Cities, States Begin to Step Up to Confront Period Poverty

The coronavirus pandemic has made access to basic needs even more difficult for families with low incomes and that includes menstrual products. Calls to address what has become known as “period poverty” were growing even before the pandemic and researchers and clinicians say the issue has only become more pronounced. States and cities, however, seem to be taking action in growing numbers, with a variety of new laws going into effect in recent months to provide easier access for period products, including a measure in Ann Arbor, Mich., that requires menstrual products be provided free in all public restrooms. Anne Sebert Kuhlmann, an associate professor of behavioral science and health education at Saint Louis University, has been tracking the issue and spoke to Spotlight recently about what’s driving the response. The interview has been lightly edited for length and clarity.

Why don’t we start with a general question: what’s happened to finally push this issue to the forefront in a number of communities? I know you’ve been tracking this for a long time.

I think one of the really important aspects has been data. We finally have started in the last few years to get some data from the U.S. Prior to that, there was attention to this and some data and research, but that was focused mostly on low- and middle-income countries. It’s really been since about 2019 that we started having some of the first data in the U.S., and that’s been important because those data have been cited in legislative hearings, both at the state and local level. Nonprofit organizations have used those data in grant proposals and donor calls to solicit funding.

I think another thing also has been, there’s been a lot of activism, especially among the younger generation—high school, and college-age students. I’ve been impressed with the number of high school and college age students who are interested in this issue; they start looking things up, and they find me and reach out to me. Over the past few years, I’ve spoken to a number of student organizations, and they really want to know how they can contribute, be involved, and get others involved. A lot of those students have started programs at their own schools or done donation drives.

And then I think the third piece has really been the media attention, which started picking up when some of the data started coming out and has really shown the extent of period poverty in the U.S. and that kind of galvanized people. Historically, menstruation has been really taboo and not something that we’ve talked about openly in our culture, but that seems like it’s shifting. We have more work to do, but it does seem like there’s been more writing about, talking about, posting about menstruation and struggles with periods and access to products. I think that’s helping to normalize the conversation. Any type of cultural change is a slow process, but I know, when I first started working on this issue back in 2017, I would not have imagined that in this relative short amount of time how much momentum has been created and how much change there has been in the conversation in popular media.

And the pandemic, I assume, has made this problem even worse, and has focused more attention on it, as it has with a number of issues?

I think the pandemic really highlighted basic needs for so many households and how many households are really living at that fragile day-to-day, week-to-week, month-to-month situation. And then the pandemic also shut down a lot of resources that people were relying on. Schools were shut down for an extended period of time and an increasing number of families relied on food banks and those types of services. Transportation, especially public transportation, got harder for families that rely on it and there was also the economic downturn that heavily impacted households, particularly low-income households, in those first few months.

Is there a statistic or two that you use to indicate how prevalent this is either from your work or the work of others?

in 2019, we did publish some of the first data from adult women in the U.S. We surveyed over 180 low-income women in the St Louis area who were connected to community service organizations and resource supports in the community and 64% of them indicated that in the past year that they had experienced period poverty at least once—meaning that they had needed products but had not been able to afford to buy them. Of that 64%, 20% indicated that that was their situation every month, that every time their menstrual cycle came up, that they were in a situation of not being able to afford and access the products that they needed.

We then started working with some high schools in the St Louis area, particularly schools that serve a lot of high needs students from high needs households. The initial work that we did in a small pilot with female students showed about 17% were reporting that they had been absent from school the previous year because they didn’t have period products when they needed them. And this was in a school where they have an in-school health clinic that had period products available, and some teachers and staff had them in their classrooms and in the school nurse’s office. So, it was within a context where there are supports, but you need to have products when you need them at home to get to school in the first place to be able to use those supports at school.

That research also found close to 70% of the students reported missing school for any reason related to menstruation, not just because they didn’t have products when they needed them. I think that really highlighted some of the struggles with managing menstruation overall, the cramping, the heavy flow, the odor, the hygiene that goes along with it. Seeing the large portion of female students that were indicating that there are missing school because of their periods, you start to think about that on a monthly basis and then cumulative over the years and it really starts to add up.

Give us a couple of examples of new programs, new laws that you think are promising, whether at the state or city level.

There has been a lot of change at the state level. A number of states over the last few years have passed tax exemption or tax reduction laws that classify period products as essential goods and either eliminate or reduce the sales tax on them. There are also several states where they have passed laws requiring period products in schools. It varies by state: sometimes all schools are required to have them while in other cases it’s just schools where a certain portion of students are eligible for free and reduced lunch. There’s also a number of states, including Missouri, that have passed laws requiring products for incarcerated persons. A lot of people don’t realize that if they’re not required to be provided in prisons and detention facilities and oftentimes people who are incarcerated have to use their money, then they’re earning pennies on the dollar in the canteen commissary.

And then at the local level, Ann Arbor, Michigan became the first municipality to require that period products be freely available in all public restrooms, like toilet paper is. That went into effect January 1st, this year and it’ll be interesting to see kind of how it plays out, and how the compliance and enforcement go.

Is there anything happening at the federal level?

Interestingly, there has been movement at the federal level in two main areas. Many people don’t recognize that one component of the Bipartisan Criminal Justice Reform Act that was signed in December of 2018 required that period products be provided free for folks who are incarcerated in the federal system. And then in the CARES Act that was passed during the pandemic, period products were classified as medical expenses, so that folks can use funds in health savings account, if they have one, to cover or purchase period products. Of course, that requires that you have an HSA and that you have funds in that HSA but it’s something at least.

And you still can’t use SNAP benefits to purchase period products, correct?

Correct, not SNAP. Some advocates have talked about that, but one of the concerns if we go that route is that we have to be sure that it would be an expansion of those benefits. You don’t want people who are already reliant on those benefits to be put in the position of making trade-offs between food and period products within the same existing level of benefits.

It would be interesting to see whether the expanded Child Tax Credit had any impact on this issue.

There’s a lot of work looking at the impact on child poverty in general, but I don’t personally know of anyone who’s working specifically on that avenue of it.

What do you have coming up? Is there any new research you’re planning to come out with anytime soon?

We have been working with the Missouri Department of Health and Senior Services to expand our work in schools and look at things a little bit more statewide, because so far, our work has been focused on the St Louis metropolitan area.