makes the point that there would be budget increases needed to afford proper products to give for free.⁸⁹ The government would have to partner with manufacturers in order to produce enough products for menstruation. Another gap in the law is that while products are being made available in public, menstruators may struggle to obtain products for use at home. The Tampon Tax is also still in effect in states, causing prices of menstrual products to be high and, at times, not affordable for menstruators.⁹⁰ Without eliminating the tampon tax, many states will still suffer from high-priced menstrual products.

Reusable Menstrual Products

One way that the struggle of period poverty can be reduced is through access to reusable menstrual products. Reusable menstrual products include pads made of cloth and cups that work similarly to tampons. Using these products means that menstruators would not have to buy a product every month but just clean the product and be able to use it again, which would allow menstruators to not have to worry about being able to afford products. Companies like Ruby Cup, Diva Cup, and GladRags, all reusable menstrual cup companies, partner with menstrual organizations and donate to them whenever a menstrual cup is purchased.⁹¹ For example, whenever a cup is purchased at Ruby Cup, a cup is also given to someone who cannot afford one.⁹²

While research is limited to the number of menstruators who use this product and the impact of reusable menstrual products, these products have the potential to change the way menstruators view their periods. Made from rubber or silicone, a cup can hold more blood, allowing some menstruators to wear it for up to 12 hours.⁹³ Companies have also claimed that menstrual cups prevent fewer bacteria buildup and less likelihood of bacteria infections. However, there is not enough research done to back that claim.⁹⁴ Menstrual products also allow menstruators to reuse the same product and can last, depending on the product, for 6 months to 10 years.⁹⁵ Research done on the financial benefit of using menstrual cups estimates over 10 years found that a reusable cup would be 5% of the purchase of pads and 7% of the purchase cost of tampons. A reusable cup would also produce 0.4% of the plastic waste used for pads and 6% of the plastic waste used for tampons.⁹⁶

With reusable period products being a recent development, a gap that can be found is the lack of research on product impact. In order for them to increase in credibility, researchers suggest more research be done.⁹⁷ Another gap in reusable menstrual products is the price. For one reusable cup, the price is usually between $20.00–40.00.⁹⁸ While reusable products will save menstruators money in the long term, menstruators may not be able to spend that much money at once on a product. There is also a risk that the menstruator will not like the product or it will not be the correct size.⁹⁹ However, some companies have size charts to help determine the correct size for each menstruator.

Preferred Citation: Krumperman, Katie. “Period Poverty in the United States.” Ballard Brief. February 2023. www.ballardbrief.byu.edu.

Viewpoints published by Ballard Brief are not necessarily endorsed by BYU or The Church of Jesus Christ of Latter-day Saints

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Footnotes

United States

Katie Krumperman

Katie is a public relations major with a minor in civic engagement leadership. She started being interested in period poverty at the age of 12 when she and other girls her age helped create reusable pads for girls in other countries. Her interest heightened when she lived in Salt Lake City, Utah for 18 months and was exposed to the effects of period poverty here in the United States. When not busy with school she loves being outdoors and being around her family and friends.