Period poverty: stigma and access issues endure, study shows

Despite ongoing efforts to make period products more available to more people, a new study has found vulnerable Australians are still struggling with access, stigma, and cost barriers.
 
The study by the Burnet Institute, published on Tuesday in the Australian and New Zealand Journal of Public Health, concluded that more needs to be done to prevent marginalised Australians resorting to desperate solutions.
 
‘I know one girl, a friend of mine she uses old towels, she just you know rips them in strips and then before she goes to bed, she just you know puts them in her undies,’ said one study participant.
 
‘If it’s no pads, then it’s paper; it’s toilet paper roll until further notice,’ said another.
 
All Australian states and territories now have policies to provide free pads and tampons in public schools.
 
Last year, the Victorian Government announced plans to expand the initiative to also provide period products via vending machines in selected public spaces. Similarly, the Australian Capital Territory Government said it would make products available in some public health services, courts and child centres.
 
The Australian Government also announced last year that free pads and tampons would be made available to people in remote Aboriginal and Torres Straight Islander communities.
 
However, stigma around menstruation remained a key reason for period product insecurity, also known as period poverty, said Burnet researcher and first author of the paper, Alexandra Head.
 
‘Many people told us they felt uncomfortable accessing products in public places because of the stigma attached to menstruation and poverty, but at the same time they need to know where they can access these products,’ she said.
 
‘We also need initiatives to improve menstrual health education and reduce the stigma surrounding menstruation.’
 
A total of 30 participants took part in the Victoria-based study, including Aboriginal and Torres Strait Islander people, multicultural people, youth, non-binary, trans or gender-diverse people, people living with a disability, people experiencing homelessness, people from low socio-economic backgrounds, and people living in regional Victoria.
 
Five key informants working with priority groups also participated.
 
Most participants reported feeling uncomfortable with accessing products in visible locations. Most felt female public bathrooms were appropriate locations for products to be made accessible, and some felt dispensers should be positioned in individual cubicles.
 
Wayfinding, signage, and inclusive design were mentioned as ways to promote visibility and ensure utilisation, specifically for multicultural communities and people living with a disability.
 
GP and women’s health expert Associate Professor Magda Simonis said discussions about periods were key to destigmatising menstruation, and ‘should be an integral part of getting to know our female patients’.
 
‘The normalisation of heavy menstrual bleeding, and the tendency for women and girls to put up with pain associated with painful periods that stop women and girls from participating in school, work, social activities, should be dismantled,’ she told newsGP.
 
‘This can only be achieved by taking a thorough history that includes menstrual patterns and pelvic pain.
 
‘It’s part of being a woman and doctors should be comfortable asking about this.’
 
Several participants believed effectiveness of a product distribution service was dependent on concurrent education and advocacy initiatives, whereas others perceived these as an opportunity to address broader menstrual health needs.
 
Approximately half the participants reported they were ‘often’ or ‘occasionally’ unable to afford necessities such as food or personal hygiene items in the past two years. Challenges in affording products were influenced by participants’ employment status, income, access to government support and social services, and housing insecurity.
 
Challenges to accessing products included living in regional or remote locations, mobility challenges due to disability, speaking English as a second language and dysphoria experienced by gender-diverse participants. 
 
Associate Professor Simonis said while addressing the stigma around periods had improved, it ‘still has a long way to go’ particularly for women from culturally and linguistically diverse backgrounds who experienced heavy menstrual bleeding.
 
She said many mothers and young women feared their GP would ‘just put them on the pill’, which could make them reluctant to discuss their periods.
 
Participants in the study also emphasised the need for destigmatising menstruation. Many were frustrated by social conceptualisations of menstruation as shameful and dirty and felt a product provision scheme may also present an opportunity for combatting stigma. The use of advertising, marketing and advocacy were suggested.
 
‘Also advocating for destigmatising periods and menstruation. I think that would … you know kill two birds with one stone’ said one participant.

The study also identified that no single menstrual product delivery strategy was likely to be best suited to all groups experiencing product insecurity. 
 
Some participants also said there was a greater need for variety among products available, depending on flow, body type, ability, gender identity and cultural norms.
 
‘You could put five girls in a line and each one of them could use something different,’ said one participant.
 
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