Population Care

Why stigma prevents treating menstrual hygiene as essential

Sara Berg, MS , News Editor

Imagine having to bring toilet paper, hand soap or paper towels along when using a public restroom. It would seem odd and unnecessary. This is what many people face when it comes to menstrual hygiene products.

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The phenomenon of “period poverty,” which is inadequate access to menstrual hygiene tools and education, is not new, but it has been exacerbated by the COVID-19 pandemic. It has left people who were already struggling to afford menstrual products with even less access to the essentials they need. “In many parts of the world—and even the United States—there are misconceptions surrounding menstruation and limits an individual from attaining education, advancements in career and even resulting in severe social stigmatization,” said Reilly Bealer, a third-year medical student at the Elson Floyd College of Medicine at Washington State University. Read this Q&A about how adversity drives Bealer’s congressional advocacy as the AMA Government Relations Advocacy Fellow.

AMA policy encourages the Internal Revenue Service to classify feminine hygiene products as medical necessities. The AMA will also work with federal, state and specialty medical societies to advocate for the removal of barriers to feminine hygiene products in state and local prisons and correctional institutions. Additional AMA policy supports legislation to remove all sales tax on feminine hygiene products.

The average lifetime cost in the U.S.—about 10 years of menstruation or 3,500 days of an average woman’s life—is about $1,800, which is the value of about 17,000 tampons or pads used in total. Without access to menstrual hygiene products, women may use makeshift sanitation products. That practice can lead to dangerous physical health impacts such as vaginal and urinary tract infections, severe reproductive health conditions and toxic shock syndrome.

“These products are not defined as essential, which means they are not covered by federal food stamps programs and other relief programs,” said Bealer. “They are not included as essential items that would potentially be tax-exempt during a public health crisis such as COVID-19.

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“This leaves people with a choice between buying tampons or providing other necessities for their families,” she added.



“I talk about my time being homeless as a teenager a lot because it has shaped the way I view the world and my perception on this issue,” said Bealer in an online presentation for the AMA Medical Student Section. This session took place during the 2020 AMA Sections Meeting, which took place ahead of the November 2020 AMA Special Meeting, a virtual gathering of the AMA House of Delegates.

“When you think of people who don't have access to menstrual hygiene products, you think of the very impoverished in very poor countries, but you don't think of this happening in the United States,” she said. “We need to change the stigma around having your period. It is not a pathological mystic thing that happens.”

“It is a normal physiological process that tells you your body's working—it's doing what it's supposed to do,” said Bealer. “The shame associated with periods prevents people from talking about it, which in turn averts dialogue about access to products, the tampon tax, and even ingredients within our pads and tampons, so let's normalize having a period.”

“Although this is long overdue, we now see that five states have implemented legislation to provide free menstrual products in public school restrooms in the most recent legislative term,” said Bealer. “Even more states have considered similar legislation, but we're not there yet.

“On a federal level, there are current proposed efforts, but unfortunately they haven't been considered a priority, especially within COVID-19,” she added. “The Department of Justice has actually been a leader in this effort first, making policy in 2017 to provide period products to incarcerated females in the federal justice system.” This was later codified into law with the First Step Act, a criminal justice reform bill enacted with bipartisan support in 2018.”

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In Bealer’s experience lobbying state and congressional legislators on access to menstrual products, “some of them don't realize this as an issue.” Too often, they “don't know that this is something that's occurring in their districts with their constituents.” That’s why further advocacy’s needed, she said.

“Although period poverty impacts many, there's still a large proportion of the population who have not even been educated on this crisis,” said Bealer. “This type of education can be delivered simultaneously with hosting menstrual hygiene product drives to collect products for those who are most vulnerable in your communities.”

Such educational efforts can combat the stigmas surrounding menstruation while remaining culturally sensitive, Bealer said.

“It’s critical,” she said, to “talk about it.”