Major progress has been made in Lansing, MI over the past week as a bill combatting the 6% sales tax on menstrual hygiene products, introduced by Rep. Yancey-(D) and sponsored by Rep. Posthumus-(R), made it through the House of Representatives. Similar bills have been introduced in Michigan before, but this is the first time that this type of legislation has made it far enough to be voted on. With bipartisan support, many are optimistic about the future of this bill and what it means for people who purchase these products on a regular basis. I can tell you firsthand that TDO is very excited!
   Over the past ten years, several states have passed legislation to eliminate the sales tax on all period-related products included pads, tampons, menstrual cups, liners, and other alternatives. Many of these strides have been made possible by state legislators and advocates, who are the best route to help combat period poverty on larger scales. Several of these movements have been championed by the national organization Period Equity (www.periodequity.org), who have had their own experience with the tampon tax and Michigan courts. Their updated statistics show that the “tampon tax” has only been tackled in about half of the states, meaning there is still a long way to go. 
    While 6% may not seem like a significant amount, the culmination of all product purchases adds up quickly. To better visualize this scenario, let’s put it into concrete terms. First, it is important to note that tampons are recommended to be changed about every four hours. There are twenty-four hours in a day, about 8 of which are for sleep, which leaves sixteen hours in a person’s day. Therefore, a sixteen-hour day with a new tampon every four hours, plus at least two for overnight, estimates that the average person with an average flow uses six tampons in a day. Now, multiply this estimate by five, as the average duration of a period is five days. That is 30 tampons for one period! According to Target’s website, the average box of tampons contains between 28-48 tampons. All of this math comes down to a roughly box a month, in which case, shows that the 6% sales tax on every tampon box purchased does has a large cumulative impact on the consumer. Eliminating this tax would relieve a huge financial burden and could reduce the long-standing effects that period poverty has.
    I have written about the tampon tax before and period poverty is a major focus of The Dot. While we do not focus on the legislative aspects of these issues, they are still important to us and significantly play a role in our work. We are hopeful and excited to see where this bill goes and what it means for period-product consumers in the state of Michigan!

1https://www.mlive.com/public-interest/2021/10/tampon-tax-could-end-after-michigan-house-passes-bills-to-end-sales-taxes-on-feminine-hygiene-products.html
2https://apnews.com/article/business-health-michigan-gretchen-whitmer-sales-taxes-525ca92a4e08faf1dbe223fd35168cc1
​3https://www.michiganradio.org/health/2021-03-10/a-legal-fight-to-end-the-so-called-tampon-tax
4https://www.pandiahealth.com/the-true-cost-of-your-period/
​

  The DOT Org, and anyone who reads this blog, understands that the inequities in access to menstrual products is an intersectional issue that needs to be addressed for the betterment of menstruators, and non-menstruators alike. Governments from countries such as Scotland, and New Zealand recently announced their plans to offer free menstrual products to people. These announcements drew global attention to period poverty, but there are ways beyond governments that people can care for one another when addressing menstrual equity. Since my freshman year at the University of Michigan in Ann Arbor, I have been curious as to if the university could provide these products to the student community, and what ripple effects prioritizing this could have.
    Receiving a formal education was not something always offered to cisgender women, who currently represent the majority of people that menstruate, so it’s not surprising that schools and other large organizations aren’t set up for their well-being. I grew up attending public schools, where soap and toilet paper weren’t consistent in bathrooms, and if my family did not openly discuss menstruation and could not afford products, I have no idea where I would have turned to get them. When I found out that my school system would start offering them for free following my graduation, I was thrilled. Even though accessing pads and tampons was never an issue for me, knowing that they were available at school made a lot of sense to me. For a lot of people, school is where they spend the majority of their time from age 5-18+, so having the option to get free products there every month makes a lot of sense, especially because not having access can impede on learning.[1] When I started attending college and making financial choices on my own, it became harder to justify spending so much money on pads and tampons monthly, and I opted to invest in a menstrual cup. In the state of Michigan, the tampon tax was recently repealed, which eliminates taxes on menstrual hygiene products, another step in the right direction towards making menstrual products more accessible and affordable.[2] But what about what universities in Michigan, like U-M could do to alleviate period poverty?
    If we’re comparing U-M to Big-10, or Ivy league schools in terms of providing free menstrual products, the University of Michigan is lagging behind.[3] Ohio State[4] and Michigan State[5], U-M’s biggest rivals, already piloted programs to provide free menstrual products. A common thread in what started/pushed these programs at other universities: student power. It’s not impossible for a university to reprioritize its funding, but it often takes a lot of pushing from students. How is this university for the “leaders and best” if we are failing to care for the health of people who menstruate?
    There is already a lot of great student work happening at U-M to address menstrual inequity. Here at the Dot Org, beyond providing tangible products to the community, we conduct research and provide educational resources to not only reduce the stigma around menstruation, but also improve the amount of information available to people. Besides us at Dot Org, there is a pilot program headed by the university to provide free pads and tampons, Maize and Blue cupboard hands some out, and there is a coalition within CSG working with administration to make the pilot program a stronger, lasting reality. Groups like LEO, GEO, and OneU provide a framework for what strong organizing for collective liberation looks like, which is inspiring to see as an undergraduate, and makes me wonder what would happen if existing activist groups brought menstrual health into their activism.
    At U-M and any other organization seeking to address menstrual equity, it is important to address period poverty as it relates to other social issues beyond sexism, such as racism, transphobia, ableism, and ecological destruction. Social justice around identity cannot be addressed in isolation. The university supplying products is a start but is meaningless without input from their target population. Buying healthy, sustainably, and ethically produced products is necessary, and prioritizing buying from black-owned and queer-owned is even more necessary when considering the interlocking systems of oppression that lead to period inequity.[6] I recognize I sound really cynical, which I am a little bit, but mostly I just want the best and want to draw attention to what I see as a really important part of menstrual health. Lately, amidst the pandemic, the mutual aid groups that have grown in prominence in my home and in Ann Arbor have inspired me to look at menstrual inequity through a new lens.[7] Maybe addressing the issue on campus isn’t up to the administration, rather it is in the hands of students to lift up each other,[8] not through a hierarchical lens of charity, but through a shared lens of identifying the needs of one another and providing for each other. I’m optimistic that within my lifetime, the stigma around this topic will be reduced, and the health of entire communities can be improved.


[1] https://www.k12dive.com/news/report-finds-period-poverty-a-top-reason-girls-miss-school/565424/
[2] https://housedems.com/legislation-removes-tampon-tax-in-michigan/
[3] University of Illinois, Indiana University, University of Iowa, University of Maryland, Michigan State University, University of Minnesota, University of Nebraska-Lincoln, Northwestern University, Pennsylvania State University, Purdue University, Rutgers University, University of Wisconsin-Madison
[4]https://www.thelantern.com/2019/08/free-menstrual-product-pilot-beginning-in-dorms/
[5]https://msutoday.msu.edu/news/2018/msu-offers-emergency-menstrual-hygiene-products
[6]https://medium.com/@ilerijaiyeoba12/a-call-for-accountability-anti-blackness-in-the-menstrual-justice-space-a1d4649d884f
and https://onlinelibrary.wiley.com/doi/full/10.1111/soin.12355
[7]https://www.vice.com/en/article/y3mkjv/what-is-mutual-aid-and-how-can-it-help-with-coronavirus
[8]https://news.cgtn.com/news/2020-10-29/-Say-goodbye-to-menstrual-shame-A-movement-across-Chinese-colleges-UYDOBafoti/index.html

    In March 2020, I wrote a brief blog post about how health inequities exacerbated by COVID-19 were also prevalent in the menstruating community. At that time, very little information was known about the virus and its biological implications so I used a sociological perspective to tackle this relationship. Now, almost a year later, I would again like to explore the ways in which COVID-19 has impacted menstruation, but with a biological lens. Although hygiene practices have since been established and first-generation vaccines are being distributed, there still remains a lot of uncertainty about the long-term and various effects of the virus. As the virus spread over the course of last year, patients openly shared their experiences and associated medical issues that arose with their infection. Hundreds of publications, both scientific and not, have explored the symptoms people associated with their COVID-19 experience. Dr. Maria Cohut wrote one such article on the MedicalNewsToday website discussing one of the lesser known bodily changes associated with COVID-19 infection: uncharacteristic menstrual cycle fluctuations. 
    Before diving into Dr. Cohut’s article, let’s begin with some general information about the average menstrual cycle* for anyone who may be unfamiliar with the whole process. A single menstrual cycle lasts 24-38 days during which a reproductive-aged person’s body prepares for a possible pregnancy. The first 1-7 days are marked by bleeding, which is when the uterine lining sheds after the body experiences a drop in hormones after the corpus luteum, which would otherwise support a developing fetus, is expelled from the body. The remainder of the cycle consists of the follicular, ovulation, and luteal phases, all of which are categorized by different hormone fluctuations and bodily changes to prepare for zygote implantation. Now, let’s focus on the beginning portion of the menstrual cycle, famously known as a period. In addition to a week of light to heavy bleeding, menstruators often exhibit a slew of premenstrual symptoms (PMS) including bloating, fatigue, increased appetite, cramps, mood changes, backaches, and headaches. Even for a standard, healthy individual, the menstrual cycle is subject to some irregularity depending on hormonal changes, stress, or other external factors. This is where COVID-19 comes into play. Again, the full extent of the virus’s biomedical influence is not known yet but Dr. Cohut looked at cases in which patients with long COVID-19** experienced previously uncited irregularities with their menstrual cycles. The interviews and Dr. Cohut’s analysis do not suggest a direct causation, but an intriguing correlation of the virus’s impacts on the menstruating body.
    Throughout the article, Dr. Cohut lists several women*** who experienced late or missing periods, an unusual amount of heavy blood clots expelled from the body, and exacerbated PMS symptoms. Each of the interviewees described their cases as having been especially abnormal as they all noticed these changes after COVID-19 infection and often in conjunction with their persisting symptoms. One of the patients explains that these changes occurred in spite of her consistent birth control use**** for the past ten years. The combination of these issues can be incredibly frustrating and often interfere with a person’s quality of life. The people had to readjust their schedules to accommodate for new onsets of cramps and headaches while controlling vicious upper respiratory symptoms during their long recoveries. 
    Unfortunately, with COVID-19 and its associated troubles being so young in the scientific world, there are not many direct interventions for patients experiencing these menstrual complications. Dr. Cohut’s article brings up a relevant point about the research being done to understand COVID-19. Although this is the first pandemic the world has seen in a century, the impact of other viruses and illness on the menstrual cycle is not often studied. The menstruating population makes up a large portion of the world, so in retrospect, should these effects not be an important field of research? As I have mentioned in other posts, the menstrual cycle is a reflection of a person’s internal health, and with a disturbance like a viral infection, people should know to expect associated menstrual changes. Just as COVID-19 showed us that socioeconomic and access inequities continue to impact menstruators, the virus also shows how the periods are not exempt from the impact of a viral infection. As a virus modifies the body, it modifies the respective functions and states of normality associated with it. The scientific community should take this gap in knowledge as a lesson to expand the biomedical research about how sickness may lead to menstrual and hormonal changes. In doing so, the menstrual community would not have to search for answers to determine whether the disruptions to their normal cycles are a part of the viral course or a sign of greater issues.  


​Sources:​​

• https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/menstrual-cycle#:~:text=The%20four%20phases%20of%20the,increase%20the%20chance%20of%20pregnancy.
  
• ​https://www.medicalnewstoday.com/articles/long-covid-and-periods-the-unspoken-impact-on-female-well-being 

 

*Menstrual cycles and the idea of an “average menstrual cycle” differ between individuals and their circumstances. Information used in this context directly came from the Better Health Channel website linked above.
** Long COVID-19 is the term given to patients who experience COVID-19 associated symptoms for longer than the common 2-week period of active symptoms.
*** Only women were interviewed in this article. This does not mean people who do not identify as women cannot also menstruate or are not subject to the same complications as described in the article or in this blog post. 
**** Birth control, depending on the type, often regulates the menstrual cycle and can help decrease PMS symptoms and heavy bleeding during periods

In March 2020, almost the entire world stopped due to the threat of a novel virus that would later infect over 6.3 million people and lead to the deaths of more than 376,000 people. Entire countries were shut down, with only essential workers allowed to leave their homes and go to work so that grocery stores, healthcare facilities, and public transportation systems could continue to operate. For societies that centered their cultures and institutions around the basis of socializing and personable interaction, the pandemic came as an extreme shock. In the United States, the pandemic led to millions of people filing for unemployment and companies bracing for significant financial losses. Almost everyone entered unfamiliar circumstances that required a lot of personal adaptation especially to daily life. Without the looming threat of economic collapse and a pandemic, those who come from lower socioeconomic statuses or impoverished areas already experience disadvantages when trying to access proper menstrual hygiene products and relevant resources. Now, a greater number of menstruators are at risk of losing access to essential products due to limited income or lack of supply in their local stores, as many stores have faced product shortages. In addition, many frontline workers were thrown into long working hours with little break time and called for better access to products in their workplaces that they would now be spending more time in. With governments determining which products and services were essential, the most widespread way to ensure menstruators had proper access to the products they needed was through legislation. In the United States, the CARES Act signed on March 27th, 2020 listed all menstrual products as essential and were now covered by Health Savings Accounts and Flexible Spending Accounts. Considering the constant battle between American menstruators and their efforts in repealing the Tampon Tax, many believe this is a step in the right direction. However, it is important to note that CARES is not an adequate solution for people who still cannot afford or find pads, tampons, menstrual cups, soap, and other hygiene goods. Another instance of positive action occurred in Wuhan City where about 40,000 pads were shipped and distributed to female frontline workers. The efforts taken by the United States and China are examples of constructive measures, but other countries continue to face systemic oppression with regard to menstrual rights. As discussed, only essential items on government-curated lists remained in production, so in countries like India where pads, toilet tissue, and soap were not among the specific items, the nation’s supply quickly became scarce. Indian menstruators in migrant or rural populations felt the hardest impact of this shortage as they had to heavily rely on relief groups to obtain what they needed. A few interviews in the cited article discuss the unhygienic means some people have had to take to “stay dry during menstruation.” Some girls biked for miles across their towns to get products while others used cloth scraps to make pads. In parts of the world where menstruation is stigmatized and access to supplies is disproportionate, the COVID-19 crisis presents yet another challenge for people to properly be able to take care of themselves during menstruation. The articles about India are only a few of the hundreds of stories where menstruators are left to fend for themselves while greater institutions continue to overlook their struggles. In fact, as previously mentioned, healthcare workers all over the globe have expressed an overall lack of menstrual hygiene products and minimal action taken by authorities to fulfill their requests. With so much uncertainty ahead in this pandemic, the best we can do is to use our resources and platforms to help others. At the end of this post, I have included some links where you can find information about donating items or money to various organizations that provide menstrual hygiene products either in the Ann Arbor/Ypsilanti area or nationally. Please feel free to repost these organizations on social media or spread the word about their missions to bring more awareness to people who may be able to contribute to this cause in these uncertain times.

• M.I.S.S.I.O.N. Houses (Ann Arbor): http://www.missiona2.org/take-action.html
• AllianceforPeriodSupplies(National): https://donate.nationaldiaperbanknetwork.org/campaign/alliance-for-period-supplies/c285680
• The Dot Org (Ann Arbor): https://www.thedotorg.org/donate.html
• PERIOD. (National): https://www.period.org/donate

Sources: 
-https://coronavirus.jhu.edu/map.html (cited on June 2nd, 2020)
-https://www.globalcitizen.org/en/content/cares-act-covid-19-menstrual-products-fsa-hsa/
-https://news.cgtn.com/news/2020-02-20/China-addresses-sanitary-needs-of-female-medics-fighting-COVID-19-OeGHMCBFYs/index.html
-https://www.modernghana.com/news/1004374/women-in-india-suffer-as-covid-19-lockdown-hits.html
-https://www.globalcitizen.org/en/content/health-care-workers-period-poverty-covid-19/

    The rapid spread of novel coronavirus across the United States led to school closures, empty shelves at grocery stores, and entire regions being placed on lockdown. When the first stories about the coronavirus outbreak in Wuhan surfaced, I can honestly say I never thought about the virus impacting my life. I trusted that modern technology and biomedical advances would contain the virus, and if coronavirus came to the U.S., our healthcare system would at least prevent an epidemic and mass hysteria. Unfortunately, neither of those assumptions have proven to be true. Despite the United States allocating the greatest percentage of its GDP towards the healthcare of all developed countries (with the most recent expenditure being $3.5 trillion in 2017), a multitude of disparities and unresolved issues within the healthcare system continue to overwhelm the funds put into it. The most notable complication involving coronavirus is the overall lack of testing available and the questionable distribution of the tests the United States possesses. On March 6th, BBC News published an article entailing the Federal government’s statement regarding the lack of testing kits despite the increased need for testing across the country. This article shed light on the contradicting statements officials have made in attempts to ease the public’s worry about the country’s preparedness for the onset of the virus. Another article that sparked my interest involved the Utah Jazz organization of the NBA, which acquired and carried out fifty-eight tests for players and associates after one player tested positive for COVID-19. The numbers and circumstances of these stories alarmed me, but what struck me most was how they paralleled many of the healthcare disparities millions of Americans face  every day. As someone who is interested in women’s health and is involved in an organization that works to reduce menstrual disparities, my mind immediately went to inconsistencies in accessing menstrual products. Before I continue, I want to be clear that I am not insinuating that the issues associated with COVID-19 and menstruation are of the same magnitude at this point in time, but I feel that there are some fascinating correlations we can draw and learn from during this pandemic. In 2018, the P&G-owned pad and tampon company Always published a study titled “1 in 5 American Girls Have Missed School Due to Lack of Period Protection” highlighting the challenges many young menstruators face in getting the menstrual hygiene products they need. This issue barely garners the same attention that coronavirus testing has because it impacts a fraction of the nation’s population, compared to COVID-19 which impacts everyone, and does not pose immediate, life-threatening danger. However, this statistic, just like the climbing number of coronavirus cases, is still an issue that needs to be addressed and resolved. Just as students, teachers, and professionals have to miss school and work to protect themselves from the possibility of contracting and spreading the coronavirus, hundreds of young menstruators have had to skip school because they do not have the period products they need in the case of an emergency. It goes without saying that this problem should not be as widespread as it continues to be. In reflecting on the Utah Jazz team's ability to readily access test, I found that the article mirrored a similar situation regarding the differences between the amount of period products available in metropolitan suburbs versus inner city convenience stores, for example. On any given day, I can walk into my local Target and pick from hundreds of tampons, pads, and liners with options like organic cotton, super heavy absorbency, and even scented varieties (please research the types of products you are buying before you use them if you have the ability to do so). These products range from about $4.00 to $13.00 which does not seem expensive, but depending on the number of products a consumer needs per cycle these costs can quickly add up. Although coronavirus tests are currently free of charge despite one’s insurance status, the simple availability of testing to the public versus those with a higher social status, such as the Utah Jazz team, is what draws puzzling similarities to the access of menstrual products across the United States. In this analogy, I serve as the NBA players while menstruators who experience homelessness or live on a low income are the rest of the nation, who have limited access to testing. While my hardest decision is choosing between Playtex and Kotex, two-thirds of low income women in the United States have had to use makeshift menstrual products from cloth and bath tissue. This inequality  persists within the United States and is likely to become more prevalent among the COVID-19 panic that sent Americans scrambling to hoard items they need amid nationwide shutdowns and quarantine orders. Again, there are several of differences between the coronavirus outbreak and menstruation, but I believe they are not as dissimilar as they seem. While everyone washes their hands for at least twenty seconds and remains six feet from each other, consider the ways coronavirus exposes the inequalities of the U.S. healthcare system, and once this is all over, if there is anything you can do about it to work towards resolving these disparities.

*In this piece, I allocate “healthcare” to mean hospitals, clinics, private practices, urgent care facilities, and all associated personnel involved in providing medical care and treatment when necessary

Sources:
-https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/highlights.pdf
-https://www.bbc.com/news/world-us-canada-51761435
-https://www.usatoday.com/story/sports/nba/2020/03/13/how-utah-jazz-got-coronavirus-tests-during-national-shortage/5046539002/
-https://news.pg.com/press-release/pg-corporate-announcements/nearly-1-5-american-girls-have-missed-school-due-lack-perio
-Prices found on Target.com in March 2020
https://www.reuters.com/article/us-health-menstruation-usa/even-in-the-u-s-poor-women-often-cant-afford-tampons-pads-idUSKCN1P42TX