Period poverty and its reach across the US

A recent study highlighting potentially toxic levels of metals in a sample of store-bought tampons has raised concerns among some members of the public and garnered attention in the media. While this study only showed the potential for toxicity—not an increased level of toxins in individuals who use the selected brands of tampons—it does highlight the importance of individual choice in access to period products. While some people may find that tampons are the most comfortable and convenient option, others might feel more comfortable using reusable or organic products. Those in the U.S. who can afford to buy the period products they need at their convenience have a plethora of choices available to them—pads or tampons, with an applicator or none, organic or not, disposable products or reusable ones.  

However, a shockingly large percentage of those who menstruate in the U.S. cannot afford the period products they need, when they need them. These individuals often have no choice. They rely on homemade, makeshift products like toilet paper, paper towels, rags, or cut up diapers. Alternatively, they may rely on donated products from schools, food pantries, churches, or other community organizations. In these cases, their choices are often restricted to whatever items have been donated, which may not always align with their specific needs.

Not just an issue ‘elsewhere’ 

Lack of menstrual hygiene and “period poverty” have been on the international development agenda for over a decade. Period poverty refers to an “insufficient access to menstrual products, education, and sanitation facilities.” Research and media coverage from various low- and middle-income countries have highlighted the challenges women and girls face in accessing essential resources—like clean, absorbent supplies, water, sanitation, knowledge, and social support—for hygienic menstrual management. The lack of these resources has been linked to negative impacts on education and psychosocial outcomes. Only recently has attention turned to “period poverty” in the U.S. 

A groundbreaking 2019 study conducted among low-income adult women in St. Louis found that 64% were unable to afford period products at least once in the previous 12 months. Furthermore, 21% of those experiencing this issue faced it every month—coinciding with each menstrual cycle. Ongoing research continues to shed light on the extent and magnitude of “period poverty” throughout the U.S. 

In 2019, an online national survey revealed that around 20% of U.S. teens ages 13 to 19 reported trouble accessing or affording period products when needed. That percentage increased to 23% by 2021 as the economic impact of the COVID-19 pandemic hit the most economically vulnerable households the hardest. A follow-up study showed that trends stabilized in 2023 but remained higher than before the COVID-19 pandemic. Similarly, a recent study among a representative sample of adults who menstruate showed that period poverty in the U.S. increased from 2018 to 2021 during the COVID-19 pandemic. Over half of the respondents in 2021 (59%) reported that they had experienced an episode of period product insecurity at some point in their lives. In 2021, about 38% reported that they were currently struggling to afford period products, up from around 30% in 2018. Clearly, access to and affordability of period products is a concern for both teens and adults in the U.S., not just elsewhere. 

Choice in products is a matter of dignity 

Surveys of the general population in the U.S. indicate that similar percentages of those who menstruate use disposable tampons and pads—47% and 46% respectively—with smaller percentages using reusable products such as menstrual cups (19%) and period underwear (19%). Our research shows, however, that product preferences can differ substantially by subgroup. Among low-income adult women surveyed, 56% expressed a preference for disposable pads, with only a small number having ever tried reusable menstrual products. Many strongly preferred overnight pads with wings which are heavily absorbent, so they could stretch their use longer and reduce the risk of staining their (often only) underwear. Among high school students, where nearly all students are eligible for free—or reduced—lunch, the vast majority use disposable pads or liners. A few had tried tampons, while even fewer had used reusable products. For both adults and students, the key factor was having personal reasons for their preferences, shaped by their experiences and beliefs. Unfortunately, the period products they preferred for their unique needs were often unavailable through the resources they depended on. 

Period poverty knows no geographic bounds 

While much of the research around period poverty in the U.S. has focused on major metropolitan areas such as New York, Baltimore, and St. Louis, recent studies emphasize that period poverty knows no boundaries. Research among adolescent girls in the upper Midwest and rural Alabama shows that students in these locations experience challenges accessing period products and trying to manage menstruation, especially at school—similar to teens in larger metropolitan areas. A statewide survey of school nurses across Missouri revealed that nurses in urban and rural areas of the state were equally likely to say they know students in their schools who are missing school due to their periods. As the percentage of students eligible for free—or reduced—lunch in a school increased, school nurses in both urban and rural areas were more likely to report that their students struggled to afford the period products they need and that their students were using homemade products to get by. A study from a representative sample of food pantry clients across Kansas, Missouri, and southwestern Illinois indicated that clients desire period products as a service at food pantries, regardless of state or rural/urban designation.   

Black and brown households are often the most vulnerable to period poverty 

Period poverty and menstrual hygiene challenges affect communities across the U.S., but Black and brown households are disproportionately impacted regardless of location. In 2021, 23% of Black respondents and 24% of Latino respondents reported struggling to afford period products, compared to just 8% of white respondents. And nearly half of Black and Latino students also reported difficulty focusing on school due to a lack of access to period products, compared to 28% of white students. Furthermore, Latinos were more likely to report that the COVID-19 pandemic exacerbated challenges in accessing period products and consistently found them less affordable in both 2018 and 2021. Moreover, Black food pantry clients were more likely than their white counterparts to express a need for period products to be included among pantry services.

Addressing menstrual hygiene needs and period poverty in the U.S. 

Lack of menstrual hygiene and period poverty are multifaceted challenges, so we need a comprehensive approach to address them. First, we need to ensure that period products are freely available in places where those who need them most can access them, like schools, prisons, pantries, and shelters. Some municipalities, such as Ann Arbor, Michigan, are now requiring period products to be freely available in all public restrooms, similar to toilet paper and soap. The COVID-19 pandemic taught us that we need to consider period products as an essential basic need during emergency situations and humanitarian crises, meaning we need to consider ongoing access to period products when planning and preparing for such emergencies. Finally, it’s essential to recognize that menstrual hygiene needs extend beyond access to and affordability of period products. They must encompass education on menstrual hygiene practices, such as managing odor and cramps, understanding the variety of period products available, and learning how to access and use them. Additionally, addressing menstrual hygiene requires infrastructure, including safe public restrooms, particularly for individuals experiencing unstable housing.

Period poverty is a real concern in the U.S. It does not discriminate by geography, but it does reflect broader patterns of socioeconomic disparities in our society, especially among Black and brown people who menstruate. Therefore, our comprehensive approach to addressing period poverty must focus on access and affordability with special attention to the most vulnerable, regardless of geography. It is our responsibility to ensure that all who menstruate have the means to manage their menstruation hygienically and with minimal impact on their daily lives. It is our responsibility to ensure the basic dignity of all in our society—regardless of location, racial or ethnic identity, or socioeconomic status.