Menstrual Inequity Among High Schoolers in the Tulsa Metro Area

By: Abigail Chow

Menstruation is defined as periodic discharge of blood and tissue from the uterus, commonly known as having a period. This common health process occurs among half the population, yet many menstruators experience menstrual inequity, the inability to access menstrual products, menstrual education, and the surrounding stigma around menstruation. According to the “State of the Period 2021: The widespread impact of period poverty on US students” commissioned by Thinx and PERIOD, two nationwide nonprofits combating menstrual inequity, one in four students (25%) in the US lack of access to period products because they cannot afford them (Thinx et al., 2021). In the context of a high school pom squad of twenty girls, approximately five would not be able to afford period products.

Without the right products, menstruators are susceptible to using hygiene products such as pads and tampons longer than the suggested four to eight hours or creating homemade remedies such as wadded-up paper towels, extra toilet paper, or clothes to substitute for a regular period product. These solutions are dangerous for a menstruator’s health because extended use can lead not only to vulvar irritation and vaginal discomfort but also to a fatal infection called toxic shock syndrome (Farid, 2021).

Along with physical implications, the lack of access to menstrual products can cause menstruators to suffer anxiety and stress due to the constant fear or embarrassment that they will bleed through their clothing. The pressure to keep one’s menstrual cycle hidden adds to both the mental stress on a menstruator and the stigma around menstruation that cultivates a negative attitude and shame towards menstruators simply because their bodies go through a biological cycle once a month. The studies conducted by Boyer, Cardoso, Free the Tampon, and Thinx all concluded that the stigma affects participants’ mental health and ability to carry out daily tasks including getting school work done.

In “Period Poverty: The Perceptions and Experiences of Impoverished Women Living in an Inner-City Area of Northwest England,” Madeleine Boyer found that the lack of access to menstrual products added to the stigma, shame, and anxiety of menstruation (Boyer, 2022). Similarly, in “Period poverty and mental health implications among college-aged women in the United States,” Dr. Lauren F. Cardoso from the University of Pennsylvania found that the issue affects college women, with 10% experiencing menstrual inequity on a monthly basis and severe depression due to the lack of access to menstrual products (Cardoso, 2021). Likewise, in a 2013 Harris Interactive study, “The Murphy’s Law of Menstruation” commissioned by Free the Tampons, an organization advocating for state budgets to fund free menstrual products in public restrooms, researchers found that unexpected menstruation led to embarrassment and anxiety among women (Free the Tampons, 2022). In “State of the Period 2021,” 38% of the students surveyed said they could not do their best school work due to the inaccessibility of menstrual products (Thinx et al., 2021).

In the last three studies, researchers conducted online research by surveying a determined amount of student menstruators within a certain age range. For example, in “State of the Period 2021,” research was weighted for age, region, and race/ethnicity in order to be proportional to the actual population size. However, in Boyer’s research, the data was gathered directly in inner-city neighborhoods in a high-income European country. Although this literature analysis has provided new insight into the correlation between menstrual inequity and mental health among menstruators, one area that has not been closely examined is the extent of menstrual inequity among high school students. This leads to the question, “To what extent is menstrual inequity prevalent among menstruators ages 13-19 in high school in Tulsa, Oklahoma?”

Building Local Context

In Oklahoma, hygiene products such as toilet paper are exempt from sales tax. However, menstrual products are not part of this exemption (Alliance, 2020). Despite how necessary tampons and pads are to help a menstruator not leak every monthly cycle, menstrual products are viewed as luxury items. Moreover, menstrual products are not covered under the WIC (women, infants, and children) program that help low-income families with groceries (Farid, 2021). This creates an additional barrier for low-income families to access menstrual products. 13.8% of people in the Tulsa, Oklahoma metro area are below the poverty line with 19% of children under 18 years old (Census, 2021). It can be assumed that some lack access to menstrual products simply because they cannot afford them due to socioeconomic reasons.

With this information, school systems in the Tulsa metro area can no longer assume they are doing an adequate job of addressing menstrual equity. They need to explore ways to improve students’ educational experiences and outcomes by alleviating the effects of menstrual inequity caused by lack of education and poor access to menstrual products.

Implications

The quantitative and qualitative data found in this study clearly indicate a need for increased access to menstrual education as well as access to menstrual products in more school bathrooms. It is hoped that these results will reinforce efforts to convince Tulsa high schools to invest in the educational success of their own students by supporting their menstrual needs.

One cannot tackle menstrual equity without addressing the underlying stigma that shames menstruators and creates an additional barrier to seeking the resources they need. 36.1% of Tulsa high school menstruators felt a stigma and negative perception of periods at their high school. All four of the interview participants expressed hesitation, embarrassment, and shame associated with asking someone for a menstrual product or having others notice they were menstruating. Three out of the four participants interviewed identified a barrier to access that the survey had not anticipated: teachers. With respect to the fact that unscheduled bathroom breaks are sometimes at odds with classroom procedures, there was a clear sense of betrayal when Participant 3 confided her problem to a female teacher and was denied access to the bathroom, which resulted in a stain on her clothing that others noticed, or when a male teacher told Participant 4 to “hold it.” One solution for this is by increasing the availability of or even implementing a curriculum for menstrual health education in high school for both students and teachers. Participant 3 expressed a desire for teachers to talk about menstruation, “to explain what we can do if we ever feel uncomfortable or just upset about it and [let us know] we can talk to them without feeling embarrassed.” By having open group discussions and sharing among menstruators from time to time, these students may feel more support and reassurance that their struggle is a normal part of their high school rhythm that they can navigate with the support of their peers, school staff, and community resources. This can also help destigmatize menstruation for both menstruators and non-menstruators and reduce barriers that might be caused by misinformation about menstruation.

Another solution is that schools to provide free menstrual products such as pads and tampons in more school bathrooms across campuses. Schools can start implementing a low-cost, low-risk pilot program by providing free menstrual products in selected bathrooms to monitor student response. After a few weeks into the program, schools can measure the rate at which the menstrual product supply needs to be restocked and address the needs of their student body. In a case study conducted by Professor Schmitt, et al. from the University of Columbia to identify the factors that facilitated or impeded success in such pilot programs, researchers found the most successful program happened when the administration committed funding and people in charge of replenishing menstrual supplies on a rolling basis (Schmitt, 2021). With that being said, it is hard to keep the administration accountable for allocating money toward free menstrual products in school bathrooms without legislation.

Today, only seven states require schools to make menstrual products accessible to students (Kuhlmann, 2021). In order for more states to join this movement, legislation needs to have funding to help schools provide access to menstrual products. In order to aid schools in this effort towards providing free menstrual products in bathrooms, a couple of bills have been introduced by the House of Representatives and Senate. New York District 6 Representative Meng introduced H.R.1882 - Menstrual Equity For All Act of 2019, which would require the state to provide menstrual products in public buildings, schools, and prisons, and allow Medicaid to cover the cost of menstrual products (Menstrual, 2019). Unfortunately, the bill did not pass into law. In Oklahoma, SB1499 by Senator Garvin would enforce a sales tax exemption from menstrual products purchased by schools, but the bill died in the chamber during the legislative session (Oklahoma, 2022). Legislative efforts towards alleviating the sales tax on menstrual products or requiring the state to provide free menstrual products are just another suggestion for helping schools provide free menstrual products in bathrooms.