A few years ago, Aydan Garland-Miner led a rally in Washington state against the tampon tax—the sales tax applied to menstrual products when states classify them as nonessential, luxury items. At the time, Washington was one of 35 states that imposed the tax.

As president of her university’s PERIOD chapter, Garland-Miner, 22, wanted to start conversations about periods. Her first project, last March, aimed to distribute 1,000 menstrual cups at Washington State University, where Garland-Miner is a student.

Then the COVID-19 pandemic hit. The menstrual cups Garland-Miner had advocated for were handed out briefly, before her classmates experiencing period poverty left campus and were left without access to these products.

Like housing and food, menstrual products are a basic need, said Lauren Ferreira Cardoso, a doctoral candidate in the University of Pennsylvania’s social welfare program.

But what happens when, like housing and food, people can’t afford menstrual products?

Without access to tampons or pads, college students may choose to bleed or use products for longer than recommended. A person menstruating might use toilet paper or unsanitary items to create makeshift pads.

One in 10 U.S. college students who menstruate face period poverty, which means they’re unable to afford menstrual products, according to a study published in January in the journal BMC Women’s Health. Cardoso was the report’s lead author; she found that students who experienced period poverty were also more likely to report symptoms of depression.

The study surveyed nearly 500 college women and found that 14.2 percent had experienced period poverty in the past year, and another 10 percent experienced it monthly. The impact is not felt equally: One in five Black women in the survey experienced period poverty in the past year. For Latina women, that figure increased to 1 in 4.

“We have to talk about periods”

Sales taxes make menstrual products more expensive to buy, but repealing the tax is not the only way to combat period poverty, particularly for college students.

“If colleges made menstrual products free, this would be much less of an issue,” said Cardoso, who added that she believes period poverty needs more attention in the United States. Legislators think menstrual equity mostly affects lower income countries, and therefore “it’s something that hasn’t gotten as much attention as it should,” she said.

In recent years, a number of states have repealed the tampon tax, but 30 states still impose sales tax on menstrual products. Most recently, Michigan reintroduced legislation to nix it.

The period poverty movement has reached outside the United States. Last November, Scotland became the first country to make period products free to anyone who needs them. In February, New Zealand announced a program to provide free period products to all students. Australia, Canada, India, and Malaysia have all removed the tampon tax.

For Garland-Miner, though, eliminating the impact of period poverty goes beyond just passing legislation.

“For people to talk about period poverty, we have to talk about periods,” Garland-Miner said. “It’s hard to mobilize people and get them comfortable about talking about periods in the first place.”

Shame and stigma make periods a taboo subject. The lack of support from state and school funds to make menstrual products accessible doesn’t help.

“When I was in seventh grade and I didn’t have access to menstrual products for one day, I heard the nurse’s office had them,” Garland-Miner said. “But I was too nervous to go to the nurse’s office to ask for a pad because I didn’t want to admit that I was on my period.”

PERIOD is a global nonprofit aiming to end period poverty and stigma through advocacy, education, and service. The organization is holding a virtual town hall with state legislators on menstrual equity on April 29.

Garland-Miner’s PERIOD chapter extends its work to the local community, working with local shelters that lack menstrual products, a situation she says is common.

Even when shelters do provide pads or tampons, employees keep the items behind a desk, Garland-Miner said. Unhoused people may feel too ashamed to request a cup or pad.

The same problem exists on college campuses.

“Where would you go to get menstrual products if you don’t have them?” Garland-Miner said. “It’s hard to figure out who to ask for help in those situations.”

At Washington State University, academic and student services buildings have some restrooms with dispensers that charge 25 cents for a tampon or pad.

If the staff forgets to stack the machines, menstruating students are left reeling from physical and emotional discomfort.

“You might be going to class with toilet paper in your underwear or makeshift product, and you’re worried about bleeding through your clothes,” Garland-Miner said. “Or you’re in the bathroom trying to improvise, thinking, ‘How am I going to fix this?’”

Schools provide toilet paper in their bathrooms, and Garland-Miner said menstrual products are a similar necessity. At least half of the student population at WSU, if not more, menstruates, she said. That includes students of all genders.

Advocating for menstrual equity

Even at a more affluent institution like Princeton University, period poverty persists.

In 2019, the university began to offer free menstrual products in 56 campus restrooms. Before the pandemic shuttered classrooms, the school planned to stock 40 more bathrooms and its eating clubs, hallmarks of the university’s social scene.

For three years, Preeti Iyer, 22, led the university’s menstrual products task force, which rolled out the distribution plans at Princeton. As part of her work, she compiled data and testimonials to present to administrators.

In surveys of hundreds of students, the task force found that students with low income struggled to access menstrual products.

“We have a lot of students say, verbatim, that some months they couldn’t afford a cell phone bill or menstrual products,” Iyer said. “For students who have to live paycheck to paycheck or rationalize what they have to spend, it’s another thing that’s a huge financial burden.”

Getting the administration to approve free menstrual products turned out to be tricky. The task force needed to figure out which businesses to partner with to buy products. They sorted through business models and worked with the facilities department to stock supplies.

“There were outlets where the undergraduate student government could’ve funded this, and it would’ve accelerated the timeline,” Iyer said.

But Iyer wanted the administration to acknowledge menstrual access as a basic need, one that required consistent funding, year over year.

To get the administration to talk about periods, Iyer relied on women high up in the administration as allies. “Most of the other people we worked with were men, and [they] maybe didn’t understand the situation so well,” Iyer said.

For Iyer, her advocacy in menstrual equity was inspired in part by her role as a woman in the STEM field. Any time she forgot a menstrual product, searching for a pad could mean forgoing an hour of class—a problem most of her classmates didn’t have to deal with.

“In the engineer quad, the lack of resources like [menstrual products] in these male-dominated environments potentially adds to the feeling that you’re not welcome there,” Iyer said.