Confidence to manage menstruation among university students in Australia: Evidence from a cross-sectional survey

Objectives: There has been increased attention to university students’ experiences of menstrual disorders, and access to menstrual products, in high-income countries. Less attention has been directed to other aspects of their menstrual experience, including confidence for menstrual management. This study aimed to understand the factors affecting university students’ confidence to manage menstruation at university. Methods: An online survey was completed by 410 participants (age range: 16–46 years, mean = 20.1 years) who menstruate and study at an Australian university. Participants reported demographic characteristics, confidence to manage menstruation at university, and personal, physical and environmental factors. A Mann–Whitney U-test analysed differences in confidence between groups of students. Pearson’s correlation coefficient and bivariate linear regressions determined associations between factors and confidence. Statistically significant associations were inputted into a multiple linear regression model. P-values less than 0.05 were considered significant. Results: A minority of students (16.2%) felt completely confident to manage their menstruation at university. Menstrual knowledge, positive perceptions of menstruation and comfort to discuss menstruation with others positively predicted confidence. Physical menstrual symptoms, negative perceptions of menstruation, perceived stigma and using a menstrual cup or period underwear predicted lower confidence. In multiple regression, private and clean and sanitary university bathroom facilities, changing menstrual products at university, perceived stigma and negative perceptions of menstruation remained significant predictors. Conclusion: Most students did not have complete confidence to manage their menstruation at university. Several personal, physical and environmental factors were related to students’ confidence to manage menstruation. Assessment of these factors in future research with university students is recommended to enable a comprehensive understanding of their menstrual needs, and inform interventions aimed at improving their menstrual management confidence at university.

Menstrual Equity Initiatives at USA Universities: A Multiple Case Study of Common Obstacles and Enabling Factors

Background: In recent years there has been growing momentum in the USA around addressing issues of “menstrual equity” and “period poverty,” including a proliferation of university-level initiatives seeking to provide access to free menstrual products. This multiple case study examined four such efforts at a diversity of tertiary institutions to identify the factors that facilitated or impeded success.Methods: We conducted a qualitative multiple case study, including a desk review and key informant interviews with student and administrative actors from universities with free menstrual product initiatives. We sought to identify key learning regarding common challenges and obstacles, enabling factors which supported success and sustainability, and practical learning for future initiatives. From the desk review, four schools (n = 4) were purposively selected to represent a range of geographic regions, student population size, and university type. Purposive sampling was used to identify students and administrators engaged in the menstrual equity initiatives on each campus (n = 20; 4–6 per school). Data from the desk review and interviews were analyzed using thematic analysis.Results: Key themes included (1) the critical role of champions, (2) the importance of social and financial support, (3) challenges diffusing menstrual equity from pilot to scale, and (4) recommendations for future initiatives. University initiatives varied greatly in terms of their scope, funding, and implementation strategy.Conclusion: This multiple case study provides valuable insights regarding the facilitating factors and obstacles faced by initiatives providing free menstrual products at universities. To date, these initiatives have proven successful across the four case studies; however, in most cases, the scope of the initiatives was constrained by limited resources and sustainability concerns. Future campus menstrual equity strategies would benefit from cross-institutional learning and dialogue highlighting design and implementation successes and challenges.

Understanding the impacts of humanitarian Menstrual Health Management for women’s confidence and agency: A case study on the Thai/Burma border

<p>Menstrual Health Management (MHM) is a growing focus within global humanitarian and development work. MHM aims to increase women and girls’ ability to care for their menstruating bodies through period products, hygiene facilities and education. It also seeks to challenge wider barriers that women face during menstruation – stigma, shame and ‘period poverty’ (the lack of access to menstrual products). NGOs promote ‘menstrual activism’ campaigns to ‘Reduce the stigma’ and ‘Help women and girls. Period.’ They tell stories of girls who, with their menstrual products, can now attend school during their period. Academic studies into the complexities of such programmes are sparse, however; particularly studies which privilege the experiences of the women involved and affected. Research on menstruation within the humanitarian field is also limited. This is despite the fact that women living in refugee camps and precarious spaces can have heightened difficulties due to scarcity of menstrual resources, disruption of support networks and facilities with inadequate privacy. Contextually and culturally embedded research that recognises the contributions and perspectives of these women can strengthen humanitarian MHM programmes and scholarship so that menstruating women can feel confidence and agency rather than stigma and shame. In light of these gaps, this study investigates Partners Relief & Development’s (Partners) ‘Days for Girls’ menstrual health programme in Thailand. The programme employs migrant women from Burma to make reusable menstrual hygiene kits and donates these kits to women in conflict-affected areas. The research worked within a feminist epistemology and mixed-methods methodology informed by principles of Appreciative Inquiry, to explore what is working well and what could be improved in Partners’ menstrual health programme. It involved refugees and migrants from Myanmar living over the border in Thailand, as well as the programme’s staff. Through thematic analysis, I found that the Days for Girls programme improves women’s agency (through increased community participation) and confidence (through menstrual literacy and menstrual provision). For the women who sew the Days for Girls kits, confidence and agency are also gained through income and skills-education. The strengths and challenges of Partners’ programme reveal the importance of menstrual literacy education, the use of women’s knowledge in NGO work with women, and a whole-of-community response to menstruation needs. The research also informs wider understandings of how MHM discourse and development practice affects menstrual stigma.</p>

Understanding the impacts of humanitarian Menstrual Health Management for women’s confidence and agency: A case study on the Thai/Burma border

<p>Menstrual Health Management (MHM) is a growing focus within global humanitarian and development work. MHM aims to increase women and girls’ ability to care for their menstruating bodies through period products, hygiene facilities and education. It also seeks to challenge wider barriers that women face during menstruation – stigma, shame and ‘period poverty’ (the lack of access to menstrual products). NGOs promote ‘menstrual activism’ campaigns to ‘Reduce the stigma’ and ‘Help women and girls. Period.’ They tell stories of girls who, with their menstrual products, can now attend school during their period. Academic studies into the complexities of such programmes are sparse, however; particularly studies which privilege the experiences of the women involved and affected. Research on menstruation within the humanitarian field is also limited. This is despite the fact that women living in refugee camps and precarious spaces can have heightened difficulties due to scarcity of menstrual resources, disruption of support networks and facilities with inadequate privacy. Contextually and culturally embedded research that recognises the contributions and perspectives of these women can strengthen humanitarian MHM programmes and scholarship so that menstruating women can feel confidence and agency rather than stigma and shame. In light of these gaps, this study investigates Partners Relief & Development’s (Partners) ‘Days for Girls’ menstrual health programme in Thailand. The programme employs migrant women from Burma to make reusable menstrual hygiene kits and donates these kits to women in conflict-affected areas. The research worked within a feminist epistemology and mixed-methods methodology informed by principles of Appreciative Inquiry, to explore what is working well and what could be improved in Partners’ menstrual health programme. It involved refugees and migrants from Myanmar living over the border in Thailand, as well as the programme’s staff. Through thematic analysis, I found that the Days for Girls programme improves women’s agency (through increased community participation) and confidence (through menstrual literacy and menstrual provision). For the women who sew the Days for Girls kits, confidence and agency are also gained through income and skills-education. The strengths and challenges of Partners’ programme reveal the importance of menstrual literacy education, the use of women’s knowledge in NGO work with women, and a whole-of-community response to menstruation needs. The research also informs wider understandings of how MHM discourse and development practice affects menstrual stigma.</p>

“Do We Not Bleed?” Sanitation, Menstrual Management, and Homelessness in the Time of COVID

Although access to adequate sanitation is formally recognized as a basic human right, public toilets have long been flagged as absent necessities by groups marginalized by class, gender, race, and ability in the United States. Navigating public spaces without the guarantee of reliable restrooms is more than a passing inconvenience for anyone needing immediate relief. This includes workers outside of traditional offices, people with medical conditions, caretakers of young children, or anyone without access to restroom amenities provided to customers. This absence is also gendered in ways that constrain the freedom of those who menstruate to participate in the public sphere. Managing menstrual hygiene requires twenty-four-hour access to safe, clean facilities, equipped for washing blood off hands and clothing and mechanisms for discreet disposal of used menstrual products. Public provision of such amenities is woefully inadequate in New York City (NYC), and homeless women especially bear the brunt of that neglect. Public health concerns about open defecation, coupled with feminist complaints that their absence restricted women’s ability to be out in public, catalyzed state investment to construct public toilets in the late 1800s. By 1907, eight had been built in NYC near public markets, and by the 1930s, the city built and renovated 145 comfort stations. However, changing public perceptions, vandalism, maintenance costs, and the City’s fiscal crisis in the 1970s all combined to reduce their numbers and degrade their quality. Public pay toilets provided a brief respite before falling victim to protest by feminists, who were rightly dismayed by policies that required payments for public usage of toilets but not for urinals. Supply deteriorated, and by 2019, NYC ranked ninety-third among large U.S. cities in per capita provision of public toilets. The remaining facilities are inadequately maintained and poorly monitored. The absence of public toilets poses an everyday challenge, but public health emergencies bring the need for public toilets into clear focus––as seen during the COVID-19 pandemic, which eliminated publicly accessible bathrooms in both private and public settings. That said, the effects of COVID on bathroom availability disproportionately affected those who were unable to heed the public health message to shelter at home––mobile “essential workers” and individuals experiencing homelessness. Homelessness advocates have long complained that civic toilet scarcity amounts to de facto entrapment, turning biological necessities into “public nuisances” for want of appropriate facilities. Criminalizing public urination and defecation in the absence of public facilities punishes the existence of individuals experiencing homelessness and challenges outreach workers’ efforts to gain their trust. With women increasingly prominent among those living on the streets or in shelters, this scarcity also impedes managing menstruation. Default reliance on private business is no answer for anyone defying passable “customer” profiles. Nor does the recent success of NYC’s “menstrual equity” efforts in schools, prisons, and shelters, with their primary focus on supplying menstrual products, suffice to cover the daytime needs of those on the move.

Asking the Menstruation Question to Achieve Menstrual Justice

Menstruation is a situs of discrimination, oppression, harassment, and microaggression. Employers fire workers for bleeding and experiencing period pain. Schools control menstruating students’ access to bathrooms, products, and menstrual education. Prisons control their residents’ free access to menstrual products. There are both “obvious and non-obvious relationships” between menstrual discrimination and discrimination on the basis of race, gender, class, gender identity, and disability. This Essay suggests we ask the “menstruation question” as part of our examination of all forms of intersectional oppressions and to achieve menstrual justice. For example, if we see something racist, we should ask “where is the menstrual oppression in this?” So too, if we see menstrual oppression, we should ask, “where is the racism in this?” Through this process, we discover the multidimensionality of menstrual injustices and how they operate as structural intersectionality. We learn that “dismantling any one form of subordination is impossible without dismantling every other.” Therefore, asking the menstruation question is critical to achieve menstrual justice.

Disposable Menstrual Products as Law's Objects

During the past few years, scholars and activists have increasingly engaged with law as a means to challenge stigma, silence, and disadvantages associated with menstruation. Menstrual items (predominantly in the form of disposable menstrual products) are becoming increasingly prominent in this “legal turn.” There have been legislative reforms to provide access to free menstrual items, litigation and legislative reforms to remove taxes on menstrual products, legislative reforms on product safety and environmental sustainability of menstrual items, and water and sanitation hygiene (‘WASH’) policies and guidelines in the context of international development interventions that focus on access to menstrual items. As regulation of disposable menstrual products assumes greater prominence in legal doctrine, feminist legal scholars are increasingly evaluating the impacts of such laws on menstruators, including in the context of diverse experiences of menstruation and menstrual injustice. But what can disposable menstrual products themselves tell us of law? In this Essay we take an object-informed approach to law in the specific context of disposable menstrual products. What insights about law might these objects provide, and how do these insights deepen our understanding of law’s relationship to menstruation, menstruators, and the worlds in which menstruators are situated? What can we appreciate about law’s role in defining, as well as recognizing and responding to, the diversity of experiences related to menstruation? How do menstrual items nuance our understanding of agency in relation to menstrual injustice? And what do these objects tell us about the limits and challenges of using law to achieve justice in relation to the embodied experiences of people who menstruate? Part II introduces some key contributions to feminist legal thinking on materiality and objects, which informs our analysis of disposable menstrual products as law’s objects. Part III introduces some of the critical threads in scholarship on disposable menstrual products, including how they relate to diversity and materiality of experiences of menstruation. Then, we turn in Part IV to explore what disposable menstrual products tell us about law’s role in menstruation, using the recent laws introduced in Scotland as a case study.

Compared to What? Menstruation, Pregnancy, and the Complexities of Comparison

This piece explores the complexities of the comparative model as applied to sex discrimination claims that are connected to female biology. On the one hand, comparisons can be a useful and precise way to pinpoint discrimination. The notion that bandages and adult diapers are tax-exempt, while tampons and pads are not, brings the unfairness of the tampon tax into sharp relief: Why are those products for absorbing bodily fluids tax-free, when menstrual products are not? The same is true for a pregnant employee who can show that her request for a light-duty accommodation was denied while the identical light-duty request by another similarly-situated, non-pregnant employee was granted. But the model also contains two traps. First, almost no comparison is perfect. There is often some potential for distinguishing and line-drawing, some way to argue that the comparison does not fully hold up. Second, the comparative model is itself inherently limiting. The biological processes of menstruation and pregnancy (along with menopause and breastfeeding, which this piece does not address) are closely intertwined with female sex and have no obvious analogues. Indeed, these processes impose specific challenges and needs that are not borne equally across the sexes. Yet the comparative model reductively suggests that if no products receive tax-exempt status, or if no employees receive accommodations for their inability to work, there is no sex discrimination issue at all. Although advocates cannot escape the current comparative framework within which they must work—and indeed should use it to their advantage when possible—we should all remain mindful of the framework’s ultimate limitations. The piece begins by analyzing Young v. United Parcel Service, Inc., the 2015 Supreme Court case that grappled with how to apply the PDA’s comparison-based standard. I discuss how Young illustrates the complexities of comparison and unpack the compromise approach that emerged. I then consider the potential usefulness of the Young approach to the tampon tax cases, while acknowledging that they arise under the Equal Protection Clause rather than Title VII. I conclude with some broader reflections.

Menstrual Justice in Immigration Detention

The menstrual injustices experienced by noncitizens detained in immigration facilities – a particularly vulnerable subset of menstruators in carceral spaces – are largely ignored. Menstruating detainees are forced to rely on the immigration system to provide adequate access to menstrual products, and on detention facilities to engage in safe menstrual management and corresponding dignity. Unfortunately, the immigration system fails many detainees, and the defining characteristics of immigration detention— the lack of access to counsel and significant geographic and social isolation that people in custody face—exacerbate the problem. Despite these isolating factors, detainees are finding ways to share their struggles with menstrual injustices. This Essay aims to categorize, amplify, and contextualize these experiences, and the need for thoughtful reform.

What's Law Got to Do With It? Dignity and Menstruation

When I think about all that is wrong in the world—the threat to democracy in the United States, the persistent systemic and individually-inflicted racism, the devastation wrought by COVID-19—I find myself asking, “Why do I care so much about menstrual laws and policies?” The answer, I have realized, is quite simple: the failure of the government and private institutions to adopt sane, respectful, smart policies concerning menstruation is an affront to dignity. Myriad policies intruding on a menstruator’s right to dignity are described throughout this Symposium and include: failing to include menstrual products in emergency- preparedness or response packages; not supplying public school students with free access to quality products; denying free and ready access to such products to people who are incarcerated or detained through our country’s immigration policies; imposing state and use taxes on such products as though they are “non-essential” goods; and not permitting menstruators to bring their own products into the bar exam.