Period Poverty: A Public Health Issue that Needs Addressing
An Essay by Lucy Fraenkel
500 million menstruators worldwide currently lack access to period products and appropriate hygiene facilities during menstruation. But surely this is an issue that only affects low-income countries or those experiencing extreme poverty and homelessness, right? Wrong. Period poverty is the reality for a large proportion of 'everyday Australians'.
Period poverty is defined as a lack of access to period products, hygiene amenities such as toilets and hand-washing facilities, waste management and menstrual hygiene education. In the absence of period products, Australian menstruators have been reported to turn to other alternatives such as socks, rolled-up toilet paper, cloth rags, child's diapers and even mattress foam. This list of creative but unhygienic alternatives goes on. The issue of period poverty is further complicated by the stigma and shame surrounding menstruation. Menstruation is not an experience limited to only those who identify as women, however, the vast majority of menstruators are women and as such period poverty is a significant barrier to achieving gender equity. Period poverty is more likely to affect First Nations people and gender-diverse people as well as people of culturally diverse backgrounds, experiencing homelessness, experiencing domestic violence and people with disabilities, all of whom already face additional forms of discrimination and barriers to accessing healthcare.
Several months ago, an interim report from a Senate inquiry investigating poverty provided evidence regarding the "dehumanising" poverty, including descriptions by a South Australian woman of having to wear "rags" during menstruation because she was unable to afford period products. On average, people who menstruate will have periods for more than 30 years in their lifetime and this does not stop during a pandemic, a cost of living crisis or any emergency, for that matter. Period products have a fixed cost that menstruators cannot avoid, and menstruation has a fixed financial, physical, emotional and social cost that cis-gendered men simply do not have to bear.
Period poverty infringes on a variety of human rights, both directly and indirectly. Dr Jyoti Sanghera of the UN Office of the High Commissioner for Human Rights stated ignoring menstrual hygiene needs and menstrual stigma "is a violation ... of the right to human dignity, but also the right to non-discrimination, equality, bodily integrity, health, privacy and the right to freedom from inhumane and degrading treatment from abuse and violence”.
The right to health
It is widely acknowledged and understood that meeting basic needs, such as food and water, is a necessity in respecting people's rights to health and well-being, but menstruators' rights to sexual and reproductive health are being forgotten. This year Plan International Australia (PIA) conducted a survey to better understand the wide-ranging impacts of the cost of living crisis and period poverty. The results were startling. The research suggests an estimated 6 million menstruators aged 18 to 42 in Australia are finding it increasingly difficult to afford period products, 1 in 5 of whom say they are now changing their period products less frequently than recommended. Poor menstrual hygiene, including using period products for longer than recommended, increases the risk of reproductive tract infections, pelvic inflammatory disease and potentially fatal complications such as menstrual toxic shock syndrome.
Period poverty can also have a profound impact on mental health and well-being. Lack of period products can result in feelings of shame and embarrassment, as well as poor self-esteem. Studies have found menstruators who have experienced period poverty in the past year are more likely to experience moderate to severe depression. Additionally, period poverty can negatively impact mental well-being through impacting personal relationships. More than 1 in 4 respondents to PIA's survey said difficulties in being able to afford period products and period management treatments were negatively impacting their sexual relationships. Stress in personal relationships is known to impact both physical and mental health, thus the negative impacts of period poverty on menstruators' sexual relationships further compound other menstrual-related health inequalities.
Equal opportunity to education and work
Over the past three years, all states and territories have invested in the provision of free period products in public schools in an attempt to ensure period poverty does not violate menstruators' right to education. However, these products are not necessarily distributed in both men's and women's bathrooms, which prevents equal access to those who menstruate but do not identify as women. Similarly, sanitary disposal facilities are commonly not present in both genders' bathrooms in schools or workplaces, which compromises gender-diverse people's right to privacy and sanitation, with indirect consequences on access to education and work. While the provision of free products is a good step in the right direction, this strategy also does not address students who miss days at school due to untreated period pain or menstrual-related symptoms.
Period poverty can refer to the inability to afford menstrual pain medications and treatments, which may result in menstruators having to forgo medications required to manage period-related symptoms, thus negatively impacting their health and ability to participate in school and work. In PIA's study, 16% of menstruators between the ages of 18 to 25 reported difficulties in accessing period products and period pain treatments were negatively impacting their education and workplace participation. The inability to buy period products or menstrual pain treatment can force menstruators to take time off school or work. Psychosocial stress as a result of period poverty also negatively impacts one's ability to engage in education and work. All of these factors can exacerbate the existing economic inequalities people who menstruate face.
The right to be treated with dignity
The right to dignity is inherently violated by the deeply engrained stigma and perceptions surrounding menstruation. Current sex education often teaches the bodily changes menstruators undergo during puberty are "troublesome", while the bodily changes cis-boys undergo are taught as "exciting and powerful". Periods are often perceived to be 'dirty' or 'repulsive'. These descriptions not only negatively impact self-esteem but they also contribute to an environment that violates menstruators' rights to dignity and equality.
There are a wide range of repercussions from period poverty that impact the right to dignity. The odours and obvious blood stains on clothing that may result from a lack of access to period products can have an obvious impact on a menstruator's sense of dignity. For example, in an interview with 7 News kidney transplant recipient Sarah Stevens described how during a hospital stay, a nurse taught her how to use a bed protector as a make-shift pad when no period products were available. In the same article, 28-year-old Australian Paisely Semrau, who had previously experienced homelessness, described the humiliation and loss of dignity she experienced as a result of period poverty. Paisely said, "Ten years ago, I was sleeping under bridges bleeding on myself with toilet paper between my legs". She described in the interview how degrading it felt to walk down the street with menstrual blood dripping down her legs. If these examples are not clear violations of the right to dignity, then to be frank I am not sure what is.
So where do we go from here?
A highly complex issue, period poverty requires a range of different strategies to properly address it, but whose responsibility is this? I believe there is a collective responsibility to eradicate period poverty, most importantly including different levels of government and commercial actors. Eloise Hall, the co-founder of TABOO Period Products, says "Wherever there's toilet paper, there should also be access to period products. And whoever's responsibility it is to buy the toilet paper, it is also their responsibility to buy period products", which is an idea I personally agree with. As such, in workplaces, it is the responsibility of the business owner to ensure period products are provided. However, it is also the responsibility of period product manufacturers and retailers to ensure prices of period products do not continue to rise such that a large proportion of the population cannot afford them. While retailers may say this simply is not possible in the current economic climate, the supermarket giant Woolworths' $1.62 billion dollar profit for 2023 suggests otherwise. For the everyday person, it is our responsibility to advocate for the need to address period poverty and begin to address the stigma surrounding menstruation ourselves by starting conversations about what is normally considered a taboo topic.
At a government and policy-making level, there are four core strategies that need to be implemented. Firstly, other state and territory governments need to follow in the footsteps of the ACT, which this year became the first Australian jurisdiction to pass legislation requiring the government to provide free period products without prejudice in locations such as public toilets, libraries and health facilities. Secondarily, sanitary bins should be provided in all public toilet stalls to respect menstruators' rights to privacy and such that the lack of necessary disposal facilities does not prevent menstruators from engaging in education and work. These period products and sanitary bins need to be available in both men's and women's bathrooms to ensure all menstruators, including those with gender-diverse identities, have equal access to necessary period products. In the absence of a cap on the price of period products, the Australian government should provide subsidies for period products and menstrual pain/symptom management for those of low socio-economic status in order to protect menstruators' rights to health, education, work, dignity and equality.
While the provision of free period products is an incredibly important step in addressing period poverty, we cannot truly eradicate period poverty in Australia until more research into the causes and perpetuating factors of menstrual stigma is identified. Such research requires an intersectional approach to ensure the needs of all menstruators are addressed and to prevent the widening of inequities between menstruators.
People's rights to health, education, work, dignity and equality should not be infringed upon because they menstruate. That is the goal and that is the future all Australians should be fighting for.