Period poverty: a public health crisis

For the purpose of this article 'girls, females, or women' are those individuals assigned as female at birth. It is not intended to exclude or dismiss individuals who do not identify as female.

What is period poverty?

"Having access to period products is a basic human right - we can't function without them," says Tina Leslie MBE, Freedom4Girls.

Period poverty affects girls, women, and people who menstruate who are unable to afford or access hygienic and safe period products. It's a growing public health concern¹ that has profound implications for a person's wellbeing and opportunities in life.

Tina Leslie, founder of period poverty charity Freedom4Girls, explains that period poverty, also known as menstrual equity, is mainly financial:

"Many people are not able to afford menstrual products. This might be because they have no money, or because they are in abusive relationships and have been coerced by their partners into giving over control of their finances."

The charity started in 2017, in response to food banks not providing period products.

"Why should people be worrying about how to manage their periods? It impacts absolutely everything: your sense of dignity, your emotions, your physical and mental health. On average, women have 3000 days of menstruation throughout our lives². We've all been caught short, but why should we be?" says Leslie.

Infection and illness

When women and girls aren't able to manage their periods safely and hygienically, this poses a direct risk to their health.

Imagine that you're in the supermarket and only have enough money for dinner or sanitary pads. To not go hungry, you may be forced to leave your current sanitary pads in when they need to be changed - something that more than one in four of UK women do³.

Or this dilemma could spur you to deal with your period using materials you can get for free or for less money. These options are usually less clean, like newspapers, or even dirty rags in the poorest communities.

Stigma and dignity

Period poverty is not just a financial issue - it's also about the stigma of menstruation, how this makes women and girls feel, and how this highlights inequality in daily life. One 2020 study found that one third of parents feel uncomfortable speaking to their children about periods⁸.

Leslie says: "Period dignity is important. In the UK, you will typically go into a public toilet and find no free period products, so often women get caught short. Why do we provide soap and other essentials, but not this. Also, If a child starts their period young, and they don't know what is happening to them, their mental health often suffers."

Work and opportunity

Period poverty affects a lot of menstruating women in low paid jobs. If they can't afford period products, they're going to have to take time off during this time of the month. Freedom4girls is trying to educate employers to tackle this and think about providing easy and free access period products.

The mental toll of having to take time off can also not be under-estimated. Imagine it's your very first day that you're having to miss - if your financial well-being depends on this job, this creates a significant amount of stress.

Some of the most vulnerable people include those who are homeless and those who use food banks. People belonging to groups with particularly high rates of lower income jobs are also more likely to suffer. This includes:

• People with disabilities.

• Refugees and asylum seekers.

• Transgender people.

Is there period poverty in the UK?

It's a myth that period poverty is exclusively a low-income country problem. According to Plan International UK, one in 10 UK girls can't afford period products, and 42% use makeshift period products because they struggle to afford them⁹.

The current financial crisis has had a huge impact but the problem precedes the recent turmoil. In 2017, period poverty made headlines when a teacher became concerned that girls were missing school due to a lack of access to menstrual products.

Access to period products by UK nation

• Écosse - in 2020 became the first country in the world to offer free access for all.

• Irlande du Nord - in 2022 made free access compulsory in all schools, colleges, and public buildings.

• Pays de Galles - currently no legislation around free access for all. There are schemes for those in education and for some workers, but without legislative back-up these aren't legally enforced.

• Angleterre - currently no legislation around free access for all. Schemes exist for those in education up to 19 years old, but these aren't enforced by law and many schools either don't stock or don't promote free period products.

Santé

Since 2019, NHS England has been required to provide free period products on request - including sanitary pads, tampons, and pantyliners - for their menstruating patients. As well as providing for those needing urgent care, this should help people in hospital long-term, including mental health inpatients.

But is this being enforced across the board? And are all women and girls aware that they can ask for these products while under the care of the NHS? In reality, many GP surgeries haven't thought of supplying products. This could be especially important for people undergoing procedures - both for patient well-being and menstrual hygiene.

Education and schools

Despite the introduction of the 2020 period product scheme in English schools, research from UK charity Girlguiding in 2022 revealed that around oe in three girls aged 11-18 still couldn't access free products in their schools or colleges¹⁰.

Lucy and Caitlyn, Girlguiding advocates, said: "We were so pleased in 2020 when the government finally introduced free period products in schools and colleges in England. But our research shows that the scheme isn't working as it should and millions either don't have access to period products or, feel too uncomfortable and embarrassed to access them at school."

As well as free stock in every school, there's a need for better education around menstruation. This includes educating boys from an early age to combat period stigma, and raising awareness among grown men - especially those in management positions - not just over periods, but other menstrual issues such as endometriosis, which can also cause women to struggle in the workplace.

Reusable products

If you live in the UK, you might think of period products as one-use-and-discard items, like disposable tampons. This likely means you need to buy more products at least once every period - over an average of 450 periods in your lifetime. Yet, a one-off purchase suddenly makes safe period protection much more affordable.

Freedom4Girls is promoting reusables in its Make The Switch campaign, with help from Hey Girls. They are spreading the message at universities, community centres, women's groups and other locations, explaining how to use reusables and empowering women to use them for as long as possible.

When used properly:

• Menstrual cups - can last 10 years.

• Reusable pads - can last four years.

Public spaces

It's not just charities like Freedom4Girls et Hey Girls who can encourage our public spaces to stock free period products. If the toilets in your local/favourite cafes, pubs, theatre, library, clubs, or community centres aren't are period product-free, you could make a big difference by asking them to stock.

"We are encouraging many everyday spaces to have period-positive toilets," says Leslie. "If they agree to provide free period products, we give them a sticker to say they have supported our campaign, that they can then stick in the window to advertise the fact."

1. ASTHO: Period poverty: a growing public health concern.

2. Plan International UK: Five reasons we need to talk about periods.

3. Sky News: Cost of living: one in four women and girls struggle to afford period products in UK - with some cutting back on food, using toilet roll and missing school.

4. Das et al: Menstrual hygiene practices, WASH access and the risk of urogenital infection in women from Odisha, India.

5. Hennegan et al: Measuring the prevalence and impact of poor menstrual hygiene management: a quantitative survey of schoolgirls in rural Uganda.

6. The World Bank: Menstrual health and hygiene.

7. Cardoso et al: Period poverty and mental health implications among college-aged women in the United States.

8. Forbes: A third of parents feel awkward talking about periods during coronavirus, study finds.

9. Plan International UK: Let’s talk. Period.

10. Girlguiding: A third of girls say period products are not available at school.