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Menstrual Health Experts Say Period Poverty Continues Across the Globe


Reproductive Health

Kind Cup donated menstrual cups for distribution to health centers, free clinics and community organizations across the United States. (Lara Cooper/Direct Relief)

A 2021 report published in partnership with Days for Girls shared that at least 500 million women and girls across the world lacked adequate access to period supplies and a private space like a bathroom to manage their periods.

In the two years since the report was published, experts working in the space of women’s and maternal health say much has changed, but barriers persist. For people who experience menstrual cycles, it’s not only sometimes annoying or painful, but it can also be a costly and isolating experience. To combat costs and keep women and girls in school and employed, entrepreneurs, health workers, and advocates are sharing solutions to support women’s health.

Menstrual products include sanitary pads, tampons, menstrual cups and discs, and lined underwear. The National Organization for Women reported that a menstruating person spends about $20 monthly on period supplies.

When Christine Brown learned about periods and the costs associated with them, she thought it was ridiculously unfair.

“I thought, well, that sucks, and that’s not fair,” said the founder and owner of Kind Cup. “That sounds so expensive that girls and women are going to have to pay for these things.”

Brown has two patents for the Kind Cup, a sustainable menstrual cup with an ergonomic shape created with a minimal carbon footprint. The founder said she began to sketch potential products when she learned that some women might use up to 22 single-use products for each menstrual cycle.

“That’s expensive,” Brown told Direct Relief.

Across the United States, advocates have lobbied for more equitable policies regarding women’s health and to decrease expenses around what’s known as the “Pink Tax,” or additional costs associated with health products targeted toward women. Several states have adjusted Pink Tax laws to decrease how much women and girls must pay for supplies. Last year, Utah’s state legislature voted to support the availability of free period products in schools. This year, California’s state legislature voted to expand the use of federal funds to include period products for needy families.

But the Kind Cup founder said there’s never a “true sense of security” regarding women and menstrual health.

“I see, as a general trend, that we’re moving forward, but then there’s stuff that comes up where you’re like, Oh, I thought we were done with that, but here we go again, you know, there’s never a dull moment,” Brown said.

At the federal level, some healthcare policies have been adapted to allow people who have periods to use employer-driven HSA and FSA funds to purchase supplies.

Brown isn’t the first to design a menstrual cup. Dozens of other products are on the market, but the Kind Cup founder said she wanted to create a product with an improved design and user experience. Brown also recognized that materials matter, and no “fancy labeling and cut corners” would suffice. Brown said that the Kind Cup needed to be a high-quality device that people could trust.  

“You shouldn’t be in pain for having tried a bunch of different products and feeling like something’s wrong with your body,” said Brown. “No, it’s clearly indicative of there being a need for something that’s a better design.”

The Kind Cup has an added social benefit. Any purchase from Brown’s site prompts the buyer to donate a Kind Cup to another person. The first 150 Kind Cups were donated to other menstruating people.

Earlier this year, almost 100 Kind Cups were donated via Direct Relief to a Florida mobile health unit, one of dozens of organizations to receive the cups free of charge.

“We have a lot of uninsured people with barriers to getting health care,” said Michelle Nall, a nurse practitioner at the University of Florida’s Mobile Outreach Clinic.

The mobile unit is a program between the College of Medicine at the University of Florida and the university’s medical system. The mobile unit’s staff provides free, comprehensive, primary care for people without health insurance – largely those affected by factors including poverty, according to Nall.

The Kind Cups will be dispersed to patients and brick-and-mortar locations associated with the university’s health system and its partners, like local food pantries and churches. The mobile unit serves about 2,000 patients in North Central Florida, and Nall said that period poverty is common among their patients.

The nurse practitioner said that the need for reproductive justice remains pertinent as government policies shift, like the Supreme Court’s overturn of Roe v. Wade in 2022 allowed states to ban abortions, which restrict a person’s choice regarding personal health decisions, and the 2023 law signed by President Joe Biden that requires employers to provide reasonable accommodations for pregnant employees through the Pregnant Workers Fairness Act.

So, Nall focuses on what she can do to provide support for menstruating people in her community—whether they plan to have children or not.

Nall said it’s key to ask questions to gain a better understanding of what a patient needs to provide the appropriate support service.

Understanding the needs of menstruating people is a worldwide advocacy issue.

Diana Nelson, global advocacy director at Days for Girls International, said that in many countries, women who don’t have access to products are more likely to miss school and or work while menstruating. DFGI is a nonprofit that distributes sustainable menstrual health products around the world and participates in education and advocacy efforts regarding menstrual health.

To ensure worldwide understanding that menstruating is a natural process, Nelson said it’s key to include people who don’t menstruate in the conversation.

“It’s natural, it’s normal, it’s nothing to be ashamed of. It’s nothing to be scared of,” Nelson said. “So many girls wake up with blood, and they have zero idea what’s happened.”

Nelson said that DFGI works with volunteers and community leaders to educate people about menstruation cycles. That includes suggestions on creating supportive environments and sharing data about the impacts on women and girls who miss school or work while menstruating. Nelson said that in some places, menstruating people do not have a private bathroom and opt to go home in the middle of the day.

“If you want to increase education, then you need girls to stay in school… research shows they are missing school either because they don’t have access to products or because you don’t have the infrastructure where they can privately change,” Nelson said. “If you want your GDP to grow, if you want to create a labor market, you recognize that women are 50% of the laborers. And if they’re missing work because of their periods, or if they’re missing work because they have to leave to go find somewhere to manage their period….they don’t come back to work, and that is impacting your growth and your job market.”

Nelson also said good advocacy means helping the broader public understand how a singular issue impacts everyone.

To address period poverty, Direct Relief has provided period products, including Kind Cups, pads, tampons, Days for Girls kits, and more across the U.S. and globally.

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