My daughter, Claire, has dedicated several years to founding and leading a local school chapter of Liv & Cur, a nonprofit organization run by high school students that raises funds and sources sanitary products and other women’s necessities for schools, women’s shelters, and orphanages.¹ Witnessing her tireless efforts, including advocating at the North Carolina State General Assembly, has prompted me to reflect on the issue of period poverty. As emergency physicians, we likely encounter this problem daily, often without realizing its prevalence and impact on our patients.

Many of us believe that period poverty is a problem limited to distant Asian or African regions. However, a report from Procter & Gamble reveals that around one in five girls in the United States has missed school due to a lack of access to menstrual products.² Due to feelings of shame and stigma, girls often don’t talk about this issue openly. Instead, they talk about this natural biological process in euphemisms like “Bloody Mary,” “Shark Week,” “Aunt Flo,” and my personal favorite, “The Curse.”²

This lack of open dialogue contributes to a widespread misunderstanding of period poverty as a critical public health issue that impacts millions of girls and women worldwide, particularly those in low-income communities. Period poverty encompasses the lack of access to menstrual hygiene products, education, and safe facilities for managing menstruation. This issue not only undermines the health and dignity of those affected but also exacerbates existing health disparities. The consequences can be severe, leading to increased absenteeism from school or work, a heightened risk of infections, and detrimental effects on mental health.³

It may come as a surprise to some that period poverty is not just a distant issue affecting women in developing regions, but a reality that also exists in our own communities. For example, menstruators in some regions of sub-Saharan Africa will use impromptu types of items, such as paper, rags, leaves, or bits of cotton and wool, rather than sanitary pads and tampons.⁴ Deprived of the availability of appropriate menstrual hygiene materials, these girls are at risk of health problems, missed educational opportunities, and compromised well-being.⁴ But the problem of period poverty is not only happening in distant lands. There are millions of girls and women similarly situated here in the United States.⁵ I had friends when I was in school using old clothes or toilet paper for their period because they could not afford to buy sanitary pads or tampons. This underscores the fact that period poverty can affect anyone, regardless of their location or socioeconomic status. The stigma surrounding menstruation often prevents open discussions about these types of challenges, leaving many to suffer in silence.

Complicating this is the “pink tax” — the additional amount women pay for items marketed specifically to them, which can include state sales tax on menstrual products.⁶ This monetary burden makes it even harder for those already financially struggling to access necessary items. The pink tax isn’t just limited to menstruation products. It can be found across various products and services targeted at women, deepening these economic gender gaps.⁵ Some examples include razors, shampoo, and body wash, which are often priced higher than men’s razors and shampoo even when they have same ingredients and functionality. By addressing period poverty, we can also challenge the systemic inequities that contribute to the pink tax, working to ensure that all essential health products are fairly priced and accessible.

As emergency physicians, we are in a great place to help combat period poverty and advocate for solutions that address health disparities and improve the lives of people in our communities. Given the significant impact of period poverty, it is crucial to recognize that this issue disproportionately affects marginalized groups, including low-income individuals, people of color, and those experiencing homelessness.² These disparities highlight the critical need for targeted interventions and advocacy to make sure that every single person has what they need to menstruate with dignity.

Role of Emergency Physicians

Emergency physicians commonly serve at the interface where we meet patients from different backgrounds who present with a range of health conditions. Here are some of the ways we can help end period poverty:

1. Awareness and Education: Emergency physicians can play a vital role in raising awareness about period poverty within our communities.⁴ By discussing this issue with patients and colleagues, we can help reduce the stigma around menstruation and encourage more open discussions about menstrual health. By providing patient literature in waiting areas or when meeting with patients, we can give patients permission to access help and resources.
2. Advocacy for Access to Products: Emergency departments can be important access points for menstrual products. We can be of immediate assistance to those in need by keeping our sites supplied with menstrual hygiene products (specifically in the bathrooms where women might collect urine for testing). Physicians can encourage policies that permit free distribution of menstrual products in public areas, schools, and community centers that will mitigate access barriers.
3. Collaboration with Local Organizations: Partnering with local nonprofits and community organizations can amplify our efforts to combat period poverty. We can work with those groups pushing for menstrual health and hygiene to find out what our communities need, and ome up with effective solutions together. This may include organizing donation drives for menstrual products or supporting initiatives that provide education on menstrual health.
4. Incorporating Menstrual Health into Patient Care: As part of holistic patient care, emergency physicians should consider menstrual health when evaluating patients. This encompasses inquiring about the menstrual life history, examining concerns around any related health issues, and offering resources. By including menstrual health in our evaluations, we can provide high-quality care that meets the individual needs of patients.
5. Research and Policy Advocacy: Research into period poverty can produce evidence of how period poverty can affect health outcomes and inform policy reform.

In conclusion, period poverty is a significant public health issue that requires urgent attention and action. As emergency physicians, we are well situated to address this need by raising awareness, advocating for access to menstrual products, partnering with local organizations, and including menstrual health as part of our patient care. By taking these steps, we can help dismantle the barriers that perpetuate period poverty and promote health equity for all individuals. Together, we can ensure that everyone has the resources they need to manage their menstrual health with dignity and respect.

Dr. Kendall is the chief of clinician engagement at US Acute Care Solutions and has 15 years of emergency department leadership experience. She is the chair of the USACS diversity, equity, and inclusion committee, the social issues and equity in medicine committee co-chair, and leads physician leadership development for USACS.

References

1. Lee H. Liv & Cur website. Accessed August 2025. https://www.livcur.org/
2. Bennett B and Bennett B. It‘s past time we ended the stigma – and tax – on periods for girls around the world. October 11, 2022. Accessed August 2025. USA Today. https://www.usatoday.com/story/opinion/voices/2022/10/11/period-poverty-international-day-girl-child/8199226001/
3. Jaafar H, Ismail SY and Azzeri A. Period Poverty: A Neglected Public Health Issue. Korean J Fam Med. 2023;44(4):183-188.
4. Davies S, Clarke G, and Lewis N. Period Poverty: The Public Health Crisis We Don‘t Talk About. April 6, 2021. Accessed August 2025. Children’s Hospital of Philadelphia PolicyLab. https://policylab.chop.edu/blog/period-poverty-public-health-crisis-we-dont-talk-about.
5. Singh B, Zhang J, and Segars J. Period Poverty and the Menstrual Product Tax in the United States. Obstetrics and Gynecology. 2020;135:68S.
6. Taylor KR. Pink Tax: What Does Price Discrimination Cost Women. May 6, 2025. Accessed September 2025. Kiplinger.com. https://www.kiplinger.com/taxes/pink-tax-womens-products-price-discrimination.