Social and economic barriers inhibit adequate access to menstrual hygiene products and education in the U.S.—particularly for vulnerable populations including school-aged individuals, those experiencing homelessness, low-income individuals, and incarcerated individuals. This is sometimes referred to as “period poverty.” ACP policy supports greater investment in public policy interventions that address social drivers of health and other factors that negatively impact health and supports federal, state, tribal, and local funding efforts to address social drivers of health.
Menstrual hygiene products, including tampons, pads, reusable menstrual cups, and other products, are important health tools for managing periods for the more than 800,000,000 people globally who menstruate on any given day. The average person who menstruates has their period for a cumulative 7 years of their life, uses between 10 to 35 pads or tampons per cycle, and uses up to 16,800 products over the course of their lifetime at a cost of roughly $1,800 in the U.S. However, despite the role of menstrual products in maintaining hygiene and health, many Americans are unable to afford or otherwise lack access to these basic necessities. In one study, 64 percent of low-income women were unable to afford needed menstrual hygiene products in the past year while 21 percent experienced this monthly; 46 percent couldn’t afford both food and menstrual hygiene products in the past year.
Those experiencing homelessness or who are incarcerated have also reported limited access to menstrual hygiene products, especially since these products are rarely publicly funded in budgets for schools, shelters, and crisis emergency centers. They are also not readily available in all correction and detention facilities and are often prohibitively expensive given meager prison wages and inflated prices. Additionally, menstrual hygiene products are generally not covered by public health and nutritional programs and are not exempt from sales tax in many jurisdictions like other necessities.
As a result, some people who menstruate have been reported to resort to other unsafe or unsanitary options, including using things like rags, tissues, toilet paper, paper towels, dirty socks, used paper bags, or a single tampon or pad for longer than the recommended time. Inadequate or improper use of menstrual hygiene products can have devastating medical consequences and may possibly result in urinary tract infections, vulvar contact dermatitis, yeast infections, bacterial vaginosis, (and, in rare cases, toxic shock syndrome), and overall low quality of life.
Insufficient access to menstrual hygiene products clearly poses a threat to public health. ACP supports public policies that reduce socioeconomic inequalities, address social drivers of health, reduce health disparities, and improve health equity.
ACP has long believed that women should have access to affordable, comprehensive, and nondiscriminatory health care coverage over the course of their life. This should include access to affordable menstrual hygiene products. ACP also strongly believes that additional efforts are needed to close gaps in the knowledge related to women’s health issues.
In 2017, the U.S. Department of Justice agreed to provide every woman incarcerated in a federal prison with menstrual products free of charge. The Coronavirus Aid, Relief and Economic Security (CARES) Act, which was signed into law, included provisions allowing menstrual products to be purchased with money from health savings (HSA) and flexible spending accounts (FSA), however, most people who lack access to menstrual products also do not have these types of accounts. On May 28, 2021, U.S. Representative Meng (NY-6) introduced legislation, the Menstrual Equity For All Act of 2021 (H.R. 3614) to improve access to necessary menstrual hygiene products. The Menstrual Equity For All Act of 2021 includes several measures to address access to menstrual hygiene products, including allowing federal grant funds to be used to provide free menstrual hygiene products in schools; incentivizing colleges and universities to provide free menstrual products; ensuring access to free menstrual products for incarcerated individuals; allowing homeless shelter federal grant funds to be used to purchase menstrual products; requiring Medicaid to cover menstrual products; directing large employers (100+ employees) to provide employees with free menstrual products in the workplace; and requiring all public federal buildings to provide free menstrual products in restrooms. ACP has written a letter in support of this legislation, which has not yet come before the House or Senate for a vote.
Some states are trying to improve access to menstrual hygiene products by passing legislation that exempts menstrual hygiene products from state and local sales taxes. However, there are at least 23 states that do not currently exempt menstrual hygiene products from state and local tax. According to The New York Times, states collectively bring in over $150 million annually in revenue from taxing menstrual products.
- Period Equity
- Tax Free Period
- The Current State of the Tampon Tax—and How We're Going to Eliminate It
- Addressing Social Determinants to Improve Patient Care and Promote Health Equity: An American College of Physicians Position Paper
- Women's Health Policy in the United States: An American College of Physicians Position Paper
- Envisioning a Better U.S. Health Care System for All: A Call to Action by the American College of Physicians
- What to know about period poverty
- The Unequal Price of Periods Menstrual Equity in the United States
- Understanding Period Poverty: Socio-Economic Inequalities in Menstrual Hygiene Management in Eight Low- and Middle-Income Countries
- Many Lack Access to Pads and Tampons. What Are Lawmakers Doing About It?