period poverty period poverty period poverty is a term used to describe a lack of access to proper menstrual products and the education needed to use them effectively. the american medical women's association defines it as "the inadequate access to menstrual hygiene tools and educations, including but not limited to sanitary products, washing facilities, and waste management". a tampon pictured with an application device period poverty is an issue that deals heavily with gender equality and economic justice worldwide. it has numerous causes and consequences that are far-reaching and reveal a lot about the lack of resources regarding menstruation. particularly since the 2000s, period poverty has become an issue that governments and other actors have tackled worldwide, both separate from and within the proliferation of gender equality. causes period poverty is caused by a variety of social, economic and cultural factors. period shaming makes girls feel insecure about the menstrual process and thus less likely to have period products on hand, as well as less likely to have conversations on menstrual health with friends and family members. in some cultures across the world, menstrual blood itself is seen as unholy and girls are encouraged to hide signs of menstrual bleeding from their male counterparts. in the us specifically, 80% of sampled 13 to 19-year-old teens believe periods have a negative association. this same study found that 57% have felt personally affected by this negative association, and 64% think society generally teaches girls to be ashamed of their periods. economic barriers can also worsen the troubles that women must endure to access safe period products. as of 2019, 35 out of 50 u.s. states tax period products as non-essential items. additionally, said products are not covered in america's food stamps program, supplemental nutrition assistance program, or its derivative for women, infants and children (wic). period poverty is interrelated with the "pink tax", a hypothesis which alleges that "women's products" are disproportionately more expensive than similar product types which are marketed towards men. consequences a lack of sanitary period products can have multiple negative health effects on the female body. using pads or tampons past their expiration date (five years when stored in dry conditions) renders the vagina vulnerable to infiltration by bacteria and mould. this can cause itchiness, irritation and an increase in vaginal discharge. leaving a tampon in for longer than eight hours can cause other adverse effects such as toxic shock syndrome. both of these situations are caused by a lack of surplus menstrual products, and 61% of american teens have reported wearing a pad or tampon for more than the recommended length of four hours. the principal consequence of period poverty not related directly to female biology is girls often have to miss school if they get their period and do not have the products to handle it. the same survey found that more than 4/5 of the girls in their sample had missed class or knew of someone missing class due to their period. a 2014 report by unesco found that 1/10 of youth worldwide miss school during their cycle due to a lack of resources on hand. case studies case-study research has been crucial in collecting and synthesizing the (limited) data on period poverty's effects worldwide. a study commissioned by irise international examined six government-run primary schools in the rukungiri district of uganda. researchers administered a questionnaire to 140 girls between march and april 2013. they found that 61.7% of those surveyed reported missing school monthly for menstrual health reasons. the main reasons cited for missing school were a lack of privacy, fear of staining their school clothes, discomfort from bloating, and pain from period cramps. also, 87.8% of these girls were unable to buy pads at some point, either because of cost or lack of availability in local stores. the researchers also performed an examination of the schools' toilets and found a complete lack of soap, water, light, privacy and overall cleanliness. a similar study conducted in the mumbwa and rufunsa districts of zambia between july and august 2015 shed more light on issues faced by a lack of menstrual health management. between 12 in-depth interviews and six focus group discussions with girls in between ages 14 and 18, the consequences of a lack of education on menstruation become more apparent. the majority of girls had no conception of menstruation's physiological basis, and many first learned about the process at menarche. the menstrual health products were mostly cloth, with a select few being able to access cotton wool or fads. the girls reported getting friction burns on their thighs from the cotton while walking to and from school, and only 1/6 of the schools investigated stocked cotton wool (the rest had toilet paper). most of the girls stayed home from school during their cycle, out of fear that they would have a menstrual "accident" in class. if they went to school they reported avoiding social interaction and many class activities, as well as being at risk of teasing from classmates. additionally, investigations of the bathrooms found that there was rarely soap provided and the toilets offered little to no privacy. the facilities all in all mostly did not meet standards put forth by the world health organization. period poverty is certainly not an issue only faced by africa or areas of the developing world. a case study done in st. louis, missouri reveals similar droughts of period products and financial strain in acquiring them. from july 2017 to march 2018 these researchers conducted 183 surveys and 3 focus group discussions with beneficiaries of 10 not-for-profit community organizations which provided shelter, food and job training. it was found that 64% of the women could not afford needed menstrual supplies in the previous year, and 21% of all those surveyed experienced this monthly. one-third had to use some product that was not a pad or tampon to deal with their flow; products mentioned included strips of cloth, diapers, rags, tissues and toilet paper. 46% had to choose between either food or menstrual health products at some point in the previous year, showing the deep interconnection between period poverty and food insecurity. 63% relied on community organizations in the st. louis area to provide period products at some point, although these pads are often of low absorbency and quality. legislation on menstrual equity united states as of 2023, 26 us states have passed or enacted menstrual equity bills related to solving period poverty. the breakdown for where these bills exist is as follows: 1 bill: alabama, alaska, arizona, colorado, connecticut, florida, georgia, iowa, louisiana, mississippi, nebraska, nevada, new hampshire, new mexico, new york, ohio, rhode island and vermont 4 bills: delaware, texas 5 bills: california, michigan 7 bills: illinois 9 bills: maryland the bulk of these bills are concerned with providing menstrual health products to incarcerated women, as well as providing them in nurse's offices and bathrooms within that state's school districts. additionally, many states have passed bills to lessen (or remove entirely) sales taxes on feminine hygiene products. additionally, 36 of the 50 states have introduced bills of this type into their legislative sessions in the 2023 session as well. the states that have done so are listed below: alabama, arizona, california, colorado, connecticut, florida, georgia, illinois, indiana, iowa, kansas, kentucky, maine, maryland, minnesota, mississippi, missouri, montana, nevada, new hampshire, new jersey, new mexico, new york, north dakota, ohio, oklahoma, rhode island, south carolina, south dakota, tennessee, texas, vermont, virginia, washington and west virginia. worldwide there are a handful of countries which have tax-free exemptions for period supplies. the countries are as follows: australia, canada, india, ireland, jamaica, kenya, lebanon, malaysia, nicaragua, nigeria, south africa, tanzania, and uganda. some countries also have tax reductions on period products. in 2019, germany moved their value-added tax on feminine sanitary products from 19% to 7% (in effect january 1, 2020). representation of women there is an argument to be made that the descriptive representation of women in executive and legislative bodies may bring about more government-level remedies to period poverty. sarah childs and julie withey investigated the decision of great britain's labour party-led government to reduce the value-added tax on sanitary products in their 2000 budget. they found that, although it was then-chancellor gordon brown who put forth the budget, it was the actions of mp christine mccafferty that spearheaded this decision. in the years leading up to 2000 the parliamentary labor party women's group put the vat reduction at the forefront of their agenda, and it was mccafferty's membership on this group that perhaps compelled her to table 3 early day motions (edms) in the months leading up to budgeting on this same topic. in the run-up to the budget session mccafferty conducted an interview on bbc woman's hour, implying that this reduction would be made in the upcoming budget. this shifted the conversation surrounding the vat from its own policy measure to a budget commitment, which made it easier to get passed. advocacy efforts the children's hospital of philadelphia offers a 5-pronged plan to destigmatize periods in general and work to provide menstrual health awareness and supplies to girls worldwide. their plan is as follows: normalize conversations about periods talk to teens about how they purchase menstrual products continue research to better understand the scope of the problem build a coalition of advocates within the medical community serve as advocates for key issues in the american context, 14 states and local jurisdictions have proposed legislation to guarantee period products inside the bathrooms of school districts, which is where many women and girls rely on these resources to be. however, these bills do not allocate funding to provide these products. period poverty had not achieved salience in the public eye as a major issue until the mid-2000s. it started to be talked about in the background of closing the worldwide gender gap in education between boys and girls. advocacy was seen as early as 2001, when the rockefeller foundation supported case study research in countries such as uganda, zimbabwe and kenya which explored menstrual-related challenges girls encountered in school. they also supported an engineer in uganda, dr. moses kizza musaazi, who developed a low-cost sanitary pad made from papyrus leaves called makapads. the focus continued later on in the 2000s as focus on the education gap was heightened around 2004. in this time, catholic relief services donated improved latrines to schools in eritrea, and the basic education program distributed comfort kits to girls in south sudan which included sanitary materials and underwear. starting in 2005, procter and gamble, one of the globe's leaders in sanitary product production, began to intervene in correcting period poverty. they collaborated with the forum of african women educationalists to remove a value-added tax on the importation of sanitary materials which many african countries had. they also partnered with various ministers of health in low and middle-income countries to identify puberty trainers, as well as distribute leaflets on pubertal changes and menstruation which teachers kept in their classrooms. 2006 brought about a wave of research in the education and public health sectors which exposed the challenges disadvantaged women and girls face in menstruation worldwide. the turn of the decade brought about an increased focus on research, with unicef supporting research in 4 countries by emory university in 2011, and columbia university hosting a conference on menstrual health management in 2012. this push caused countries such as kenya, south africa and india to launch efforts to subsidize the provision of sanitary materials to girls in need.