In her 11 years of practice, Dr. Anne Banfield, an OB-GYN at Davis Health System in West Virginia, has rarely, if ever, encountered a patient who voluntarily mentioned their struggles paying for menstrual hygiene products. People with low incomes can feel ashamed to talk about their challenges, she said.
“Women don’t come to their physician and tell them that they can’t afford pads and tampons and menstrual cups and period underwear and all those sorts of things,” Banfield said. “For many people, poverty imparts a feeling of shame … when they can’t provide for their own needs.”
Financial barriers, stigma and poor education around menstrual cycles have forced many into period poverty, defined as inadequate access to menstrual hygiene products and education. The problem has worsened during the coronavirus pandemic, Banfield said.
As state and local officials become more aware of the issue, states have passed laws to exempt feminine hygiene products from sales taxes or ensure schools are equipped with free products.
Louisiana, Maine and Vermont this year joined Washington, D.C., and 20 other states that have either ended sales taxes for menstrual products or never had a tax in place, according to Period Equity, a legal organization based in New York that focuses on menstrual equity.
Lawmakers in 17 additional states introduced sales tax proposals that failed or have not passed. Five states—Alaska, Delaware, Montana, New Hampshire and Oregon—don’t have any sales taxes.
Advocates say this is a step in the right direction, but they argue that states must also work to reduce cultural and social stigmas, make products free in publicly available places and invest in sexual education.
“Those legislative ideas are just a small handful of the kinds of ways we can use policy to eradicate both challenges to access as well as stigma,” said Jennifer Weiss-Wolf, co-founder of Period Equity. “It’s not just that people are embarrassed or [feel] shame, but that we don’t actually pursue progressive or proactive solutions because we just are choosing to not talk about it.”
The laws have their critics. Some opponents argue that states need that revenue to fund education and other services. Period Equity estimated that the 27 states with menstrual product sales taxes receive a total of $119.7 million in revenue from those taxes a year.
Earlier this year, New Hampshire Republican lawmakers introduced legislation that would have reversed a previous law that requires schools to provide free tampons and sanitary napkins to students. Proponents of the bill said it would release schools from the financial burden of paying for the products. The proposal died when the legislature adjourned.
“I don’t think the state of New Hampshire should be micromanaging schools regarding how and where to provide these products,” said state GOP Rep. Judy Aron, according to the Concord Monitor. “Those things should be left up to the discretion of the school administration.”
Mental Health Effects
Women of color in the United States are more likely to experience poverty than White women, so they’re also more likely to have trouble paying for period supplies.
Experts cannot quantify the extent of period poverty in the United States because research on menstrual health is limited. However, a 2019 study published in Obstetrics and Gynecology found nearly 64% of surveyed low-income women in St. Louis, Missouri, could not afford menstrual hygiene supplies during the previous year.
About 46% of the women could not afford to pay for food and menstrual products, and 21% were unable to afford products on a monthly basis. One-third of them used cloth, rags, tissues or toilet paper, the study found, whereas others used children’s diapers or paper towels because they didn’t have pads or tampons.
The inability to afford clean sanitary products can affect women’s mental health. A study published in January in BMC Women’s Health found that 68% of college students who reported experiencing period poverty monthly also reported moderate or severe depression.
Other health risks, Banfield said, include toxic shock syndrome, a rare and potentially fatal medical condition caused by bacterial infection; recurrent discharge from lengthy tampon use; rashes; and inflammation, all of which can result in physical and mental trauma. Pads and menstrual cups can help, she said, but their cost is a barrier.
There are additional hurdles for people who get their periods but don’t identify as women and girls, including transgender boys and men, and individuals who are nonbinary. Some schools, for example, might provide products in girls’ restrooms but not in those for boys.
Costs are as variable as menstrual cycles. An online period product calculator published by statistics firm Omni Calculator found the average woman spends about $10 a month on menstrual products, which includes tampons, pads or menstrual cups. This doesn’t account for pain pills, wipes or other items. Prices can vary depending on the brand of items or the heaviness of the menstrual cycle.
The items’ necessity, advocates say, is why they should be exempt from sales tax and provided for free in schools.
On the first day of July, Maine Gov. Janet Mills, a Democrat, signed a revised biennial budget bill into law that ends the sales tax on feminine hygiene products beginning Oct. 1. The month before, Louisiana’s and Vermont’s governors signed similar laws to eliminate the so-called tampon tax. Louisiana also got rid of sales taxes for children’s and adult diapers.
In Vermont, state revenues are up as a result of federal COVID-19 relief aid. That was one of the reasons the sales tax bill was easier to pass this time around than in previous years, Sen. Ruth Hardy, a Democrat who co-sponsored the measure, told Stateline.
“It made it an opportune year to make sure this legislation passed and made it easier for people to say yes who did not in the past,” Hardy said. Another law, Hardy added, mandates that schools make period products available in most gender-neutral and girls’ bathrooms.
As with many national social movements, young people have been on the frontlines of the menstrual equity push. In 2020, students across the country raised money, lobbied, held school assemblies and launched social media campaigns to make period products free in their schools, The Wall Street Journal reported. In Washington state, middle school students created a GoFundMe account to buy products to place in schools.
Washington Gov. Jay Inslee, a Democrat, signed legislation this session that requires schools, colleges and universities to provide free products in all gender-neutral and girls’ bathrooms. Last year, Inslee also signed a bill that exempts the products from the state’s sales tax.
So far, at least eight states require schools to offer free tampons and pads to students, said Weiss-Wolf.
School closures during the COVID-19 pandemic made it harder for students to access pads and tampons. About 23% of pupils have struggled to afford period products, according to a 2021 study by PERIOD, a youth-led nonprofit that strives to eradicate period poverty, and Thinx, a feminine hygiene company.
About 27% of students said being in school has made it easier to get supplies, the study found. About 50% of students said they wore period products longer than recommended.
“Returning to school alone will not solve the challenges students face. Students do not think schools foster an environment in which they feel comfortable discussing periods or even attending class while they are on their periods,” the authors of the report wrote. “This stigma and lack of access can have a very real impact on a student’s education, especially for students of color and lower-income students who tend to be more impacted by lack of access to products.”
States have moved slowly even with the national push to eliminate the taxes, Banfield said, but she said poverty should be treated as a medical, socioeconomic and educational issue, and that period poverty should be treated as a public health crisis.
“This is not your Starbucks that you're having in the morning because you want to have it. These are things that you need,” Banfield said. “This is a normal biologic function.”