Background: The lack of access to period products, also known as “period poverty,” is a problem that millions of people face worldwide. Investigators have examined the extent of this phenomenon among low-income and college-aged populations in the United States and have found that period poverty is a pervasive issue in this country as well, despite its status as a high resource country. Purpose: The purpose of this study was to determine the prevalence of period poverty in school-aged adolescents in Toledo, Ohio; to analyze the demographic factors associated with this lack of access; and to evaluate its effect on school attendance, extracurricular activities, and mental health. Methods: This study used an observational, cross-sectional design and was approved by the Institutional Review Board. Participants completed a survey to assess adequate access to menstrual products, level of understanding about their health, feelings towards menstruation, and the perceived impact of periods on these students’ lives. Data analysis determined the relationship between various measurements of period poverty, menstrual knowledge, and participant demographics. No personal identifiers were collected. The study was conducted for twenty days between February and March 2023. Participants’ guardians could opt their students out of the survey or students could opt themselves out prior to the start of the survey. Students who did not opt out received the survey via their school email accounts. Nonmenarchal individuals were excluded from further survey participation, while eligible subjects who chose to complete the survey had the option to withdraw or leave questions blank. Survey data was collated using Microsoft Forms, and analysis was performed using Statistical Analysis Software (Version 9.4). Results: A total of 408 students, aged 11 through 19, participated in the survey. Because many of the survey questions included a “select all that apply” option, responses to those questions fell into more than one response category. Of those surveyed, 36.4% identified their race/ethnicity as Black, 30.7% as Caucasian, 7.5% as Hispanic, 25.4% as “Other.” When asked where respondents get their period products, 86.4% indicated from the store, 58.6% from parent(s)/guardian(s), and 12.9% from school. Our study found a statistically significant correlation between increasing age and increasing concern for lack of period products. To the question “Why don’t you have pads or tampons?” 61.0% of respondents had “left [products] at home,” 36.2% expressed financial concerns, and 18.3% reported inadequate transportation. When asked if students ever had to miss school due to their cycle, 9.4% indicated not having products as their reason. Our study also determined a statistically significant relationship between the income status of the school (middle vs. low) and whether or not students had access to period products (p = 0.0439). Participants also reported high rates of missing sports, work, theatre/music practice, and spending time with family/friends due to their menstrual period. 92.2% indicated cramps as their reason for missing these activities, 68.2% indicated heavy bleeding, and 9.4% as not having products. Of participants reporting availability issues, 35.0% reported using a product longer than advised and 65.5% reported using toilet tissue or fabric instead. A majority of participants reported that they learned about menstrual period management from personal experience or from a parent/guardian. We noted a statistically significant, positive correlation between participants’ age and their likelihood of receiving period education from their parent(s)/guardian(s). In other words, older students were more likely to receive education from their guardians than younger students. When asked about self-perceived knowledge gaps, participants were most interested to learn about menstruation-related mood swings and dysmenorrhea symptoms. When students have new questions about periods, they report turning to their parent(s)/guardian(s) and the internet most frequently. The most common feelings participants associated with their periods were sadness, anger, anxiety, and embarrassment. Conversely, fewer respondents reported happiness, excitement, or pride. Conclusions: People across the world face period poverty, and our survey shows evidence of this phenomenon among Toledo students. Due to lack of access to menstrual hygiene products, students report repurposing miscellaneous items in place of pads or tampons, missing extracurricular activities, and associating negative emotions with their cycles. Our study limitations include: a small sample size, limited external validity, and selection bias. Future directions include rectifying these limitations, positing additional questions to gain better insight to the degree of period poverty, and interacting directly with the respondents as project investigators. Doing so will garner participants’ trust, provide them with direct avenues to resources, and minimize education and language barriers. Combined, these efforts would offer a greater representation of the target population. As menstrual cycles continue to affect the daily lives of menstruating people, we believe that closing the access gap can have profound positive effects on communities’ physical and emotional wellbeing.
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Oct 8, 2024
Anteneh Mulugeta Eyasu + 2
