Enhancing client engagement and alleviating period product insecurity: A cross-sectional study of community-based period supply banks' distribution of free period products through intermediary partner agencies in the United States.

BACKGROUND: Period products like pads, tampons, and a variety of disposable and reusable hygiene supplies constitute just one facet essential for effectively managing menstruation in a way that allows an individual to feel comfortable carrying out their daily routine. Given the absence of comprehensive public policies ensuring access to period products for economically disadvantaged menstruating individuals, community-based basic needs banks, particularly period supply banks, were established to alleviate the challenges faced by those experiencing period product insecurity. These initiatives specifically aim to furnish essential menstrual products to individuals in need. OBJECTIVES: This study aimed to assess any organizational benefits experienced by community-based organizations distributing period products on behalf of period supply banks. DESIGN: This cross-sectional study is a formative evaluation of the distribution of free period products by period supply banks, which provide access to essential menstrual hygiene products for individuals in need through partnership with community-based partner agencies. METHODS: Staff members at agencies distributing period products were invited to complete an anonymous web-based survey at two different time points about their agency's experiences distributing free period products. All participants provided informed consent via the web-based survey. RESULTS: Agency staff reported that since they started providing period products, clients were more likely to: start a conversation about other needs (66.7%), extend the length of their relationship with the agency (60.0%), keep scheduled appointments (62.1%), ask for assistance with another need (75.0%), communicate between visits (42.4%), participate in other agency programming (55.9%), and seek other agency services (73.5%). Due to a shortage of period products, 41% of agencies have had to turn away clients needing period supplies. CONCLUSION: Period supply banks, in collaboration with community-based partner agencies, enhance access to both menstrual products and the associated support, fostering engagement with diverse resources and opportunities among recipients. However, addressing unmet needs necessitates policies and additional funding to ensure universal access to essential hygiene supplies for everyone to thrive and actively participate in society.

Positive benefits for agencies giving away free period products from a period supply bank in the United StatesWhy we did this study: In the United States, many people with periods cannot afford to buy period supplies when needed. When people do not have enough period products, they may have to stay home from places they want to go, like work, school, or community spaces. Period supply banks want to help ensure everyone has period supplies, so that, they take in donations and buy more supplies. Then, period supply banks partner with other agencies that give period supplies for free to individuals experiencing need.What we wanted to learn: We wanted to know if the agencies that give away free period products through partnerships with period supply banks have any benefits from doing so.What we did: We asked people who work at an agency that gives away free period products received through a partnership with a period supply bank to take an online survey at two different times, when the agency began the collaboration with the period supply bank and after distributing period supplies for several months. Only people who wanted to be in the study did the survey.What we learned: Agencies who give away free period products benefit because clients are more likely to talk to them about other needs they have, enroll in a program or receive another resource from the agency, miss fewer appointments, and stay in an agency program longer. Sometimes, agencies do not have enough products for everyone who needs period supplies. More funding and policies are needed to help period supply banks buy enough period products for everyone who needs them.

A pilot survey of students' menstrual attitudes, experiences, and needs on an urban university campus.

BACKGROUND: In the United States, many menstruators face barriers to period management, such as period poverty, or the lack of access to relevant knowledge and affordable menstrual products. Our current understanding of the social, emotional, and physical impacts of period poverty on students in post-secondary institutions is largely limited. OBJECTIVES: The purpose of this pilot study is to assess period poverty, period-related class disruption, and avoidance of menstrual hygiene management on campus among students and to identify recommendations for action at the University of Illinois Chicago and other urban universities. DESIGN: An online cross-sectional study from February to May 2023. METHODS: Enrolled students who were at least 18 years old completed an anonymous, self-administered online survey. Through descriptive statistics and chi-square tests in SAS version 9.4, we analyzed the sociodemographic, academic, and menstrual characteristics of those who had a period in the past 12 months. We also performed a thematic analysis of students' open-ended responses regarding their menstrual experiences on campus. RESULTS: Of our sample (N = 106), 17.1% of students have faced period poverty, 55.8% experienced period-related class disruption, and 47.5% avoided changing their menstrual products on campus. The relationships between the three menstrual experiences were statistically significant. In the open responses, students reported that their personal experiences with menstruation were largely painful and disruptive. We identified the following themes: (1) inadequate water, sanitation, and hygiene facilities; (2) understocked, empty, or non-existent menstrual product dispensers; (3) a desire for additional resources for menstruation; and (4) the unpredictability of menstruation. CONCLUSION: Our findings indicate that students continue to face obstacles to menstruation management due to inadequate support related to menstrual infrastructure, products, and pain. We outline several recommendations for university/college institutions to prioritize a more inclusive and supportive educational environment for all students.

Students' experiences of menstrual periods while on an urban university campusIn the United States, many girls, women, and other menstruators encounter challenges while managing their menstrual periods. Such barriers include period poverty, or the inability to afford resources and menstrual products such as tampons or pads. In this study, we explored how period poverty impacts college/university students. We shared an online survey with 106 students who were older than 18 years, had a period in the last 12 months, and attended the University of Illinois Chicago. We asked them about their menstrual, social, and academic experiences. We found that approximately one in six students could not afford menstrual products at some point in their lives, over half missed all or portions of class due to their period, and about one in two students avoided changing their menstrual products on campus. The relationships between these three menstrual experiences were statistically significant. Many students also reported that periods were largely painful, disruptive, and unpredictable and that their campus had few physical resources and more obstacles to managing menstruation. From our findings, we identified several steps that universities and colleges can take to prioritize a more inclusive and supportive educational environment for all students.

Examining menstrual health experiences in Philadelphia, PA: A qualitative investigation.

BACKGROUND: While menstruation is a physiologic process, it remains highly stigmatized. Despite the sheer number of menstruators, menstruation is a highly individualized experience, with wide variation in duration, symptoms, and management. This wide variability lends itself to large disparities in access to menstruation management products and subsequently the lived experience of menstruators. OBJECTIVES: The research team sought to understand lived menstrual experiences, symptoms, management tactics, and commonly used and desired resources among 20 cisgendered women aged 18-45 years in Philadelphia. DESIGN: This project was a qualitative research study. METHODS: We used a collaborative, community-based participatory research approach with No More Secrets, a Philadelphia-based grassroots sexuality awareness and menstrual health hub. Semi-structured telephone interviews were used to gain insight into general menstruation-related experiences, communication, worries, and concerns, with subsequent thematic analysis via Key Words in Context approach. RESULTS: Four themes emerged following analysis: cycle characteristics, menstruation management, coping resources, and future resources. Participants largely spoke about their menses as a negative experience, asked for more comprehensive, verified sources of information and needed greater access to menstrual management supplies. CONCLUSION: Menstruation is a highly individualized experience with a large variety in knowledge, menstrual product use, and individual needs. Despite the individuality of menstruation, our community-based research shows that there is a dire need for interventions that promotes knowledge and access to menstrual care.

Menstrual health: Inequities in a cohort of menstruating people in the Brazilian southeastern region.

OBJECTIVE: To assess menstrual hygiene management (MHM) and period poverty in a group of low- and medium-income menstruating people. METHODS: A cross-sectional study was conducted at the University of Campinas, Brazil, from January to June 2022 with 535 participants aged 18-49. For data collection, we used the abbreviated version of the WHO Quality-of-Life questionnaire (WHOQOL-BREF) and a pre-tested questionnaire with items regarding MHM and period poverty. RESULTS: We found an inverse relationship between the risk of no access to supplies to perform menstrual hygiene, which increased by 2.5% and each point less in the environmental domain of quality of life (QoL), and this risk increased by up to 3.1 times among participants who reported difficulty making ends meet. The risk of not having adequate conditions to perform menstrual hygiene at home increased by up to 2.6% for every one-point drop in the environmental domain of QoL. The risk of not having adequate conditions to perform menstrual hygiene outside the home increased by up to 1.3% for less points in the psychological domain of QoL, and 44.4% of those who indicated inadequate conditions for menstrual hygiene reported two or more childbirths. CONCLUSIONS: Menstruating people who have an increased risk of lacking menstrual supplies and have an increased risk of inadequate conditions for MHM at home and outside the home, as well as those who have two or more deliveries and those having difficulties making ends meet, scored low on the QoL, especially in the environmental and psychological dimensions.

Corrigendum: Editorial: Period poverty.

[This corrects the article DOI: 10.3389/frph.2023.1140981.].

A Multimodal Qualitative Approach to Understanding Menstrual Health Equity among Adolescents and Young Adults.

STUDY OBJECTIVE: Menstrual inequity-unequal access to menstrual health care or products-negatively affects well-being in relation to the menstrual cycle, a construct known as menstrual health. Few studies have explored menstrual inequities among adolescent and young adult populations in the United States. This multimodal qualitative research aimed to explore factors that influence the lived experience of menstruation among this population. METHODS: This qualitative study consisted of individual interviews among menstruators ages 13-24, recruited from an urban academic medical center. Participants (N = 20) were a mean age of 19 years; 25% previously endorsed period poverty, and 90% were publicly insured. We conducted semi-structured interviews using participant video diaries in a video elicitation exercise. Data were coded by 2 investigators using thematic analysis driven by grounded theory. RESULTS: Emergent themes included the need to normalize menstruation, the need for comprehensive menstrual health education, and the need for menstrual products to be more accessible. Twelve youth prepared video diaries, and all reported positive experiences with the video process. CONCLUSIONS: This youth-centered, multimodal study is one of the first to qualitatively explore the lived experiences of menstruation among adolescents in the United States and identified key inequities in menstrual health from their own perspectives. Thematic findings were mapped onto a proposed framework for menstrual equity that can be applied to future research and efforts around policy change. More research is needed to assess the impacts of these policies.

Period Poverty: an Epidemiologic and Biopsychosocial Analysis.

In the United States, approximately one in five persons experience period poverty, defined as the inability to obtain resources needed for healthy, safe, and dignified menstrual management. Limited access to an inadequate number of menstrual supplies may lead to longer-than-recommended use, which can increase skin chafing, disruption of vaginal flora, and intravaginal toxin overgrowth. However, period poverty goes beyond simply having enough menstrual products and can encompass the embarrassment, stigma, shame, and barriers in conversation surrounding menstruation. Discussion and critical examination of the multilayered attributes surrounding period poverty have been intermittent in academic literature, particularly from a domestic lens. Thus, this narrative review and theoretical analysis aimed to describe the epidemiology of period poverty and analyze its biological, socio-emotional, and societal implications. We applied a descriptive epidemiology approach of person, place, and time, and employed a social-ecological lens to examine risk factors. Our findings describe the incidence, distribution, and possible ways to alleviate period poverty. Practitioners, medical providers, and public health professionals may have limited knowledge of period poverty, what it entails, and who it impacts, but they have great potential to address it and associated menstrual inequities in their work. With its widespread implications for psychosocial and community-level health, this phenomenon needs urgent attention to promote menstrual equity as an issue of human rights and social justice. We conclude with research and policy recommendations for alleviating period poverty.

Menstrual Equity in the Criminal Legal System.

Background: Menstrual equity, that is, access to menstrual products and safe menstruating environments, is a basic human right not available to many vulnerable populations. Methods: We conducted a cross-sectional survey with a convenience sample of women involved in the criminal legal system to document experiences with access to hygiene and menstrual products while incarcerated. Results: Of the 156 respondents, 62.6% had to trade or barter to receive even basic hygiene products such as soap or shampoo; food and personal favors were used as the common currency. More than half (53.8%) received less than five menstrual products at intake/initial processing; 29.5% had to trade or barter menstrual hygiene products. Almost one-quarter (23.1%) suffered negative health consequences from prolonged use of products because of limited supply. Discussion: Findings document the lack of menstrual equity among women involved in the criminal legal system. Assuring the human right of menstrual equity in this population requires changes at the legal, the policy, the institutional, and the individual level.

Menstrual health and management during the COVID-19 syndemic in the Barcelona area (Spain): A qualitative study.

BACKGROUND: Available evidence suggests that menstrual health and management have been impaired during the COVID-19 syndemic. However, research in this area is scarce, and it is failing to voice the experiences of women and people who menstruate regarding their menstrual experiences. OBJECTIVES: This study aimed to explore the experiences of menstrual health and menstrual management among women and people who menstruate in the Barcelona area (Spain) during the COVID-19 syndemic. DESIGN: This is a qualitative study, conducted taking a critical feminist approach, is embedded in the 'Equity and Menstrual Health in Spain' project. METHODS: It includes photo-elicitation individual interviews with 34 women and people who menstruate in the area of Barcelona (Spain). Data were collected in person and through telephone calls between December 2020 and February 2021. Analyses were performed using Thematic Analysis. RESULTS: Main findings navigated through the menstrual changes experienced by some participants, especially women living with long COVID-19, and the barriers to access healthcare and menstrual products during COVID-19. While some participants experienced menstrual poverty, this did not appear to be exacerbated during COVID-19. Instead, access to menstrual products was compromised based on products' availability and mobility restrictions. Menstrual management and self-care were generally easier, given that menstrual experiences were almost exclusively relegated to private spaces during lockdown periods. CONCLUSIONS: Our findings highlight the need to further research and policy efforts towards promoting menstrual health and equity, considering social determinants of health, and taking intersectional and gender-based approaches. These strategies should be further encouraged in social and health crises such as the COVID-19 syndemic.

Assessing menstrual equity amongst BAMER women fleeing gender-based abuse in Sheffield (UK): A cross-sectional study.

OBJECTIVES: Menstruation is not openly discussed in numerous Black, Asian, minority ethnic and refugee (BAMER) communities. Consequently, it is unclear if transitioning between cultures impacts BAMER women's menstrual health. This study aimed to evaluate menstrual equity and sanitary protection preference amongst BAMER abuse survivors displaced to Sheffield (UK). METHODS: Fifty participants were recruited from women's support services between December 2018 and May 2019. Selection criteria required participants to menstruate, identify as BAMER, be displaced, and have experienced gender-based abuse. Descriptive and inferential statistical analyses were performed using SPSS (IBM, USA) to assess menstrual equity. RESULTS: Many struggled to afford products (86 %), changed them infrequently (68 %) or improvised sanitary wear (40 %). Financially restricted women often changed products irregularly (p = 0.02) or used proxy items (p = 0.02). Participants disliked reusable pads (48 %) and vaginally inserted products (tampons 46 %, cups 78 %) without having tried them. Negativity surrounding reusable pads (p = 0.01) and cups (p = 0.04) was linked to menstrual taboo. Few women knew of menstruation prior to menarche (28 %). These participants were more likely to accept male doctors (p = 0.04), unlike those that regarded menstruation as taboo (p = 0.02), unclean (p = 0.02) or shameful (p = 0.001). CONCLUSION: We provide key information regarding the menstrual health status of marginalised women. Our findings suggest limited menstrual-health education at menarche and negative belief-systems may compromise access to products and healthcare in adulthood. This study advises policymakers to unify distribution of hygienic absorbents and menstrual-health education to normalise menstruation, thereby reducing menstrual shame and empowering women to make informed sanitary protective choices.

"It always gets pushed aside:" Qualitative perspectives on puberty and menstruation education in U.S.A. schools.

Adolescent girls in the U.S.A. often lack sufficient education on pubertal and menstrual health topics. This educational gap may be growing given the current decline in American elementary and middle schools' delivery of sexual health education. Furthermore, little is known about the actual scope and quality of existing menstruation and puberty education in U.S.A. schools. This paper provides insights into some of the challenges with the delivery of menstruation and puberty education in schools. Qualitative and participatory research methodologies were utilized with Black and Latina girls ages 15-19 and adults working with youth in three U.S.A. cities (Chicago, Los Angeles, and New York City), exploring experiences of menstruation within school and family contexts. Findings revealed tension between school responsibility and family authority in providing menstruation and puberty education in schools, school- and teacher-related delivery challenges, and inadequate and disengaging menstruation and puberty content. Further research is needed on the effectiveness and best practices for providing this education in schools, including improved understanding on student and parent preferences, delivery mediums and the scope of content.

Experiences of menstrual inequity and menstrual health among women and people who menstruate in the Barcelona area (Spain): a qualitative study.

INTRODUCTION: Menstrual health and menstrual inequity have been neglected in social, economic, healthcare and political spheres. Although available evidence is scarce, it already suggests a link between experiencing menstrual inequity (which refers to the systematic disparities in accessing menstrual health and education, menstrual products and spaces for menstrual management, among other aspects) and menstrual health outcomes. The aim of this study was to explore experiences of menstrual health and menstrual inequity among women and people who menstruate aged 18-55 in Barcelona and surrounding areas (Spain). METHODS: A qualitative study, using a critical feminist perspective, was conducted. Sampling was purposeful and selective. Recruitment was through sexual and reproductive health centres, social media and snowball sampling techniques. Thirty-four semi-structured photo-elicitation interviews were conducted between December 2020 and February 2021. Interviews took place in sexual and reproductive health centres, public spaces, and by telephone. Data were analysed using Reflexive Thematic Analysis. RESULTS: Three themes were identified: "Systemic neglect of menstruation and the menstrual cycle", "When "the private" becomes public: menstrual management" and "Navigating menstrual health: between medicalization and agency". Experiences of menstrual inequity appeared to be widespread among participants. They referred to the impact of having to conceal menstruation and the barriers to managing menstruation in public spaces. Choosing menstrual products was often influenced by price and availability; several participants reported menstrual poverty. A general lack of menstrual education was described. Menstrual education was usually gained through personal experience and self-learnings, or through families and friends. Menstruation and the menstrual cycle had a significant impact on participants' day-to-day. Accessing and navigating the healthcare system was challenging, as participants mostly reported feeling dismissed and almost exclusively offered hormonal contraception as a panacea to address menstrual health. CONCLUSIONS: The impact of menstrual inequity appears to be far-reaching. Multidimensional structural policies should promote agency in individuals and communities to enable opportunities for menstrual education, access to menstrual products, healthcare services and adequate menstrual-management facilities. Health professionals' training is also necessary to improve access to and quality of menstrual healthcare. Policies need to be inclusive of non-binary and trans people, and vulnerable populations.

Improving menstrual equity in the USA: perspectives from trans and non-binary people assigned female at birth and health care providers.

Menstruation research has largely focused on addressing menstrual management barriers facing cisgender women and girls in low and middle-income countries. Scant literature has assessed the menstrual management needs of trans and non-binary people assigned female at birth. To better understand these frequently invisibilised menstruation-related needs, we conducted a multi-method qualitative study in New York City which included: 17 in-depth interviews across trans and non-binary people (n = 10) and health care providers who serve them (n = 7); and seven anonymous post-interview participatory writing responses with trans and non-binary participants to further elucidate their lived experiences with menstrual management. Lack of health care provider transgender competency, public toilet design (i.e. gaps in cubicle doors and lack of in-cubicle menstrual product disposal bins), and the social dynamics of public toilets (i.e. work and school) were identified as significant barriers to managing menstruation safely and accessibly for trans and non-binary people. These findings have important implications for healthcare policy, public toilet legislation and advancing menstrual equity in the USA.

A Policy for Addressing Menstrual Equity in Schools: A Case Study From New York City, U.S.A.

There has been a growth in menstrual equity policy advancements in the U.S.A. in recent years; with much of the new legislation prioritizing the needs of adolescent girls in schools. New York City, a predecessor of this movement, was the first U.S.A. locality to pass such legislation in 2016. The aim of this case study was to better understand the various factors which led to the development, passage and initial implementation of New York City's Menstrual Equity in Schools Policy. Data collection methods included a desk review and qualitative assessment with several actors involved across the policy and introduction phases. Key findings included (1) the utility of community narratives and a pilot project as a means for overcoming initial skepticisms, proving feasibility, and generating support; (2) the importance of policy champions for overcoming fiscal objections and navigating political discourse; and (3) lessons learned from early implementation efforts, including variance in awareness and distribution models. This case study yields valuable insights into the practical considerations when designing or implementing policies aimed at tackling issues of menstrual equity within school settings.

Menstrual Equity Initiatives at USA Universities: A Multiple Case Study of Common Obstacles and Enabling Factors.

Background: In recent years there has been growing momentum in the USA around addressing issues of "menstrual equity" and "period poverty," including a proliferation of university-level initiatives seeking to provide access to free menstrual products. This multiple case study examined four such efforts at a diversity of tertiary institutions to identify the factors that facilitated or impeded success. Methods: We conducted a qualitative multiple case study, including a desk review and key informant interviews with student and administrative actors from universities with free menstrual product initiatives. We sought to identify key learning regarding common challenges and obstacles, enabling factors which supported success and sustainability, and practical learning for future initiatives. From the desk review, four schools (n = 4) were purposively selected to represent a range of geographic regions, student population size, and university type. Purposive sampling was used to identify students and administrators engaged in the menstrual equity initiatives on each campus (n = 20; 4-6 per school). Data from the desk review and interviews were analyzed using thematic analysis. Results: Key themes included (1) the critical role of champions, (2) the importance of social and financial support, (3) challenges diffusing menstrual equity from pilot to scale, and (4) recommendations for future initiatives. University initiatives varied greatly in terms of their scope, funding, and implementation strategy. Conclusion: This multiple case study provides valuable insights regarding the facilitating factors and obstacles faced by initiatives providing free menstrual products at universities. To date, these initiatives have proven successful across the four case studies; however, in most cases, the scope of the initiatives was constrained by limited resources and sustainability concerns. Future campus menstrual equity strategies would benefit from cross-institutional learning and dialogue highlighting design and implementation successes and challenges.