PERIOD POVERTY IN A PANDEMIC: HARNESSING LAW TO ACHIEVE MENSTRUAL EQUITY.

• Author: Crawford, Bridget J.

TABLE OF CONTENTS INTRODUCTION I. PERIOD POVERTY IN A PANDEMIC A. Access to Affordable Products B. Hygiene and Sanitation 1. Hygiene 2. Sanitation C. Information and Support 1. Schools 2. Medical Professionals D. Stigma and Shame II. THE ROLE OF LAW III. THE SALIENCE OF PERIOD POVERTY CONCLUSION INTRODUCTION

During the lockdown caused by the coronavirus pandemic in Wolverhampton, United Kingdom, 20-year-old student Indu Indu switched to using a cloth rag in lieu of menstrual pads after she lost her part-time job in a beauty salon. Indu found the cloth itchy and uncomfortable; it also limited her mobility. "I'm not comfortable going outside with these cloths on," she explained, "that's why I prefer to stay at home." (1)

After the coronavirus lockdown began in Lucknow, Uttar Pradesh, India, 17-year-old Hina and a group of friends began making menstrual pads to compensate for the dearth of menstrual products at local stores. Hina observed: "Periods are considered shameful. During the lockdown when even medicine shops were closed, many girls were worried how they would manage." (2)

Dana Marlowe runs a Maryland nonprofit organization called I Support the Girls that collects donations of bras and menstrual products "for shelters, prisons and people in need." (3) In March 2020, during the early days of the pandemic in the northeastern United States, I Support the Girls donated 900,000 menstrual products to the Salvation Army and to the City of Trenton, New Jersey, for use in its homeless shelters. By comparison, in March 2019, the group had donated 200,000 menstrual products to similar organizations. (4)

Pandemic or not, menstruation goes on. In spite of the sea-changes in how people live, work, and attend school for the foreseeable future, one thing that the COVID-19 pandemic has not changed is the fact that approximately half the population menstruates for a significant portion of their lives. (5) Menstruation is a biological process; it typically begins at age twelve, but can start as early as age eight and as late as age fifteen. (6) Every month over a three- to seven-day time frame, the built-up uterine lining sheds approximately two to three tablespoons of blood from the body--this is typically known as a "period." (7) In the United States, the average age of menopause (the permanent cessation of menstruation) is fifty-two. (8)

In the United States and Western Europe, most individuals use products like tampons, disposable pads, menstrual cups, period underwear, or reusable menstrual pads to absorb their menstrual flow. (9) In some countries, locally-made pads, old cloth, mattress cuttings, dried grass, or similar methods may be used to manage menstruation. (10) This is slowly changing, in part because of the work of entrepreneur Arunachalam Muruganantham, featured in the Oscar-winning documentary Period. End of Sentence., whose pad-making machine allows multiple nonprofits, job training organizations, and women's microfinance groups to make and supply low-cost pads to underserved communities in India and elsewhere. (11)

In recent years, more public attention has focused on the multiple ways that menstruation impacts everyday life. In May 2013, the German nonprofit organization WASH United initiated what would ultimately become Menstrual Hygiene Day, an occasion since commemorated annually on May 28 by various awareness events around the globe. (12) The United States saw its first "National Period Day" on October 19, 2019, marked by rallies and social media campaigns. (13) All around the world, there is growing awareness of "period poverty," defined in various ways: inability to afford commercial menstrual products; (14) inadequate access to supplies and services needed for menstrual hygiene, broadly understood; 15 lack of adequate menstrual education; menstruation-associated stigma and shame; and the combination of some or all of the above. (16) The COVID-19 pandemic has exacerbated many aspects of period poverty.

This Article looks closely at the issue of worldwide period poverty through the lens of the public health crisis precipitated by the COVID-19 virus. The pandemic has made it more difficult to manage menstruation--a normal, involuntary occurrence for approximately half of the population. We note at the outset that menstruation is not the exclusive province of cis women and cis girls; there arc trans men and trans boys, as well as gender non-binary, intersex, and genderqueer people who menstruate as well. (17) The world health crisis precipitated by the COV1D-19 pandemic has made more visible the multiple difficulties faced by all who menstruate.

The Article reveals four distinct areas of concern related to periods in a pandemic. First is the problem of access to affordable products. In the early months of the pandemic, the virtual shutdown of economies in many countries prompted closures of retail shops and disruptions in supply chains, making it difficult for many people to access needed menstrual products. (18) Even in places where these products were still available for sale, price-gouging put them out of reach of some customers, particularly given the other economic strains that the pandemic imposed on people's finances. (19) Second, there are unique challenges for maintaining hygiene and sanitation during a pandemic. In some countries, public toilets or washing facilities have been shut down, making it more difficult or dangerous to find or use shared resources. (20) In other places, intermittent water shortages or access to soap have curtailed personal and household hygiene. (21) Disposal of used menstrual products has also become challenging during times of stay-at-home orders, especially in societies where custom calls for disposal of these products far from home. (22) Third, sources of menstruation-related information and support have diminished during the pandemic. Schools have closed in many places where schools or teachers provide most (or all) instruction in health and the biology of menstruation; (23) in some of these places, schools are also significant providers of tampons, pads, or menstrual cups. (24) Relatedly, for people of all ages, access to healthcare has declined. Those suffering from menstruation-related conditions like endometriosis, polycystic ovary syndrome, or other issues have often been reluctant or unable to seek medical help during the pandemic, particularly during the early crisis stage when doctors and hospitals were focusing on treating the sickest patients. (25) Fourth, the pandemic elevated occurrences of menstrual stigma and shame, with stay-at-home orders making it difficult for some to maintain personal or cultural standards for privacy surrounding menstruation. (26)

The Article next considers what role the law can play in facilitating access to material and intangible support necessary for menstruating individuals to participate in daily life. For example, if a particular local or national government permits only businesses that are designated as "essential" to continue operations during the pandemic, lawmakers should treat the manufacture and retail of menstrual products as "essential." Relatedly, during the first weeks of the pandemic in the United States, Congress passed the Coronavirus Aid, Relief, and Economic Security (CARES) Act, on March 27, 2020, and included a provision in the Act that allowed funds from tax-advantaged health savings accounts to be used for purchasing any "menstrual care product." (27) With this provision, Congress implicitly acknowledged how essential such products are to the health of those who menstruate. In all countries, during pandemic times, there should also be a priority on continuing school-based educational programs that facilitate education about menstruation as well as access to menstrual products (or the means of making them). To be sure, the law is not well equipped to deal with all pandemic-era issues related to menstruation. Issues related to stigma, shame, or lack of privacy do not have ready legislative solutions. But raising awareness of period poverty during a pandemic, and taking concrete steps to address it, has the potential to help reduce ignorance and the related stigmas that treat menstruation as something secretive, suspicious, or dirty.

This Article proceeds in three parts. Part 1 explores the four previously mentioned aspects of period poverty that have been made more visible by the pandemic: lack of access to affordable menstrual products; lack of access to needed supplies and services for health and sanitation; lack of menstruation-related information and lack of support from schools and health professionals; and menstrual stigma and shame. Part II then asks what role the law can play in eliminating period poverty during a pandemic. There may be legislation that can support the ongoing operation of manufacturing supply chains that arc important in the distribution of menstrual products, along with greater efforts to promote the dissemination of such products and menstrual education to those students who lack access at home. Similarly, although stopping the spread of disease certainly must be the top priority during a pandemic, it may still be possible to facilitate the safe maintenance of communal washing and sanitation facilities in some way. Part III then assesses the extent to which menstruation-related issues came into focus more sharply during the pandemic due to the efforts of grassroots citizens' groups, nongovernmental organizations, the popular press in multiple countries, and even some lawmakers. For those who arc concerned about eliminating period poverty, there is some cause for hopefulness in the growing levels of public awareness of and comfort in discussing menstruation-related matters. In particular, Scotland's unanimous passage on November 24, 2020, of the Period Products (Free Provision) (Scotland) Act--which requires local authorities to ensure that period products...