Sharing the voices of our Bay Area Students - Local Bay Area volunteer and student, Sonali Dhruva., shares her research and thoughts on the inequities within Women’s Healthcare and how Simply the Basics is working towards a solution.

This was not written by Simply the Basics staff but is a project written by a local student. 

“Over the past decades, medical technology and policy have faced numerous advancements, yet over 12.6 women throughout the nation are struggling, forcing them to choose between necessities like food or menstrual supplies. I am a current senior in highschool in the vibrant Bay Area, and when I was given the opportunity to research a current issue in our world through our benchmark assignment, I chose to specialize in an issue that I have observed myself and many of my peers facing as well. My culture has created such a stigma around the idea of menstruating, restricting women’s accessibility during their cycle , not letting them eat certain foods or go certain places, originating from the idea of a period being associated with dirty or uncleanliness, and less of a beautiful passage into womanhood. From grades 5 and up I have witnessed my friends whispering asking for a pad and hiding it fully on their way to the restroom, afraid of embarrassment. Others of my friends attempted unhealthy substitutes for a pad/tampon like a rag or toilet paper because of the price or lack of access to the menstrual products. The more I witnessed this chaos the more I questioned, how is it still so difficult for countless women across the nation to access menstrual products shame free, considering over half of our population is biologically female?

Women's health specifically faces greater vulnerability through increased chronic conditions from hormonal and menstrual changes primarily from their reproductive health, and a higher prevalence of mental health issues. Therefore women tend to have a greater necessity for certain procedures and screenings to prevent developing threatening health conditions and such services can rack up large expenses. A prevalent reason for the high cost and the limited accessibility is that roughly 9.71 million women ages 19-64 (10%) are uninsured in the United States as of 2023. To worsen matters, Medicaid policies created for low-income individuals tend to leave out many essential women's procedures, especially those pertaining to reproductive health, causing women to have to pay out of pocket which can be incredibly expensive. Numerous single mothers are not able to care for their children and hold a job at the same time and cannot afford help making it more difficult for them to receive work-provided insurance coverage for themselves or their child or save enough money to afford menstrual supplies. Of the women who left the workplace in 2023, 28% reported they had to stay home to tend to their children and homes, and this nature is especially prevalent in women of color, making them more vulnerable to healthcare issues as a result of limited access to services. When considering women’s period cycles, menstrual supplies like pads and tampons are typically available at many local stores but can be expensive and there tend to be limited free supplies available in low-income areas. The consistent gamble between necessities and health is common when purchasing period products or birth control, food, rent, etc. This unfortunately leads to women subbing in alternatives instead of sanitary supplies during menstruation cycles, which can cause unsafe medical conditions like bacterial vaginosis and toxic shock syndrome along with numerous social and educational issues. For lower-income individuals, not being able to afford regular checkups or gynecologist/breast cancer screenings more often, can put them at a greater risk of disease and compromise the quality of life for many women across the nation. Healthcare costs directly correlate with higher financial insecurity, the development of threatening medical conditions, prolonged mental health struggles, and struggles in working in daily processes.

The results of unaffordable female products and services impact the lives of countless women and their families of women poorly through detrimental physical and mental health struggles. Prioritizing accessibility through free supplies, greater coverage of women’s procedures, and greater health education allows for improved women's health and quality of life without sacrifices. This can be increased safety of menstrual material and cycle education, public government-sponsored supply of sanitary pads in public spaces, and expanded Medicaid coverage of essential women's services. Through the free distribution of menstrual products public facilities and schools can advocate for women's well-being through access without women having to face concerns of costs or confusion. Madilyn Morcelle, a Senior Attorney at the National Health Law Program, discusses how Medicaid expansion would allow women to receive reproductive and preventative care improving their health and happiness, and quality of life for numerous low-income women throughout the nation. The solution to the complex problems of women's health and services thus involves a combination of distribution of free menstrual supplies, public health education, and Medicaid expansion of covered women's reproductive and preventative services, all of which will allow women throughout the United States to have improved healthcare, and thus greater personal, career, and family developments, improving their satisfaction in the quality of life overall productivity, ultimately boosting the nation’s socio-economic prosperity.

Almost every woman undergoes a menstrual cycle throughout their lifetime, leading period pads to be a major necessity in a majority of American households. According to Makayla Olson, an education and children’s health professor at Portland State University, “Without consistent and reliable access to period products, a menstruator is left to resort to unsafe and unsanitary practices, such as using a product for too long which can result in infection and illness, or finding a replacement for common menstrual products, like soaking up bleeding with a cloth or toilet paper.” Emily Forschen, a senior director at the CALMatters nonprofit, explains that the gamble between two necessities in each household has led to various women attempting to reduce their spending by leaving in tampons more than the given duration and relying on pad/tampon substitutes. Such unsafe menstrual product substitutions/overuses can be fatal through the bacterial buildup, which can lead to fatal medical conditions and pain including Bacterial Vaginosis and Toxic Shock Syndrome. The most efficient solution to such conditions is an available free supply of sanitary pads in public bathrooms like in schools and universities along with workplaces and public facilities. Through the available supply of menstrual products, women are less inclined to resort to unhealthy solutions, reducing the likelihood of developing bacteria-induced infections or conditions. This resolution is demonstrated through the Menstrual Equity Act which when enacted in 2021 required all of California’s public community colleges, universities, and secondary schools (middle school and above) to supply free menstrual products on their campus. The legislation was later extended from grades 6-12 to incorporate grades 3-12 making it accessible to all children likely to require menstrual supplies. Additionally, the California constitution required the local agencies and districts who supplied the products to be granted reimbursements through statutory provisions. This allowed for the vulnerable proportion of women not being able to afford supplies to get access and therefore improved their quality of health. There is a general social stigma around menstruation as well, and considering many legislatures are men, the topic is often taboo or shown in an embarrassing/shameful light, making its advocacy and addressing more difficult. The passing of this legislature took multiple attempts and a large statewide action; it can be more difficult to implement in certain locations where local facility/government isn’t as funded or as powerful due to living in more rural areas making it difficult for people to access such supplying facilities, considering that the previous 2017 version of this bill was rejected due to “budgetary constraints.”

Women’s health issues are especially prominent in rural areas with limited access to health services and products along with sex education. There is a direct connection between women who undergo health complications and women who have limited health education and services. Students living in marginalized communities felt they had fewer puberty and menstruation learning opportunities and often relied on doctors to explain it to them. This can be consequential since nearly 40% of healthcare providers tend to carry the assumption that their patients learned about menstruation from their families or at school. To young women who are unfamiliar with the period process, attempting to figure out where to access and how to use period products may become burdening, create distress and confusion, or cause them to make poor choices regarding their health. According to Amelia Trant and her fellow authors in the Journal of Pediatric and Adolescent Gynecology, “[e]education regarding menstrual hygiene and resources is essential for adolescents in understanding their options regarding sanitary supplies, what to expect from their menses each month, pain management, and possible infections.” The solution involves the expansion of menstrual health education aside from the traditional health class (grades 5-8) to understand topics currently excluded from most classrooms including menstruation ovulation, the follicular and luteal phases, the cycle throughout the month, symptoms of each, who to consult, and how to use the products safely. This solution is demonstrated in Oregon’s Menstrual Dignity Act which enacts a more in-depth menstrual education for female students along with staff education on supporting students dealing with menstruation. The legislation also enacts statewide school access to menstrual products in male, female, and gender-neutral bathrooms throughout Oregon. Health education is a particularly more sensitive solution to deal with due to parent behavior in different regions; taking time out of classrooms and adding to health/puberty curricula in several school districts can either be faced with opposition from parents (especially because of their own religious/personal reasons or their want withheld/prolong the information from their child) or supported widely depending on the general priority.

When considering enacting the solution throughout the nation, it is important to note that the greatest impact is made through supplies distribution and to educate and answer questions, informational poster products listing what they are used for and how to use them in school bathrooms will help confused younger students as well. A collaborative education, coverage, and supplies plan will aid in ridding students of embarrassment and shame of stigma, and encourage change and greater reproductive justice, therefore enhancing the quality of life for many women across the nation. Simply The Basics is the top nonprofit in the Bay Area central that has directly taken on countering period poverty through distributions and has not simply stuck to the surface level indirect donations. By considering the homeless population and other lower-income, vulnerable individuals, Simply the Basics has developed a new form of improving health conditions for many women statewide and created a vibrant new volunteer opportunity for individuals to give back. The nonprofit emphasized quality control through their Hygiene Bank Association ensured proper regulation of the hygiene distribution services and helped in creating a community. Simply The Basics prioritizes women being able to focus on thriving in life without worries of surviving. Without a doubt, I am not surprised to hear 98% of Receiving Sites have reported an improvement in their clients' health due to having greater access to hygiene care and/or other basic needs. My goal is improving low-income women's access to healthcare, and being able to volunteer and work with Simply the Basics has been a dream, and given me a strong belief that I am contributing to my cause.”

Citations:

• Borchelt, Gretchen. “The Impact Poverty Has on Women’s Health.” American Bar Association [circa2017],www.americanbar.org/groups/crsj/publications/human_rights_magazine_home/the-state-of-healthcare-in-the-united-states/poverty-on-womens-health/. California State Legislature, Assembly Bill No. 230.

• California State Legislature, 10 Oct. 2023, leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202320240AB230&search_keywords=Menstrual+Equity.

• Forschen, Emily. “Latest ‘menstrual equity’ Bill Would Require California’s Public Colleges To Provide Period Products.” CalMatters, 13 July 2021, calmatters.org/education/higher-education/college-beat/2021/07/menstrual-equity-california-colleges-period-poverty/.

• “In 2020, More than 12.6 Million Women and Girls Lacked Health Insurance; Being a Woman Still Raises the Odds of Being Poor in America; and the Wage Gap for Women Overall Narrowed to 83 Cents.” National Women’s Law Center, 14 Sep. 2021, nwlc.org/press-release/in-2020-more-than-12-6-Million-women-and-girls-lacked-health-insurance-Being-a-woman-still-raised-the-odds-of-being-poor-in-america-and-the-wage-gap-for-women-overall-narrowed-to-83-cents/.

• Krumperman, Katie. “Period Poverty in the United States.” Ballard Brief, 12 Feb. 2023,www.ballardbrief.byu.edu.

• Morcelle, Madeline T. "Reforming Medicaid Coverage Toward Reproductive Justice."American Journal of Law and Medicine, vol. 48, no. 2-3, 2022, pp. 223-243. ProQuest,www.proquest.com/openview/bab0e072b262e54e5cc9702c953b69d5/1?pq-origite=gscholar&cbl=48702.

• Olsen, Makayla. “The Impact of Period Period Poverty on Low-Income Adolescents in the United States.” Portland State University, 18 June 2023, pdxscholar.library.pdx.edu/cgi/viewcontent.cgi?article=2590&context=honorstheses.

• Sadinsky, Sophia. “Sexual and Reproductive Health Care Is Key to Achieving Universal Health Coverage.” Guttmacher Institute, 13 July 2021, www.guttmacher.org/article/2021/07/sexual-and-reproductive-health-care-key-achieving-universal-health-coverage.

• Serafi et al. “The American Rescue Plan Act’s State Option to Extend Postpartum Coverage.”State Health and Value Strategies, 1 April 2022, www.shvs.org/resource/the-american-rescue-plan-act-state-option-to-extend-postpartum-coverage/.

• Trant, Amelia. “Menstrual Health and Hygiene among Adolescents in the United States.”Journal of Pediatric And Adolescent Gynecology, 6 January 2022,www.jpagonline.org/article/S1083-3188(21)00363-6/fulltext.

• “Women’s Health Insurance.” Kaiser Family Foundation, 21 Dec. 2022, www.kff.org/womens-health-policy/fact-sheet/womens-health-insurance-coverage/.