Quite a bit of the work at ICH is done with the intention of achieving more equitable health outcomes in communities, and some of that work has been related to sexual and reproductive health. An intersection of sexual and reproductive health and health equity that I am interested in is menstrual equity. Menstruation has long been stigmatized which has led to a lack of information on menstruation and a lack of social support for menstruators* and non-menstruators** alike, and discriminatory legislation against menstruators. Despite menstruation being a natural, uncontrollable process, menstrual products are unaffordable to many menstruators, and are not supplied for free in public restrooms even though they are essential supplies.
The lack of access to menstrual products is one of the key reasons for the fight for menstrual equity. Ensuring sustainable access to clean, usable menstrual products for all menstruators is crucial for menstrual health- it may even be argued that this access should be considered a human right. One of the main steps towards greater access to menstrual products is the dissolution of state tampon taxes, or sales taxes applied to menstrual products. As of February 2022, 27 out of 50 states still have tampon taxes, with their persistence implying that menstrual products are considered non-essential by those state governments. In the US alone, tampon taxes are estimated to cost menstruators an extra $120 million annually– internationally, the cost is likely billions of dollars. Menstruators living in poverty are most affected by tampon taxes- in a 2017-2018 study of 183 low-income women in St. Louis, MO, two-thirds reported not being able to afford menstrual products in the previous year. Additionally, Black, Latinx, Native American, LGBTQ+, and disabled menstruators are . Having research on the effects of repealing tampon taxes, especially if and/or how the saved money benefits the most vulnerable menstruators, would be helpful in the movement towards having the tampon tax repealed in other states as well as other countries.
The other main step towards helping menstruators access menstrual products is advocating for the passage of laws for state and local governments to provide menstrual products in public schools, homeless shelters, and prisons. In the 2019 State of Menstrual Access Survey, administered by the Massachusetts chapter of the National Organization for Women (Mass NOW), 230 school nurses, 26 homeless shelter representatives, and sheriffs from the six county correctional facilities across Massachusetts responded to questions about menstrual product access in their organizations. Through this survey, the data revealed that over half of the school nurses had seen students missing class to acquire menstrual products. Menstrual products were often not in school or shelter budgets, with many relying on donations to purchase them, and nearly a quarter of shelters not providing them at all. The sheriffs said that while the products are supplied to inmates for free, there were no consistent policies to ensure that this happens consistently. These findings indicate a lack of menstrual equity affecting some of the most vulnerable populations in the state.
In Massachusetts, there have been ongoing efforts by local menstrual equity groups and state politicians to pass the I AM Bill, which would make it state law for menstrual products to be provided free of cost in public schools for students grades 6-12, in homeless shelters, and in state correctional facilities. Starting in January 2019, this bill was presented by State Senator Patricia Jehlen and Representatives Jay D. Livingstone (8th Suffolk) and Christine P. Barber (34th Middlesex); it was passed by the Massachusetts Senate on March 3, 2022, but has yet to be passed by the MA House of Representatives to become state law. In Massachusetts, the cities of Cambridge, Somerville, Boston and Fall River have piloted free menstrual product programs in their public high schools, and the city of Brookline has passed a bill to make menstrual products free in all public buildings. The impacts of these pilot programs could be further researched- for example, if fewer students miss class trying to obtain menstrual products, will their academic performance, engagement in class and general well-being improve? Will the staff and administration at schools and shelters have greater morale or be more productive if they don’t have to worry about how to finance the purchase of menstrual products? What impact will consistent policies surrounding menstrual products have on inmates and correctional facility staff? Having such data could potentially form the basis for similar bills in other municipalities and states in the future.
In the long-term, a few key steps to achieve greater menstrual equity will include: ensuring that all menstruators have access to needed facilities during menstruation, e.g., restrooms, toilet paper, running water, and waste disposal, making sure menstruators have adequate, timely access to medical care they need related to menstruation, and educating menstruators and non-menstruators from a young age on menstruation to begin eradicating societal stigma. There is also an urgent need for consistent research on the effects of these menstrual equity steps to understand their benefits, in order to continue to change discriminatory laws and policies and societal attitudes towards menstruation. Though there is a long way to go before menstrual equity is achieved, I remain optimistic and hopeful for a future where it is a reality.
*Menstruators is an inclusive term for all people that menstruate, which includes cisgender women, transgender men, non-binary and intersex people. It is also important to note that not all individuals who fit into these groups menstruate.
**Non-menstruators is an inclusive term for all people who do not menstruate, which includes cisgender men, transgender women, non-binary and intersex people. It can also include cisgender women who do not menstruate, which can be attributed to a variety of reasons.