Menstruation Without Taxation - Annals of Internal Medicine: Fresh Look Blog


Wednesday, January 20, 2021

Menstruation Without Taxation

With significant progress already made, the women’s health movement continues to advocate for the improvement of women’s physical and mental health. Women have been included in clinical research trials since 1993, and more research is dedicated to understanding how certain diseases affect women differently than men (1). Women’s rights to comprehensive reproductive health care, including access to birth control and legal abortions, have made notable headway but are still constantly challenged (1). Likewise, period poverty, the inadequate access to menstrual hygiene tools and education, has been largely overlooked in the United States (2).

Women do not have a choice when it comes to menstruation. The average woman has her period 2,535 days, or approximately 7 years, of her life (3). The average woman uses 10 to 35 pads or tampons each cycle, adding up to 16,800 products used over the course of her lifetime (4, 5). It should come as no surprise that menstrual hygiene products are a $2 billion industry in the United States alone (5). Yet, unlike “necessary” goods, such as groceries and toilet paper, menstrual hygiene products are still subject to sales tax in most states (6).

Most American women believe access to menstrual hygiene products is a right (7). Labeling them as “luxury” items sets up barriers to access and negatively affects women who are low-income, experiencing homelessness, migrants or refugees, or incarcerated. Indeed, menstrual hygiene products cannot be purchased using the Supplemental Nutrition Assistance Program or the Special Supplemental Nutrition Program for Women, Infants, and Children (4). Some women have even reported trading food stamps for tampons because they cannot afford them (8).
Nearly two thirds of women accessing not-for-profit community organizations in St. Louis reported not having money to purchase menstrual hygiene products in the past year, and 46% struggled to buy both food and menstrual hygiene products (4). This left many women to rely on donations, which are not always available or available in the quantity needed (4). In addition, women experiencing homelessness reported limited access to safe public restrooms, which can result in extended use of a single tampon or pad, up to 12 to 14 hours, instead of the recommended 8 hours or less (4).

Women with no other choice will resort to using rags, tissues, toilet paper, or even dirty socks or used paper bags found on the sidewalk during menstruation (4, 9). The inadequate or improper use of menstrual hygiene products can lead to serious medical consequences. Repetitive use of unclean materials and poor menstrual hygiene can result in urinary tract infections and vulvar contact dermatitis (10, 11). It is also associated with worse quality of life (12).

There has been some progress made toward ending period poverty, eliminating the tampon tax, and ensuring menstrual equality. The United Nations declared menstrual hygiene a public health, gender equality, and human rights issue (5, 13). The U.S. Federal Bureau of Prisons provides menstrual hygiene products to incarcerated women at no charge (3). Kenya became the first country in the world to repeal its tampon tax in 2004, with other countries like Australia, Canada, and India only recently following suit (14). In February 2020, Scotland became the first country to approve a bill that will provide free menstrual hygiene products to women of all ages (15).

Yet, there is still much to be done. Research surrounding period poverty and its health implications is limited, particularly within the United States. The American College of Physicians supports efforts that close knowledge gaps related to specific women’s health issues (16). Therefore, research efforts should address the experiences of vulnerable populations, including school-aged girls, women experiencing homelessness, low-income women, women who are migrants or refugees, women with disabilities, and LGBTQ+ people who menstruate (11). This may include barriers to access; knowledge surrounding menstrual hygiene and health; shared experiences among women; and the implications of menstruation on girls' and women’s abilities to attend school, work, and participate in daily life.

Furthermore, there needs to be a broad movement at the local, state, and national levels to remove unnecessary barriers to menstrual hygiene products. This includes eliminating the tampon tax in all states, allowing products to be bought with the Supplemental Nutrition Assistance Program and Special Supplemental Nutrition Program for Women, Infants, and Children, and providing free or low-cost menstrual hygiene products to all those in need. This is a simple yet effective policy that the American College of Physicians should support in its efforts to address social determinants of health and promote health equity (17, 18).

The tampon tax puts half the population at a disadvantage because of their biology. Menstruation is a not choice and menstrual hygiene products are a necessity. Women deserve to menstruate with dignity.



  1. Nichols FH. History of the women's health movement in the 20th century. J Obstet Gynecol Neonatal Nurs. 2000;29:56-64. [PMID: 10660277]
  2. Alvarez A. Period poverty. American Medical Women’s Association. 31 October 2019. Accessed at on 1 June 2020.
  3. Zraick K. It’s not just the tampon tax: why periods are political. The New York Times. 22 July 2018. Accessed at on 2 June 2020.
  4. Sebert Kuhlmann A, Peters Bergquist E, Danjoint D, et al. Unmet menstrual hygiene needs among low-income women. Obstet Gynecol. 2019;133:238-244. [PMID: 30633137] doi:10.1097/AOG.0000000000003060
  5. Weiss-Wolf J. America’s very real menstrual crisis. Time. 11 August 2015. Accessed at on 1 June 2020.
  6. Bach N. 35 states in the U.S. still charge women a tampon tax. Fortune. 11 June 2019. Accessed at on 2 June 2020.
  7. Bame Y. 50% of women think tampons and pads should be free in all public restrooms. YouGov. 24 October 2017. Accessed at on 2 June 2020.
  8. Wessler SF. Timed out on welfare, many sell food stamps. Type Investigations. 16 February 2010. Accessed at on 2 June 2020.
  9. Hovitz H. Tampons are a necessity, not a luxury. VICE. 24 May 2017. Accessed at on 2 June 2020.
  10. Sumpter C, Torondel B. A systematic review of the health and social effects of menstrual hygiene management. PLoS One. 2013;8:e62004. [PMID: 23637945] doi:10.1371/journal.pone.0062004
  11. Winkler IT. Human rights shine a light on unmet menstrual health needs and menstruation at the margins [Editorial]. Obstet Gynecol. 2019;133:235-237. [PMID: 30633147] doi:10.1097/AOG.0000000000003098
  12. Singh B, Zhang J, Segars J. Period poverty and the menstrual product tax in the United States [29F]. Obstet Gynecol. 2020;135:68S. doi:10.1097/01.AOG.0000665164.05365.d0
  13. Every woman’s right to water, sanitation and hygiene. United Nations Human Rights, Office of the High Commissioner. 14 March 2014. Accessed at on 2 June 2020.
  14. Salam M. Goodbye, tampon tax (at least for some). The New York Times. 9 November 2018. Accessed at on 2 June 2020.
  15. Wamsley L. Scotland poised to become 1st country to make period products free. NPR. 27 February 2020. Accessed at on 2 June 2020.
  16. Daniel H, Erickson SM, Bornstein SS; Health and Public Policy Committee of the American College of Physicians. Women's health policy in the United States: an American College of Physicians position paper. Ann Intern Med. 2018;168:874-875. [PMID: 29809243] doi:10.7326/M17-3344
  17. Butkus R, Rapp K, Cooney TG, et al; Health and Public Policy Committee of the American College of Physicians. Envisioning a better U.S. health care system for all: reducing barriers to care and addressing social determinants of health. Ann Intern Med. 2020;172:S50-S59. [PMID: 31958803] doi:10.7326/M19-2410
  18. Daniel H, Bornstein SS, Kane GC; Health and Public Policy Committee of the American College of Physicians. Addressing social determinants to improve patient care and promote health equity: an American College of Physicians position paper. Ann Intern Med. 2018;168:577-578. [PMID: 29677265] doi:10.7326/M17-2441

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