September 17th, 2021
Story

Ariana Ortega of Ft. Collins says she often struggles to afford purchasing menstrual hygiene products. Products donated through a local nonprofit allow Ortega to put money towards food and other necessities instead.

Photo by Valerie Mosley

By Fran Kritz

As the new school term begins at Denver Public Schools (DPS), students who menstruate may be surprised to find new additions near the paper towels and soap in girls’, all-gender and teacher restrooms: free tampons and menstrual pads.

While many private and public schools in the state have tampons and pads available for sale in restrooms, until recently getting access to free supplies would mean asking a school nurse or administrator—sometimes embarrassing for a young student, especially one who is transgender or nonbinary. DPS is among the first school districts in the state to now make free supplies easily available in all elementary, middle and high schools.

The DPS program was suggested by a student, and then supported by DPS leadership. “A high school student brought us the idea in 2020,” says Trena Marsal, executive director of facility management at DPS. The student knew of a classmate who was using menstrual products for longer than recommended because she could not afford a full month’s supply.

Marsal says the current pilot project—at a cost of about $50,000 for the school system annually—will be evaluated throughout the year, “not for closure but for whether we are fully meeting the need.”

The school district, the largest in Colorado, is joining close to a dozen initiatives across the state—many launched just in the last year or two—aimed at reducing the number of menstruating people who, when not able to afford tampons and pads, skip school or work; use products longer than safe or comfortable; or find makeshift products like rags and cotton when the choice becomes purchasing period supplies or diapers, gas or food.

Other consequences of “period poverty” can include shame, low self-esteem, discomfort, odor, stress and health risks, says Anne Banfield, MD, an American College of Obstetricians and Gynecologists section vice chair who works on menstrual equity issues with national advocacy groups.

“Using the same tampon or pad for too long risks very uncomfortable skin irritation and rashes, and extended use of the same tampon has been linked to toxic shock syndrome, a rare, life-threatening complication of some bacterial infections,” Banfield said.

The issue of menstrual equity has gained more attention in many states recently, including Colorado, where menstrual products are now available for free in some of the State Capitol restrooms.

“The need is hardly new, but with increased attention to gender, racial and social equity in the U.S., we’ve seen new initiatives—and legislation—across the country to make the products free for those who can’t afford them,” says Jennifer Weiss-Wolf, vice president at the Brennan Center for Justice at the New York University School of Law and author of a 2017 book that helped bring attention to the issue. Weiss-Wolf is also the co-founder of Period Equity, a nonprofit that focuses on menstrual equity, including eliminating sales tax on menstrual products. More than 30 states—but not Colorado—have eliminated that tax.

Why focus on the sales tax, which in Colorado comes to just 20 cents for a $7 box of tampons? “Besides the fairness of it—bagged salad doesn’t have sales tax in Colorado, but tampons do—when you’re scrounging for change under the couch because your period just started, that 20 cents can make the difference in whether you can afford what you need or not,” says Dana Marlowe, founder and executive director of I Support the Girls, a national organization that distributes period supplies, bras and underwear to people experiencing poverty and homelessness. The group has Colorado chapters in Colorado Springs, Denver and Fort Collins.

And being able to get tampons at that price assumes you have transportation to get you to a retail store, says Marlowe: “If you have no car or don’t have the time to travel to a lower-cost store, you’re buying period supplies at a local corner store that often kicks up the cost—and the tax to be paid—by several dollars, exacerbating the problem even more.”

Period expenses climb still further if you need more than one box of tampons or pads per cycle; use both pads and tampons each month for a heavy flow; or add panty liners for more protection—not to mention “pairs of underwear that can’t be laundered because you’re homeless or embarrassed to wash them in a public laundromat,” says Erin Persaud, operations director and Denver chapter director for I Support the Girls. Persaud says underpants are the most requested item the group gets each year; in 2020, the group distributed 500,000 pairs nationwide.

Emily Jorgensen of Windsor, Colo. launched another initiative, the Grace Upon Grace Project, two years ago when she spent the night in a New York City hotel and was charged $40 for a box of tampons and package of pads. The items would have cost about $14 at a chain pharmacy store.

“I could pay it, even if I was outraged at the cost,” says Jorgensen, “but then I wondered what the products were costing poor women and how they were paying for them.” Jorgensen now hosts a monthly product distribution out of a small warehouse in Loveland that serves about 500 clients, funded by donations of money and supplies.

Several months ago, Ariana Ortega, 28, saw a post about Grace Upon Grace in her Facebook feed offering free menstrual products on a day she realized she had no extra money to purchase the supplies she needed. An apartment leasing manager and single mom of a 3-year-old, Ortega, who lives in Ft. Collins, earns $24,000 a year and sees her salary quickly eaten up by rent, food, daycare and utilities.

“They say I make too much for Medicaid and food assistance,” says Ortega. Even if she did qualify for those benefits, it wouldn’t help with period supplies—they’re not covered by either program.

“When I first heard about Grace Upon Grace, I had just run out of menstrual products, and money to buy them—and didn’t know what I was going to do,” says Ortega. She immediately messaged Emily Jorgensen and although the next distribution wasn’t for another three weeks, Jorgensen “met up with me hours after I reached out.”

It wasn’t the first time Ortega had run out of supplies: “One time, on the last day of my period, I had nothing to use and I rolled up a bunch of tissue paper. It made me depressed because here was something I needed and I couldn’t even afford it.”

Ortega uses both pads and tampons for her period and had been spending $25 to $30 each month. “I go to Grace Upon Grace’s monthly distribution and they give me a supply of everything I need, plus diapers and pull-ups for my son. The money I save goes instead for food, gas or anything else my son needs.”

Kristin Hernandez, 48, also read about Grace Upon Grace online and contacted Jorgensen to see if she qualified. Her need was great enough that Jorgensen actually brings products to Hernandez’s mobile home in Loveland each month.

Hernandez, whose husband is incarcerated, worked at a factory until 2019, when she became disabled after a car crash. She is no longer able to work; her right leg, as a result of the crash, was amputated this summer. “I wouldn’t say I had enough [money] for what I needed or wanted while I was working, but I could always pay for tampons,” says Hernandez.

Now Hernandez’s daughter Alex has moved in, along with her two young children, doubling the cost of period products for the household. Alex doesn’t work in order to provide full-time care for her mother.

“I did the math when I read about Grace Upon Grace, and realized the money we’d save could go right to food for the kids,” says Kristin Hernandez.

Pads and tampons are sometimes available from sources other than nonprofit initiatives, but in varying amounts.

“This is gaining greater awareness among food pantries, and menstrual supplies are often on lists of needed items, but it’s still fairly case-by-case and dependent on donations,” says Ellie Agar, director of communications at Hunger Free Colorado.

Greg Pratt, executive director of the Bienvenidos Food Bank in Denver, says the pandemic has changed how and what is given to clients. “While the pantry used to stock necessary items, including period products, food is now boxed to limit contact among clients and staff because of COVID-19—and the food boxes don’t contain the supplies.”

Hernandez gets a fixed amount and supplements, if she needs to, with lower-quality tampons her daughter buys at a nearby discount store. The higher-quality products Jorgensen provides are important for early in the period cycle, when menstruating people tend to have heavier flows and need more absorbent products.

A 2019 study polled 183 low-income women in the St. Louis area and found that 64% were “unable to afford needed menstrual hygiene supplies during the previous year.” Abbie McAdams, a student at the University of Denver and founder of the menstrual equity organization Red Equity, estimates that, based on population and income levels for the state, more than 265,000 people in Colorado are at risk of, if not already experiencing, period poverty.  

Advocates continue to call for federal programs such as Medicaid and SNAP (food stamps) to cover period products (as well as diapers, which are jointly distributed by some of the menstrual product nonprofit groups). One bright note, says Weiss-Wolf, is that under the federal CARES Act, created to help alleviate need during the COVID-19 pandemic, people can, for the first time, use funds from employer-based flexible spending and health savings accounts to pay for menstrual products. While low-income workers are unlikely to have access to or fund such accounts, “it’s an example of the federal government allowing use of these funds, which can be an important precedent for other federal programs to pay for the products in the future,” says Weiss-Wolf.

In Colorado, Gov. Jared Polis signed legislation in 2019 making menstrual products available for free in state prisons, and legislation has been introduced but not yet passed to make the products available for free in local and county jails. This summer, a law was passed authorizing $100,000 to the Colorado Department of Education to allow public schools and districts to supply menstrual products at no cost, with priority given to schools in lower-income communities. Schools can begin requesting funding later this year.

Students at Arvada West High School, who knew of classmates that couldn’t afford period products, brought the idea to State Rep. Brianna Titone of Arvada, who co-sponsored the legislation with Rep. Leslie Herod and Sen. Faith Winter. “This is about eliminating barriers for students to get what they need for a healthy life,” says Titone, who says the next step is to encourage free menstrual products in restrooms at private businesses and public buildings, “to help turn this into a mainstream movement.”

Nationally, Congresswoman Grace Meng of New York has introduced, for the third time, draft legislation that would expand funds and regulations aimed at making period products free or more affordable. Colorado Reps. Diana DeGette and Joe Neguse are co-sponsors, though there is not yet a Senate companion bill.

Weiss-Wolf says the legislation’s content is already bearing fruit by highlighting need and ideas to help provide menstrual products at no cost. Tenets of the bill include:

  • Ensuring that incarcerated people and detainees in federal (including immigration detention centers), state and local facilities have access to free menstrual products, including requiring guidance on distribution.
  • Allowing homeless assistance providers to use grant funds that cover shelter necessities (such as blankets and toothbrushes) to also use that money to purchase menstrual products.
  • Requiring Medicaid to cover the cost of menstrual products.

Colorado State University, University of Colorado Denver, University of Colorado Boulder and University of Northern Colorado are among several colleges that have begun making menstrual products available for free to students and faculty. At the University of Northern Colorado, for example, advocacy by students led to funding to convert coin-operated menstrual product vending machines in women’s and gender-neutral bathrooms, to have products dispensed for free.

The project, called Project M.E. (for menstrual equity), also provides kits that any student can sign up for online and get precisely the amount and type of menstrual products needed. The program was launched by Colorado School of Public Health graduate student Rosie Glaser, who had noticed period poverty among classmates as far back as middle school while growing up in suburban Chicago.

Rose Grose, PhD, an assistant professor of community health education at the Colorado School of Public Health at University of Northern Colorado, who is not involved with Project M.E. but is in favor of it, says she is unsurprised that period poverty projects have continued and even begun during the pandemic. “With COVID-19 affecting employment and housing security, there has been more attention to issues of health equity in general,” Grose said.

Advocates like Red Equity’s McAdams were buoyed this summer by the Scottish government announcing that menstrual products would soon be available free of charge—reportedly the first country in the world to do so. Few advocates think that will happen anytime soon in the U.S., but all progress lends credence and attention to the effort, McAdams says, who is developing a coalition of menstrual equity advocacy groups in Colorado that includes Red Equity, Grace Upon Grace and Period Kits—the latter of which recently distributed its millionth product.

Many of the groups see a great deal of their work—and success—in simply raising awareness about the issue. “I hold a number of events to discuss menstrual equity,” says Jorgensen. “No one will advocate for you if they don’t know about and feel passionate about your issue.”

Geoff Davis, the compliance manager for Bayaud Enterprises, a Denver-based organization that provides services for people experiencing homelessness, founded Period Kits after an employee mentioned that other workers at Bayaud had trouble affording menstrual supplies, and created awareness events to help advance the issue.

“I can explain how important that is with one example,” Davis says. “At the Women’s March last year, at least a quarter of the people who approached our table thought we were collecting donations for girls and women in Africa.”

For Ariana Ortega, Kristin Hernandez and the tens of thousands of people in Colorado who struggle with the cost of menstrual supplies each month, the issue is not just affordability but also dignity.

“I know people who folded up toilet paper during their periods because they couldn’t afford pads or tampons, and no woman should have to do that,” says Hernandez. “If someone qualifies for public assistance, then menstrual products should be covered as well. They’re no luxury, they’re a necessity.”

Fran Kritz
Health care and health policy writer
Washington, DC