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.