While gender may be a fluid and social concept [Freud, 1994]1, one’s biological sex is more definitive; and the classification is primarily follows a binary system – male or female. Thus sex can be defined as either of the two main biological categories (male and female) into which humans and many other living things are divided on the basis of basis of their reproductive organs and functions. There are noted differences in anatomy and physiology, as well as development – from puberty and aging. [Gur, 2002; Parker, Kalasky, & Proctor, 2015; Giefing-Kro et. al, 2015]2-4 These biological differences between men and women (will refer to cis-gendered) actually result in notable socioeconomic differences across the lifespan. Thus, women and girls face a certain degree of socioeconomic disadvantage, and in some cases marginalization, due to having to cope with the monetary and social costs of menstruation.
Taxation for Menstruation
All of those who purchase feminine hygiene products, whether they are tampons, pads, panty liners, etc., do so for the same exact reason; to effectively and safely manage the blood that their body sheds from their uterine lining every month. That is it, as consumers, women have no choice in the matter. Menstruation is an inevitable process, which may only be reduced by the use of contraceptives – but even acquiring contraceptives for this purpose will come with additional costs. It is this inevitable nature of periods, coupled with the social expectation or norms that maintains that women and girls must not walk around freely bleeding, and leaving behind bio specimen samples on every item that we may sit on; that provides the central argument against the taxation of products that are used to manage menstruation. Unlike cigarettes, alcoholic beverages, and even condoms; women and girls have no choice but to purchase feminine hygiene products monthly. Even if they maintained a smoke free lifestyle, had drinks only on occasion, and took a vow of celibacy-they would still have to manage the blood that is expelled from their bodies monthly.
Currently 40 out of the 50 states in the United States charges sales tax on feminine hygiene products. Only five of these states specifically do not tax tampons, and they are: Maryland , Massachusetts ,Pennsylvania , Minnesota and New Jersey. These items, despite their obvious necessity, are seen as “luxury” items. This classification becomes even more ridiculous when one considers items that certain states choose to exempt from sales tax and are qualify as medical care related tax deductions. They include: breast pumps, artificial teeth, and vasectomies. Also, there are other products that although they are clearly a luxury, are not taxed by certain states. These items include: a bag of M&Ms, a latte, yachts, and yes even luxury jets.
There is a glimmer of hope, as City Council member Julissa Ferreras, is spearheading a city-wide campaign to find a solution the problem. In June 2015, she convened the first-ever roundtable on menstrual health inviting a diverse array of community leaders. The campaigns plan is to provide free tampons and pads in New York City’s public schools, shelters, and correctional facilities. The Council also plans to introduce two legislative resolutions, the first that will eliminate sales tax on feminine hygiene products in New York State, and the second to authorize inclusion of feminine hygiene products in the Supplemental Nutrition Assistance Program and Women, Infants, and Children program. The efforts in New York will likely create a precedent that sets the stage for future reform, including that at the federal level.
This global debate has resulted in noteworthy activism, political action, and policy change in a number of countries. Despite initial opposition to reform, on December 15th the French parliament voted to cut the country’s “tampon-tax” from 20 percent to 5.5 percent. This reform puts France in line with the United Kingdom, where the tax on sanitary products is 5 percent (It used to be 17.5%!) Although, this may seem like small victories, the policies are not progressive enough; being that the taxes should truly be abolished; and that is what members of the United Kingdom government are attempting to do. They are lobbying the European Commission, so that they can remove the rate entirely; apparently the policy is not currently permitted by European Union law. The lobbying efforts are a result of activism around the topic, including an online petition entitled “Stop taxing periods. Period” which garnered more than 250,000 signatures. The petition was launched after British MPs, in a decision of 305 to 287, voted against a move to end the 5% “Tampon Tax”. Activist rightfully argued that tampons and pads should not be considered “non-essential luxury items”, if men’s razors and exotic meats are not classified as such. While, Ireland has a zero-rate tax on tampons and sanitary towels but this was brought in before laws that meant taxes had to be the same across the European Union. On July 1, 2015 the Canadian government scrapped the “Tampon Tax”, meaning that tampons, pads, and menstrual cups are no longer subjected to Canada’s five percent ‘Goods and Services’ tax (GST). The change in legislation came about after nearly 75, 000 Canadians signed onto a petition demanding the repeal of the tax. Amidst similar pressure and petitions in Australia, government treasurer Joe Hockey recently said he would ask officials to remove the 10 per cent consumption tax on the items.
Health Equity & Social Justice
Access to feminine hygiene products encompasses a number of public health issues, and truly is a matter of social justice. According to the Centers for Disease Control & Prevention, Health Equity should be understood in the following terms:
Health equity is achieved when every person has the opportunity to “attain his or her full health potential” and no one is “disadvantaged from achieving this potential because of social position or other socially determined circumstances.” Health inequities are reflected in differences in length of life; quality of life; rates of disease, disability, and death; severity of disease; and access to treatment. [Source: Centers for Disease Control & Prevention]
So, how does this relate to feminine hygiene products and being able to afford a pack of Kotex pads?
Consider the cost of these items, along with the taxes accessed on them. Now consider how essential they are for girls and women to function in society – whether it be to attend school, participate in physical education or exercise, or to walk with dignity with unsoiled clothing. In parts of the Global South, there are girls who are unable to attend school, due to the lack of available products to manage effectively manage their menstruation. [Chebii, 2012; Jewitt & Ryley 2014]5-6 For example, UNICEFestimates that 10% of African girls do not attend school during their periods. This interruption in their education puts them at a social disadvantage that will likely affect them over thelife course. More about that here.Among the various organizations that are attempting to address this problem is One Girl, whose Launchpad initiative raises funds for and delivers affordable, biodegradable sanitary pads to women and girls in Sierra Leone, using a network of female entrepreneurs and school systems. The pads that they provide are called Makapads, and they are made of from papyrus leaves and are fully biodegradable. Also, they are less cumbersome too use than reusable pads, or products such as diva cups, which can be challenging to insert; particularly for those who have not given birth. There is also a company called LunaPads that has the Pads4Girls program, which provides in-kind donations of menstrual products. The distribution of these pads helps girls overcome a barrier that is known to contribute to what has been referred to the feminization of poverty; which is a phenomenon that finds that the greatest number of the world’s poor and socially disenfranchised are women; further women experience poverty at rates that are disproportionately high in comparison to men. Thus, the lack of sufficient access to education often amounts to a loss of opportunity for wealth building, social mobility, and improvement of health outcomes.
For women in the workplace, the challenge of managing their periods continues, and many have to miss work, and thereby lose pay and much needed income in their time of absence. A study showed that 73% of female factory workers in Bangladesh miss an average of six days-and of again six days of needed pay-every month because of their periods. Due to these obstacles, the Millennium Development Goal (3), to promote gender equality and empower women, will not be achieved.
What about post-industrial nations?
Feminine hygiene products are widely available in post-industrial nations, and often there is an entire aisle dedicated to these products. One can find every type of tampon, maxi pad, panty liner, etc. that is available when entering a drug store or even a Target or Walmart. Personally, I will recommend steering clear of tampon products that are made from cardboard. I realize that they are biodegradable, it pains me to admit that I use the plastic applicators, because they are far less PAINFUL.
Nevertheless, despite their availability, these products still come at a cost, and these costs quickly add up; and create a barrier to access for some of the most vulnerable women and girls in society – homeless, low income, incarcerated, and so on. We can consider the individual obstacles and circumstances for homeless, low income, and incarcerated women:
The homeless are one of the most vulnerable populations, exposed to the elements, at risk for contracting infections, being victims of physical harm, and dealing with food insecurity issues; and for homeless women these hardships include having to cope with monthly menstruation and they challenges to do so in a hygienically sound manner. These women do not have access to sanitary bathrooms where they can properly replace and dispose of soiled feminine hygiene products; also the costs of these products means that they may be forced to extend their use or go without, and use whatever materials that they can find, whether it be socks and dirty rags — to absorb the flow of blood. The (fem) me program was implemented by students at The University of Georgia’s School of Public and International Affairs & College of Public Health to focus on providing hygiene products to homeless women, assist them in meeting their basic feminine hygiene needs, as well as providing them with other tools to promote health. The programs stated primary aim is to “alleviate the health concerns caused by a lack of access to feminine hygiene products.”
The Low Income & Food Insecure
For low income or economically marginalized women, which happens to be a growing number of the U.S. population, and even includes women with undergraduate and post-graduate education, such as the many Adjunct professors; there are already substantial hardships when it comes to affording shelter, food, and transportation. And even in the cases where these women qualify for and are given some financial assistance, such as food stamps (distributed through EBT cards), they cannot buy sanitary products, because they are not covered under the Supplemental Nutrition Assistance Program (SNAP) program. This has actually led to women resorting to sell their food stamps, in order to purchase sanitary products.
What is not often–or ever highlighted in the list of human rights offenses carried out in the American prison-industrial complex is the dehumanizing of women prisoners by denying them or not providing them with an adequate supply of sanitary products. For-profit prisons, are well for PROFIT, and thus charge women prisoners extraordinarily high prices for sanitary products, and due to limited budgets, not-for-profit prisons also charges inmates. These items must be bought at the prison commissary, and there is no guarantee that they will be in stock; often leaving women to go without. Also, as the economic concept of Supply and Demand teaches us, the value of sanitary products in prisons have gone up, due to their scarcity; thus they are being used as bargaining chips or power/negotiating toolsover already vulnerable women. Now, if we couple this with the fact that the vast majority of women in incarceration have been convicted of non-violent crimes, that may be deemed as ‘crimes of poverty’, such as possession and prostitution; it is clear that there is currently a great miscarriage of justice. In viewing these circumstances using an intersectional lens of analysis, it is clear that those who have to cope with more intersecting factors of oppression–based on race, ethnicity, sex, class, and sexuality–will also be those who are more likely to be incarcerated. Thus, statistics like this are not surprising:
In 2010, black women were incarcerated at nearly 3 times the rate of white women (133 versus 47 per 100,000). Hispanic women were incarcerated at 1.6 times the rate of white women (77 versus 47 per 100,000).
[Source: The Sentencing Project]
Further, women who had to resort to committing ‘crimes of poverty’, are those who already lived below the poverty line and did not have access to healthcare before they were imprisoned. Cases have shown that they exhibit high numbers of abnormal menstruation. As any woman who grew up with sisters, shared a dorm room, or spent a lot of time working alongside female coworkers would know, our biological clocks become somewhat synchronized; and the same occurs with incarcerated women, and this coupled with a shortage of feminine hygiene products, presents a problem of unsanitary conditions and risk for bacterial and fungal infections.
A Woman’s Worth Inc. officially launched its Dignity Behind Bars project in 2015, and it works to relieve indignity and increase public health by assisting women and girls around the globe, including domestic abuse survivors and homeless women in the United States. The organization conducts surveying, but more importantly provides very much needed sanitary products. Those who would like to donate unopened pads or tampons can send them to A Woman’s Worth, Inc. P.O. Box 5309, Beaverton, OR, USA 97006. For other ways to get involved or assist, read here.
When considering the costs of sanitary products, and the fact that only women and girls have to bare these costs due to inevitable changes that their bodies undergo monthly, one should understand the current demand to abolish taxation on feminine hygiene products. From a social justice perspective, the practice is biased and/or inequitable, in that women and girls are the only group that are expected to pay this tax. It is as if women and girls are being penalized, simply because they are biologically female. Perhaps, the tax on these products should then be referred to as the “Female Tax”?
Hygiene & Dignity
Let’s get back to the free flowing blood and consider public health’s endeavors around hygiene in the 19th century, [Mara et al 2010]7 which along with improvements in sanitation led to a remarkable reduction in infectious diseases, and helped to expand life expectancy. Public health has provided a number of historic examples that hygiene and sanitation are the most effective way of safeguarding against the spread of disease in a community. A great example of this was Dr. John Snow’s efforts which successfully halted the cholera epidemic in London in 1854. As we live in a more urbanized world, with population densities that are greater than any time in history, maintaining proper hygiene and sanitation are becoming even more critical. In the United States is common to see signs posted in restrooms stating that it is mandatory for employees to wash their hands. While globally there are a number of public health campaigns focused on increasing awareness about the importance of handwashing and hygiene. In fact, Global Handwashing Day was held on October 15 this year. Given this historical background, one would expect that ensuring that women and girls have a clean, safe, and appropriate way to manage their menstrual blood; which includes obtaining feminine hygiene products, the capture of the blood, changing and discarding of the feminine hygiene product, would be consider an imperative for any society that would like to control the spread of infectious disease.
Those who have the greatest hardship when it comes to dealing with their periods in a hygienically-sound manner, are homeless women, as well as other women dealing with economic hardship, who may try to prolong the wear of a particular product, and in doing so would put themselves at risk for infections, such as toxic shock syndrome, and diseases such as cervical cancer. If one cannot afford maxi pads or tampons, and have to prioritize food and/or shelter over these products, that leaves them with few options.
Demands & Next Steps
Ultimately, the cost and thus accessibility of products that slightly more than half of the world’s population needs multiple times a day, every month, for 30 -35 years on average, is simply too much, and represents a human rights and public health problem. These products have erroneously been classified as luxuries, by systems of government that continue to be male-dominated, meaning that those who have made this critical decision, have never experienced a period and have no understanding of the importance and value of these products. They obviously do not realize that sanitary products are vital women and girls full participation in society. Further, these governments do not recognize that feminine hygiene and menstrual care are health issues, and should be treated as such. Again, the problem has much to do with patriarchy and male-dominated houses of government and political pundits, such as Rush Limbaugh, who openly mocks and attempt to discredit women’s health issues that deal with access to products; whether it be sanitary products or birth control; and who can forget Republican presidential candidates comments lashing out at Debate moderator, Megan Kelly, claiming that she ” got blood coming out of her wherever“. Fortunately, almost all employers are now required to pay for contraception in their health plans, under the A ffordable Health Care Act’s provision that preventive services must be covered. Before this change in regulation, women had to literally cover the costs of preventing pregnancies and pay to have sex, while many insurance plans covered sexual enhancement products such Viagra; allowing men to have more sex than they were naturally able to perform on their own.
Unfortunately, there is this lack of understanding and willingness to make the necessary policy reforms, even when The United Nations and Human Rights Watch have linked menstrual hygiene to human rights. What more do must women and girls do, to convince the other half of the world’s population that sanitary products are indeed a necessity? The truth of the matter is that we shouldn’t have to convince men about the importance and human rights implications of access to feminine hygiene products, because those who will not have to endure 30+ years of periods, should not be allowed to vote or decide upon what is best for those of us who have to.
When it comes to availability of feminine sanitary products, in order to uphold health, wellness, human dignity, and gender equality; the following demands must be made:
Make all feminine sanitary products sales tax-exempt.
Classify feminine sanitary products as tax-deductible medical care products.
Amend the IRS Tax Code to list menstrual products as being eligible for Flexible Spending Account allowances.
Incarcerated prisoners must be provided with a free and adequate supply of sanitary products. Access to these items should not depend on whether they have the means to purchase them at the prison commissary.
Expand the federal Supplemental Nutrition Assistance Program (SNAP) and Women, Infants, and Children (WIC) programs to include feminine hygiene products.
If taxes are going to be charged, then they should only go to support social programs that benefit women and girls; and full disclosure of the monies collected and distributed should be carried out.
Food banks and homeless shelters should provide feminine sanitary products; as part of their general services.
Free sanitary products should be made available on school campuses, university women’s health centers, and at the job site, for female employees who find themselves having an “emergency situation”.
Hotels should consider leaving complimentary sanitary products, right along with the soap, shampoo, body lotion, etc.
1. Freud, S. The social construction of gender. Journal of Adult Development. 1994; 1(1):37-45))
2. Gur, RE. Gur RC. Gender differences in aging: cognition, emotions, and neuroimaging studies.Dialogues of Clin. Neuroscience. 2002 Jun; 4(2): 197-210. PMCID: PMC3181676
3. Parker BA, Kalasky MJ, Proctor DN. Evidence for sex differences in cardiovascular aging and adaptive responses to physical activity. Eur J. Appl Physiol. 2010 Sept. 110(2):235-246. PMCID: PMC2929283. doi: 10.1007/s00421-010-1506-7.
4. Kro-Giefing C, Berger P., Lepperdinger G., Grubeck-Lobenstein B. How sex and age affect immune responses, susceptibility to infections, and response to vaccination. Aging Cell. 2015; 14:309-321. Doi: 10.1111/acel.12326
5. Chebii S. Menstruation and Education: How a lack of sanitary towels reduces school attendance in Kenyan slums. Open Society Initiative for Southern Africa. 2012.http://www.osisa.org/buwa/regional/menstruation-and-education-how-lack-sanitary-towels-reduces-school-attendance-kenyan-s
6. Jewitt S., Ryley H. It’s a girl thing: Menstruation, school attendance, spatial mobility and wider gender inequalities in Kenya. Geoforum. 2014; 56:137-147. doi:10.1016/j.geoforum.2014.07.006
7. Mara D., Lane J., Scott B., Trouba D. Sanitation and health. PLoS Med. 2010 Nov; 7(11): e1000363. PMCID: PMC2981586. doi: 10.1371/journal.pmed.1000363