world us and uk many low-income and/or homeless girls and women in the inner cities of the united states cannot afford sanitary supplies. food banks in new york report that feminine hygiene products are in high demand. homeless women in the united states may face the challenge of not being able to shower or use the communal toilet in homeless shelters as often as they need to in cases where there are restrictions on toilet usage. in new york, proposals to help lower-income women access menstrual sanitary supplies include proposals to remove the sales tax on feminine hygiene products and "distributing free tampons in public schools." sales tax are levied on menstrual supplies in 36 states. on may 1, 2018, the national diaper bank network, which provides millions of diapers to poor and low income parents and advocates for policy change around basic needs, launched the alliance for period supplies and began distributing free period products through allied organizations across the u.s. homeless women in other industrialized countries, such as the united kingdom, face problems affording tampons and sanitary napkins. scotland became the first country in the world to provide universal access to free period products in 2020. disposal of used materials a review in 2018 found that disposal of menstrual waste is often neglected in sanitation systems. this leads to improper disposal and negative impacts on users, the sanitation systems and the environment. solid waste disposal systems in developing countries are often lacking, which means women have no proper place to dispose of used products, such as pads. inappropriate disposal of used materials also creates pressures on sanitation systems as menstrual hygiene products can create blockages of toilets, pipes and sewers. it is estimated that tampons, pads, and applicators, generates 200,000 tonnes of plastic waste in the uk each year. in developing countries, women experience a lack of access to affordable menstrual hygiene products in addition to a lack of access to other services such as sanitation and waste disposal systems needed to manage their menstrual cycles. lack of access to waste disposal leads women to throw used products in toilet systems, pit latrines, or discarded into open areas such as bodies of water. these practices pose dangers to workers who handle these wastes as it increases possible exposure to bloodborne infections in soaked menstrual products and exposure to chemicals found in menstrual hygiene products. inappropriate disposal also creates pressures on sanitation systems as menstrual hygiene products create sewage blockages. the effects of these inadequate facilities have been shown to have social effects on girls in developing countries leading to school absenteeism. taboos main article: culture and menstruation despite the fact that menstruation is a healthy biological process, it is approached with hesitance and misinformation because of deeply-rooted cultural taboos surrounding menstruation. cultural, religious and traditional beliefs — particularly in developing countries — can lead to restrictions that women or girls face during their period. in some societies, women do not wash their bodies, shower, or bathe during menstruation. they may not be allowed to use water sources during menstruation. even if they have access to toilets, they might not use them because of the fear of staining the toilet bowls (in the case of dry toilets or flush toilets where the flush is not powerful). this impairs the use of menstrual cups compared to pads as the cups are normally emptied into toilets. expanding the discussion to include consideration of waste management is part of the attempt to "normalize" conversations about menstruation. approaches for improvements mhm in schools should not be a stand-alone programme but should be integrated with existing programmes on wash in schools, school health and nutrition programmes, puberty education programmes, and emergencies. in rural bolivia a menstrual hygiene management game was developed for school girls that stimulated detailed responses, and diversified participatory activities in focus group discussions. the board game helped to ease girls’ discomfort discussing menstruation. improving mhm requires community-wide attitudinal changes. involving men in mhm is a key in order to get them to support their wives and daughters. other organisations have also worked with games and stories to teach mhm, dispel common myths and start conversations. gamess help to create a positive atmosphere around a topic generally associated with shame and embarrassment. in 2014, wash united initiated menstrual hygiene day on may 28. menstrual hygiene day creates an occasion for publicizing information about menstrual hygiene management issues in the media as a way to raise awareness, celebrate and normalize menstruation and menstrual hygiene. the day offers an opportunity to actively advocate for the integration of menstrual hygiene management into global, national, and local policies and programmes.