Study clarifies sex-based burdens during the pandemic, raises awareness for menstrual equity

Income loss was a strong predictor of menstrual product insecurity across the U.S. during COVID-19, and populations with lower incomes and the lowest educational attainment were most vulnerable, according to a new study conducted by Columbia University Mailman School of Public Health in partnership with the CUNY School of Public Health. The odds of not being able to afford products for those who experienced income loss was 3.64 times that of those who had no income loss and 3.95 times the odds for lower-income participants compared to higher-income participants. The findings are published in the American Journal of Public Health.

Of 6,753 adults enrolled in the CHASING COVID study, a national cohort created by CUNY's Institute for Implementation Science, a subset of 1,496 individuals participated in the Columbia study who were recruited through advertisements in English and Spanish on social media platforms. For inclusion participants must have menstruated since March 2020 and could not be currently pregnant.

Half of the study population reported economic loss during the pandemic, more than one-half experienced COVID-related housing anxiety, and over one-third experienced food insecurity. Other outcomes cited from the pandemic related to menstrual product insecurity were the inability to leave home because of underlying health conditions, transportation challenges, and a lack of internet access or credit to make purchases of menstrual products online.

The responses we received are proof that the pandemic has had gendered implications, including women's increased vulnerability to the social and economic repercussions of lockdowns and expanded caretaking roles. Until now the gendered experience of COVID-19 had been inadequately explored including access to menstrual products."

Marni Sommer, DrPH, MSN, RN, associate professor of sociomedical sciences at Columbia Mailman School and principal investigator

While there has been growing attention globally to 'period poverty' or the inability to afford menstrual products, during the pandemic, U.S. women's economic security significantly decreased. Women were more likely to have become unemployed than men, and food bank dependence increased significantly. Menstrual products are not included within most American public assistance programs and cannot be purchased under the Supplemental Nutrition Assistance Program (SNAP) or the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

"The passage of the Coronavirus Aid, Relief and Economic Security (CARES) Act in 2020 enabled certain segments of the population to use health savings accounts and health reimbursement arrangements, however, this indicates only limited progress as it still requires knowing that funds can be used for menstrual products and having the funds to make purchases," said Andrew R. Maroko, PhD^, of the City University of New York, and senior author.

"Our study findings should help inform the evidence gap and lack of data on U.S. period poverty that existed until now including how COVID-19 compounded menstruation management challenges," noted Sommer. "The data is proof that appropriate health and social policy legislation is warranted including free or heavily subsidized menstrual products. Everyone faced challenges in the pandemic but the reality of sex-based burdens became clear, raising awareness of the urgency for menstrual equity."