Homeless women experience practical challenges in managing menstruation alongside feelings of embarrassment and shame

By Dr. Liji Thomas, MDMar 19 2024Reviewed by Danielle Ellis, B.Sc.

Homelessness is an experience that puts health at risk in multiple ways: physical, mental, social, emotional, and sexual. For women, this includes menstrual health as well. There is little knowledge about the extent of this problem.

A new study published online in Women and Health reviews literature on this topic, from the practical challenges through the emotional strain to demonstrations of resourcefulness in managing periods while homeless.

Background

Homeless women are often faceless and voiceless in research and healthcare, even though mental illness is often the reason for and/or the result of homelessness. Recent research showed health needs went unmet in a quarter of homeless women, including pregnancy complications and disability. Many homeless women neither expected nor sought healthcare anymore.

Women have unique challenges linked to their menstrual periods and pregnancy. Period poverty is a phenomenon where a woman is too poor to have access to sanitary products for her period. This makes menstrual health management (MHM) a challenge and promotes the use of potentially or really unsafe sanitary products like rags or toilet paper.

At the same time, schools in many low-income countries or regions fail to provide for the needs of girls having their period, a matter that UNICEF has emphasized. The same unfulfilled needs for privacy and facilities for MHM exist for homeless women but without any obvious efforts on the part of organizations to set up strategies to meet them.

Most existing research on period poverty focuses either on the very poor or on middle-class White women in the developed world. Underprivileged women in industrialized countries, including people experiencing homelessness, have not been addressed so far. This is ironic given the widespread knowledge that homeless shelters already struggle far too often to provide bedding, privacy, or ventilation adequate for the needs of the users.

The present study is a qualitative review aimed at pulling together evidence on the needs of menstruating women in the homeless population.

About the study

The researchers searched multiple electronic databases using relevant keywords. The nine studies included came from four countries, namely, the USA, Canada, Nepal, and the UK, with almost 600 participants. Five dealt only with MHM among homeless women.

The recurring motifs in this study were challenges in accessing facilities, materials, and privacy for MHM while homeless, the positive and negative emotions engendered as a result of this need for MHM, and how women dealt with these challenges.

Logistical challenges

The main difficulties faced had to do with not having privacy, a hygienic environment, or access to menstrual products while homeless. Period poverty was high in this group, leading to neglect of basic needs to manage this requirement.

Shelters often ask residents to leave during the day, forcing them to rely on public facilities. Public washrooms and restrooms are not readily available, forcing homeless women to manage their menstrual needs in public spaces like the corner of a subway, for instance. This compromises both their health and safety. Restrooms in restaurants and shops are open only to customers and, therefore, inaccessible to these women.

The lack of facilities to change menstrual products leads to an increased likelihood of leakage and a greater load of laundry to be washed. Unfortunately, this is due to the limited availability of hostels for people without housing. This means that stained products are discarded rather than washed, and the woman then has to obtain a replacement or go without that item of clothing.

Sanitary disposal of menstrual products is also a problem in many homeless shelters, adversely affecting public cleanliness and often leading to toilet blockages.

Cultural sensitivities should be honored while designing solutions, for instance, providing washable menstrual cloths in places where they are the preferred option. Period products are also costly, and even those supplied free are not always enough, falling short in timely supply or number.

With all of these factors at play, the resulting difficulty in maintaining a groomed and clean appearance triggered a vicious cycle where such women could not access privately owned bathrooms for a wash and to change their menstrual products.

Emotional cost of MHM

The difficulties in maintaining cleanliness and a spotless appearance during menstruation lead to feelings of shame, where the women feel they are despised and stigmatized because of their periods. Others were more likely to assume the worst about these women because of their perceived unhygienic habits.

Again, many menstrual products are supplied free via male workers, which arouses feelings of shame in women at having to reveal that they are having a period and further humiliate them. In many cases, hostel staff were perceived to be rather like correctional officers, making women even slower to reveal their menstruation-related needs.

Sadly, this means that “women feel that they’re being discriminated against, harassed, sexually harassed because they’re menstruating.” Access to menstrual products is limited for people experiencing homelessness, who also lack the freedom to choose the type of product they prefer.

How to manage

Homeless women tried to navigate these challenges and still preserve their self-respect by using old rags, sponges, or even wads of tissue paper to hold menstrual flow. Others reused menstrual products despite their already being soiled. This allowed them to escape having to buy or ask for menstrual products from a perceived hostile staff.

Some used female towelettes as washcloths when available. Still, vaginal infections were more common due to the difficulty of good MHM in these extreme conditions, exacerbated by the inability to afford effective ointments.

Desperate women sometimes pretend to be ill so they can go to the hospital and get privacy as well as access to menstrual products.

Some women routinely chose not to eat or walk rather than use a bus or gave up some precious leisure activity so they could buy menstrual products. Others stole from the stores (‘survival shoplifting’). Others used public assistance or handouts from friends and family to buy what they needed for MHM. Still, others gave up bus fares or money for leisure activities to buy menstrual products.

The future course of action

This is a pioneering study in the experience of menstruation in homeless women, exploring and helping to fill a research gap. Further extended studies are required to understand how race, disability, and neurodivergence may have additional implications for period management among people experiencing homelessness.

The researchers noted that some services were very useful, especially when conducted privately. These included the distribution of menstrual products and birth control products.

Homeless women appreciated having public centers open as places where they could go to ease their discomfort after leaving their night shelters. Peers relied on sharing their knowledge about places where they could shower, share menstrual products, and get other MHM support.

The study throws light on the desperate need among people experiencing homelessness for “free, readily available, good quality, culturally appropriate menstrual health products.” Rather than donating products indiscriminately, It also highlights the need to stop gatekeeping and provide washing and bathroom facilities that are clean, private, and safe for all marginalized groups.

“These findings highlight the need for a call to action for commissioners and policymakers to address the sub-optimal provision of MHM resources in homeless services as a fundamental right alongside other health provisions.”