Recognizing Menstrual Supplies as Basic Health Necessities: The Bioethics of #FreePeriods

Bioethics in the News logoThis post is a part of our Bioethics in the News series

By Sean Valles, PhD

Activism against “period poverty” has gone mainstream

Within the last month, Scotland became the first country to provide free menstrual products in schools, and London student Amika George earned a Campaign Award from the influential Bill and Melinda Gates Foundation for starting the #FreePeriods social activism campaign. Why is the accessibility of menstrual products getting attention from human rights activists and governments? Because for many people* they are basic necessities that remain out of reach.

A survey commissioned by Proctor and Gamble’s Always® brand of menstrual products reports “nearly one in five American girls have either left school early or missed school entirely because they did not have access to period products.” Take that survey with a grain of salt, given who sponsored it, but it provides a sense of the scope of a previously-known problem. Like most problems that disproportionately hurt people who are already most marginalized by society, “period poverty” has only received sporadic attention in media outlets and public conversation. Previous reporting on the subject includes discussions of the problem among people who are homeless in San Francisco, and among adolescents from low-income families, living in the Pine Ridge Indian Reservation and in the Nashville area.

“Period poverty” is gradually getting recognized as one piece of the complex cycle of poverty. Imagine finally getting a job interview after struggling with unemployment, only to have to choose between skipping the interview or trying to make a makeshift pad out of wadded toilet paper or an old sock, then hoping it doesn’t fall out or leak in front of the would-be boss. When one can’t afford the health/hygiene supplies to avoid bleeding on one’s clothes (nor afford to replace any clothes stained by a period), a lack of timely access to menstrual products can have the drastic effect of making it hard to participate in public life.

Bioethics of access to menstrual products

Access to menstrual products is clearly a problem, but is it a bioethics problem? Absolutely. As the FDA will tell you, menstrual pads, reusable menstrual cups, tampons, etc. are medical devices. Menstrual products are medical technologies used to manage one’s hygiene according to cultural norms. It is a bioethical harm to limit a person’s access to the tools a society has decided are necessary for meeting its basic standards of hygiene.

After decades firmly in the U.S.’ collective ethical blind spot, public opinion on how society ought to respond to “period poverty” is divided, and has a conspicuous gender gap. In the U.S., almost three-quarters of women support providing free menstrual supplies in schools, while just over half of men do. Half of women agree public bathrooms should provide free menstrual supplies while just over a third of men do. I’m a little surprised to see that latter set of numbers so low, but I suppose we’re still accustomed to the idea that toilet paper and hand soap are necessary health/hygiene products that must be available in every public bathroom, while menstrual supplies are typically kept in paid dispensers or not available at all.

Image description: a close up photograph of a menstrual product dispenser, showing coin slots for pads and tampons available for 25 cents each, quarters only. Image source: Beth Van Dam/Flickr Creative Commons.

Adding insult to injury, Michigan continues to impose a sales tax on menstrual products, whereas food and medicines are exempt. Most states have similar taxes on menstrual products, even though legal scholars, such as Crawford and Waldman, have argued that the taxes are doubly unconstitutional; they violate both the Equal Protection Clause and the core constitutional principal that laws must have a rational basis. Legislation to end Michigan’s “Tampon Tax” received unanimous supporting votes in the Senate Finance Committee in March of 2017, but has been effectively ignored by the Senate since then. I suspect that the lack of progress, despite unanimous committee support, is related to the fact that in Michigan’s legislature there are three male legislators for every female legislator (on a related note, take a look at the names of the authors in the bibliography at the end of this post).

That tax loophole is part of a category of problems: bioethical harms resulting from sexist economic inequities. It is not the only example, either. For instance, among personal care products that are marketed to men and women (e.g. razors and shaving cream), there is an average markup of 13% on the items marketed to women. Meanwhile, the gender wage gap leaves women only making around 80% of what men make.

Some of the problems hiding in our bioethical blind spot will be complex and difficult to solve, such as the problem that dental care has long been treated as separate from medical care (Medicare and Medicaid largely exclude coverage). By contrast, the inaccessibility of menstrual products would be far easier to fix. Very minor changes to tax policies and social norms could make menstrual products as widely available as toilet paper. Most households still buy the toilet paper of their choosing, but we expect even the shabbiest public bathrooms to have toilet paper in it for free.

We can fix this

When will we start treating menstrual products like the health/hygiene/medical necessities they are? Scotland has recognized that at the very least no student should miss class because they don’t have access to sanitary pads. What is the argument against this? Perhaps a generic political concern about former social privileges getting recast as legally-mandated rights or socially-demanded expectations? Whatever the merits of that general concern, nobody wins when low-income students miss school and low-income women miss job interviews because they don’t have pads. If nothing else, where is our human empathy for those suffering the preventable indignities of being stuck without a pad?


*A note on biology
Sex, gender, and human bodies are complex and diverse. Not all post-adolescent/pre-menopausal women menstruate. Not all people who menstruate are women. Not all menstrual bleeding happens in the uterus: endometriosis is a common (but too rarely discussed in public) condition in which endometrial (uterine) tissue implants in other parts of the body and responds to menstrual cycles by bleeding much like the uterine tissue does. Complex and diverse.

Sean Valles photo

Sean A. Valles, PhD, is an Associate Professor in Lyman Briggs College and the Department of Philosophy at Michigan State University. His book Philosophy of Population Health: Philosophy For A New Public Health Era was published by Routledge in May 2018.

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More Bioethics in the News from Dr. Valles: Trump’s Attempt to Reignite the Coal Industry Is Another Health Policy BlunderPolitics and the Other Lead Poisoning: The Public Health Ethics of Gun Violence; Climate Change and Medical Risk

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