Menstrual Health Access & Equity: A Comprehensive Resource Hub

Menstrual health is a fundamental part of bodily autonomy, dignity, and equality - yet access to safe, sustainable, and effective period care remains out of reach for too many.

This resource hub is designed to break down barriers between people and equitable menstrual health access - from social stigma and cultural taboos to educational gaps, product availability, and supportive policies.

Gone are the days when periods had to be whispered about in shame or managed with guesswork and compromise. It’s time for a bold new conversation about menstrual equity that puts power back in your hands.

Get ready to explore the realities, challenges, and opportunities shaping menstrual health today. Together, we can build a future where everyone can manage their period with confidence, comfort, and dignity.

Understanding Menstrual Health Access & Equity

Menstrual health access and equity mean ensuring every person who menstruates has the resources, education, and support to manage their periods safely, confidently, and with dignity.

This goes far beyond just products - it’s about breaking down all the social, economic, cultural, and infrastructural barriers between people and equitable menstrual care.

In many parts of the world, people get creative with whatever materials they can find to manage menstruation, often resorting to makeshift solutions.

As the American Medical Women’s Association highlights:

Many women without access to menstrual products improvise with old blankets, chicken feathers, old rags, newspapers, mud, and even cow dung.

This underscores the urgent need to address these systemic challenges and ensure equitable access to safe, sustainable menstrual products and facilities.

Access to clean, private restrooms with water and disposal options is fundamental, yet approximately 2.3 billion people worldwide lack basic sanitation facilities, making menstrual management a daily struggle for many. As UNICEF’s Chief of Water, Sanitation, and Hygiene, Sanjay Wijesekera, says:

Meeting the hygiene needs of all adolescent girls is a fundamental issue of human rights, dignity, and public health.

This highlights menstrual hygiene as a personal concern and a universal public health and human rights priority.

Education is another critical piece. Without comprehensive, culturally sensitive menstrual health education, myths and stigma persist, leading to shame and unsafe practices. Breaking the silence and delivering clear, inclusive information empowers people to reclaim their menstrual health confidently.

Menstrual health equity demands an integrated approach - providing access to quality products, education, safe sanitation, healthcare, and supportive policies - to dismantle the unnecessary barriers millions face every month.

Causes of Menstrual Health Access & Equity Challenges

The barriers to menstrual health equity are complex and interconnected, spanning economic, social, cultural, infrastructural, and policy dimensions. Understanding these causes is vital to advancing solutions that ensure safe, dignified, and sustainable period care for all.

Economic Barriers

Cost remains a significant obstacle for many, as affordable menstrual products are still out of reach for too many people.

Even in wealthier countries, a substantial portion of menstruators face financial challenges that force difficult choices, like prioritizing food over period care. Studies suggest that about 42% of people who menstruate in the U.S. struggle to pay for period products.

Beyond affordability, distribution through limited channels (like social services) can reduce personal agency and access. This economic burden affects health, confidence, and daily participation in school, work, and social life.

Cultural Stigma and Menstrual Taboos

Menstruation remains shrouded in deep-rooted cultural stigma and taboos worldwide, which can create powerful barriers to menstrual health access and equity.

In many communities, periods are considered “dirty,” “impure,” or shameful, fueling silence, embarrassment, and discrimination that affect how people experience and manage their menstruation.

For example, in Vietnam, members of ethnic minority groups like the Thổ people are taught to avoid certain activities during menstruation and face shame and fear around their periods, limiting discussion and acceptance of menstruation as a natural bodily function.

When I got married, my mother-in-law told me that I should not touch the worship items or brew green tea for my father-in-law during menstruation days.- Truong Thi Hoa

Stigma often leads to social exclusion and secrecy, preventing open conversations, comprehensive education, and advocacy.

Education Gaps

Comprehensive and accurate menstrual health education remains a critical gap worldwide, leaving many adolescents unprepared to manage their bodies and periods confidently.

Key findings from a 2025 study conducted among secondary school students in Tanzania reveal essential insights:

• Only about 34% felt well-informed about puberty, and 31% felt well-informed about menstruation.
• Knowledge varied widely, with accuracy ranging from 36.2% to 97.4% on puberty topics and 21.7% to 87.4% on menstruation-related questions.
• Before menarche, 39% primarily relied on schoolteachers for information, but after menarche, 51% relied on their mothers.
• Participants expressed a strong preference for receiving information from school clubs (40%), healthcare providers (23%), and teachers (11%), highlighting the value of safe, trusted spaces for learning.
• Many adolescents receive puberty and menstruation education too late, often after physical changes have already begun, limiting their ability to prepare adequately.

The study emphasized that school health clubs, especially those facilitated by trained health professionals and integrated with water, sanitation, and hygiene (WASH) programs, offer an effective platform for early, stigma-free education that empowers both boys and girls.

By addressing these gaps, menstrual education can equip young people with the knowledge and confidence to manage their health with dignity and become advocates for menstrual equity in their communities.

Insufficient Sanitation and Hygiene Facilities

Access to clean, private, and well-equipped sanitation facilities is a cornerstone of menstrual health equity, yet it remains a critical challenge worldwide.

According to the World Bank, more than 500 million menstruating people lack access to adequate facilities and products necessary for proper menstrual hygiene management. As defined by the WHO/UNICEF Joint Monitoring Programme (JMP), menstrual hygiene management is:

Women and adolescent girls are using a clean menstrual management material to absorb or collect menstrual blood, that can be changed in privacy as often as necessary, using soap and water for washing the body as required, and having access to safe and convenient facilities to dispose of used menstrual management materials. They understand the basic facts linked to the menstrual cycle and how to manage it with dignity and without discomfort or fear.

Addressing these sanitation and hygiene gaps requires integrated, multi-sectoral efforts combining infrastructure improvements with education, product access, and supportive policies to create truly menstrual-health-friendly environments.

Policy and Health System Gaps

Despite growing awareness of menstrual health as a critical public health and human rights issue, policy frameworks and healthcare systems often fail to address the full spectrum of menstrual equity needs.

Many policies disproportionately focus on adolescent girls in schools, overlooking menstruators across the life course, including marginalized groups such as low-income adults, transgender and non-binary individuals, incarcerated persons, and unhoused populations.

This narrow focus limits the impact of initiatives and perpetuates exclusion from decision-making processes, which often lack meaningful participation from those most affected by menstrual inequities.

Although progress has been made in the United States, 23 states have implemented tax exemptions on menstrual products, and laws like California’s Menstrual Equity for All bill require free products in schools and colleges, but many gaps remain.

Access to menstrual products is still inconsistent in public facilities, healthcare settings, and correctional institutions, impacting the health and dignity of millions.

Impact of Menstrual Health Access Challenges on Health and Well-being

Limited access to menstrual health resources affects physical health, emotional well-being, education, and economic participation. The consequences of menstrual health inequity reverberate widely, making it a pressing public health concern globally.

Physical Health Consequences

Without access to safe and hygienic menstrual products, many are forced to use improvised or unsafe alternatives. This increases the risk of infections, including urinary tract infections and bacterial vaginosis.

For example, women using disposable pads were less likely to experience bacterial infections than those using reusable materials without adequate sanitation.

Prolonged use of menstrual materials due to lack of access to clean products and facilities can also cause irritation, itching, and discomfort.

Mental and Emotional Well-being

Mental health is deeply affected by menstrual health challenges. Research shows that those facing menstrual resource barriers report higher rates of depression and anxiety.

In North America, young women experiencing menstrual health access difficulties showed depressive symptoms twice as often as those without such challenges. The fear of leakage, associated embarrassment, and stigma can lead to social isolation and stress.

Educational and Economic Impact

Menstrual health barriers frequently cause absenteeism from school and work. In one study, 1 in 3 adolescents in a U.S. pediatric emergency department reported difficulty accessing menstruation products, leading to missed school days and disrupted education.

Globally, studies have linked menstrual health access challenges with lower academic performance and higher dropout rates, which perpetuate cycles of economic disadvantage.

Why Menstrual Equity Matters

Menstrual equity represents the right of all menstruating individuals to access affordable, safe, dignified menstrual products, comprehensive education, healthcare, and sanitation facilities.

It is essential to gender equality and public health, addressing systemic barriers disproportionately affecting marginalized populations. It ensures that menstruation is no longer an obstacle to full participation in education, work, and society.

Menstrual equity encompasses multiple facets:

	Focus Area	Key Requirements
	Product Access	Affordable and diverse menstrual products (pads, tampons, menstrual cups, underwear) must be freely or cheaply available
	Sanitation and Hygiene Facilities	Safe, private, and well-equipped restrooms with clean water and disposal options
	Menstrual Health Education	Comprehensive, culturally sensitive education dispelling stigma and misinformation
	Healthcare Access	Services addressing menstrual disorders and reproductive health needs
	Policy and Advocacy	Laws and initiatives that eliminate taxation on menstrual products and support free product distribution in schools and public buildings

According to the Harvard Human Rights Journal, menstrual equity is a matter of human rights, dignity, and health and requires an integrated approach addressing social, economic, environmental, and health factors.

Addressing menstrual inequity involves removing financial, infrastructural, and social barriers through informed policies, education, and advocacy, ensuring every menstruator can manage their period with dignity and safety.

Menstrual Products: Innovation, Safety, and Standards

Understanding menstrual products’ efficacy, safety, standards, and access is essential.

Menstrual products vary widely in design, usage, safety profiles, and suitability depending on individual preferences, environmental conditions, and local infrastructure.

• Disposable Pads: Made from cotton blended with superabsorbent polymers. They are easy to use, readily available, and absorbency ranges from light to heavy flow.
• Tampons: Internal absorption with varied absorbencies; often made from cotton, rayon, or blends.
• Menstrual Cups: Reusable silicone or rubber devices that collect menstrual fluid.
• Menstrual Discs: Disc-shaped internal devices; newer alternative. This can be worn during intercourse; it has a larger capacity.
• Reusable Cloth Pads: Made of washable fabric; sustainable and cost-effective. It is eco-friendly and culturally acceptable in many regions.
• Period Underwear: This absorbent, washable underwear is designed for menstrual flow. It is stylish, reusable, and requires minimal additional products. However, it may have a higher upfront cost and needs laundering.

The Apple Women’s Health Study (AWHS) data affirms that traditional menstrual hygiene products - sanitary pads and tampons - remain the most commonly used options among menstruating women in the U.S. The chart below summarizes the distribution of widely used menstrual products:

Figure 1. Usage of menstrual hygiene products among 7,394 menstruating participants.

Though still less prevalent, menstrual cups and period underwear are gaining adoption, with approximately 19% of study participants reporting the use of each product.

These newer options offer reusable, eco-friendly alternatives and are valued for comfort and sustainability. However, their uptake remains lower than that of conventional products, possibly due to limited awareness, initial learning curves, and access barriers.

Menstrual Health and Safety: Product Toxicology and Clinical Care

Menstrual health products intersect with clinical care and product safety concerns, making it essential to provide a practical, combined resource for staying safe and recognizing when to seek clinical help.

This combined approach helps users efficiently navigate risks, proper product use, and symptoms that require medical attention, without repetitive information.

Menstrual products such as tampons, pads, cups, discs, period underwear, and reusable cloth pads carry distinct safety considerations. Key risks include:

Toxic Shock Syndrome (TSS)

Toxic Shock Syndrome (TSS) is a rare but serious condition that can affect people who menstruate, most notably associated with tampon use.

During menstruation, bacteria such as Staphylococcus aureus may become trapped in the vagina, particularly if tampons are left in for longer than the recommended time, generally no more than eight hours.

It is important to note that leaving a tampon in too long is a key risk factor, but not the sole cause - any product that stays in the vagina beyond recommended times can increase risk.

Reduce your risk of toxic shock syndrome (TSS) during menstruation by:

Figure 2. Practical tampon safety checklist to reduce TSS.

Individuals who have previously had TSS are advised to avoid tampon use altogether to prevent recurrence. Awareness of symptoms, careful product use, and timely healthcare contact if warning signs arise remain key to safety.

Materials and Chemicals

Menstrual products may contain various materials and chemicals that warrant consideration for safety.

Some tampons, pads, and other products have been found to contain trace amounts of substances such as PFAS (per- and polyfluoroalkyl substances), phthalates, fragrances, dyes, and potential allergens.

Although the precise health impact of these chemicals from menstrual products is not yet fully determined, vaginal tissue is exceptionally absorbent, potentially increasing exposure risks.

Safe alternatives include organic, unbleached, fragrance-free products, reusable cloth pads, and menstrual cups/discs made from medical-grade silicone or natural rubber, which reduce chemical exposure.

Cleaning and Sterilization

Reusable menstrual products like cups, discs, and cloth pads require careful cleaning and occasional sterilization to maintain hygiene and minimize infection risk.

The most effective sterilization method for menstrual cups and discs is boiling in water for 3 to 5 minutes before and after each menstrual cycle. This kills most bacteria, viruses, and fungi without damaging the medical-grade silicone or rubber material. Another alternative is to find a menstrual cup cleanser made specifically for cups and discs.

Dermatologic Concerns

Contact dermatitis and sensitivities may arise from product materials or chemicals. Switching products and consulting a clinician may be necessary when irritation occurs.

Use the following safety guidance for each product type:

• Tampons and Pads: Follow recommended wear times for tampons, change pads regularly, and use appropriate disposal methods.
• Menstrual Cups and Discs: Follow cleaning and sterilization instructions strictly, using safe water. Replace products according to manufacturer guidance.
• Period Underwear and Reusable Cloth Pads: Wash thoroughly between uses with appropriate detergents. If applicable, follow dosage and disposal guidelines.

Timely clinical consultation is vital when warning signs appear or in managing underlying menstrual disorders:

Category	Key details	Clinical action/implication
Red Flags	Fever during tampon use; severe pelvic or abdominal pain; heavy bleeding; anemia symptoms (fatigue, pallor); recurrent infections	Seek immediate care
Screening Prompts	Ask about menstrual cycle history, pain severity, and mental health	Identify conditions needing further evaluation
Common Conditions	Dysmenorrhea, endometriosis, PCOS, fibroids, anemia, bacterial vaginosis, urinary tract infections, PMDD	Provide first-line management, self-care guidance, and referral as needed
Special Contexts	Low-water/low-privacy settings; adolescents’ first periods; postpartum recovery; perimenopause	Tailor product safety advice and clinical guidance

Having outlined safe product use and clinical care pathways, we now turn to real‑world evidence illustrating how these issues manifest for adolescents in clinical settings.

Case Study: Menstrual Equity Initiatives at U.S. Universities

Across the United States, university campuses are becoming key battlegrounds for advancing menstrual equity, mainly driven by student-led initiatives that provide free menstrual products and foster inclusive period care environments.

A multiple case study conducted by researchers at Columbia University examined four diverse university initiatives to uncover common challenges, successes, and enabling factors in this growing movement.

Background and Scope

The study focused on four universities representing a range of geographic regions, sizes, and public-private statuses. Each campus had launched programs to provide free menstrual products in campus bathrooms, responding to widespread unmet menstrual needs among students.

For example, prior research found that 14.2% of undergraduate women reported an inability to afford menstrual products at least once in the past year, with Black, Latina, immigrant, and first-generation college students disproportionately affected.

Key Findings and Impact

• Champions Drive Success: Student leaders, often student government members, were instrumental in initiating and sustaining the initiatives. Their passion and organizational skills helped secure funding, administrative buy-in, and widespread student support.
• Inclusive Implementation: Distribution strategies varied but included providing products in female-assigned bathrooms, single-use restrooms, and increasingly gender-neutral and male-assigned restrooms to support transgender and non-binary students - a critical step toward accurate menstrual equity on campus.
• Funding and Sustainability: Budgets were sourced from student wellness fees, university administration, or grants. While pilots successfully demonstrated need and feasibility, scaling up faced consistent funding and administrative support challenges. Collaborative partnerships between students and staff were key to overcoming these hurdles.
• Addressing Stigma through Messaging: Student advocates shifted messaging strategies depending on the audience. They highlighted menstrual equity and social justice to peers while framing the issue to address urgent “emergency” needs for administrators to garner support.
• Challenges Overcome: Some administrators' resistance to data-backed proposals, pilot results, and persistent advocacy was overcome mainly through concerns about misuse, vandalism, or cost. Reports of product misuse were rare, underscoring the efficacy of these initiatives.

Data and Outcomes

While the qualitative study highlighted substantial unmet menstrual needs on campuses that these initiatives addressed, small-scale pilots showed widespread product uptake, reflecting the critical demand among students.

Participants noted reductions in menstrual-related stigma and increased awareness around menstrual health issues.

The study also underscored important equity aspects, as students of color and underserved groups were more likely to experience menstrual product insecurity, making inclusive product distribution - especially beyond female-only restrooms - an essential equity measure.

Campus Equity Momentum

University menstrual equity initiatives are thriving grassroots movements contributing valuable lessons to broader menstrual health efforts. They are champion-led, data-driven, inclusive, and focused on sustainability.

They highlight the transformative potential of student activism combined with institutional partnerships in advancing menstrual equity, a crucial yet often overlooked component of gender and health equity on campuses and beyond.

Advancing Equitable Menstrual Health Access

Menstrual health equity is imperative for ensuring that all menstruators have consistent access to safe, affordable products, clean sanitation facilities, accurate education, and supportive healthcare.

Persistent barriers - including economic hardship, entrenched stigma, inadequate water and sanitation infrastructure, and policy gaps - undermine physical health, mental well-being, educational attainment, and social participation worldwide.

Closing this gap requires integrated strategies that prioritize human rights, embed culturally sensitive education, expand product accessibility, and enforce inclusive policies.

Progress hinges on cross-sector collaboration to dismantle systemic inequities and establish menstrual health as a foundational public health and gender equality priority.

References