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Open Access 01-12-2024 | COVID-19 | Research

Menstruating while homeless: navigating access to products, spaces, and services

Authors: Andrea L. DeMaria, Rebecca Martinez, Emily Otten, Emma Schnolis, Sofia Hrubiak, Jaclyn Frank, Risa Cromer, Yumary Ruiz, Natalia M. Rodriguez

Published in: BMC Public Health | Issue 1/2024

Abstract

Background

People experiencing homelessness (PEH) in the United States face substantial challenges related to menstruation, exacerbated by the COVID-19 pandemic. Limited access to period products, heightened stigma, and gynecological challenges contribute to increased hardships for PEH, highlighting the need for improved services and policies to address period equity and overall well-being for this vulnerable population.

Methods

We conducted semi-structured qualitative interviews with PEH (n = 12) and community healthcare and social service providers (e.g., case managers, shelter directors, community health workers, and nurses, n = 12) in Lafayette, Indiana, a city located between Indianapolis and Chicago in the United States. We used thematic analysis techniques for data analysis.

Results

PEH’s limited access to products, services, and safe spaces hindered effective menstruation management within restrictive community contexts. Although community healthcare and service providers offered some support, complex interactions with the healthcare system, stigma, and limited access to spaces exacerbated barriers. The COVID-19 pandemic further intensified these difficulties by closing public spaces, worsening economic conditions, and straining service provider resources.

Conclusions

Results highlight critical organizational and policy gaps in the United States for menstruation management resources and services, emphasizing the need for better integration into health and well-being programs for PEH. These insights will advance reproductive and public health research, shedding light on the disparities faced by PEH in managing menstruation in Indiana and contributing to the national discourse on addressing these barriers. Amid the complex landscape of public health, particularly during and after the pandemic, prioritizing menstrual health remains essential for all individuals’ overall well-being, including those experiencing homelessness.

De Bode L, Hygiene. and heartache: Homeless women’s daily struggle to keep clean [Internet]. Al Jazeera America. [cited 2021 Mar 4]. Available from: http://america.aljazeera.com/articles/2015/1/13/-scared-to-walk-thestreet.html

Upadhye J. This Is How Homeless Women Cope With Their Periods [Internet]. Bustle. 2017. Available from: https://www.bustle.com/articles/190092-this-is-how-homeless-women-cope-with-their-periods

Weiss-Wolf J, Epstein-Norris L. Blood In The Streets: Coping with Menstruation While Homeless [Internet]. HuffPost. 2017. Available from: https://www.huffpost.com/entry/blood-in-the-streets-menstruation-homelessness_b_9019638

Moore L. What It’s Like to Get Your Period When You’re Homeless [Internet]. Cosmopolitan. 2015. Available from: https://www.cosmopolitan.com/sex-love/news/a47596/what-its-like-to-get-your-period-when-youre-homeless/

Mitchell MK, Ramsey LR, Nelson S. The Body Image of Women at a Homeless Service Center: An Analysis of an Underrepresented, Diverse Group. Gend Issues [Internet]. 2018 [cited 2021 Mar 4];35:38–51. Available from: http://link.springer.com/https://doi.org/10.1007/s12147-017-9192-y

McNamara B. How Periods Perpetuate Homelessness [Internet]. Teen Vogue. 2017. Available from: https://www.teenvogue.com/story/homelessness-and-periods

Goldberg E. For Homeless Women, Getting Their Period Is One Of The Most Difficult Challenges [Internet]. HuffPost. 2015. Available from: https://www.huffpost.com/entry/homeless-women-tampons_n_6465230

Little A. When you’re homeless and menstruating [Internet]. Ms. Magazine. 2015. Available from: https://msmagazine.com/2015/09/08/when-youre-homeless-andmenstruating/

Meadows-Fernandez R. Getting your period can be a pain. Getting it while homeless is even worse [Internet]. Yes Magazine. 2017. Available from: https://www.yesmagazine.org/democracy/2017/07/27/getting-your-periodcan-be-a-pain-getting-it-while-homeless-is-even-worse/

10.

2016 AHAR. Part 1 - PIT Estimates of Homelessness in the U.S. - HUD Exchange [Internet]. [cited 2021 Mar 4]. Available from: https://www.hudexchange.info/resource/5178/2016-ahar-part-1-pit-estimates-of-homelessness/

11.

National Alliance to End Homelessness. State of Homelessness: 2020 Edition [Internet]. Available from: https://endhomelessness.org/homelessness-in-america/homelessness-statistics/state-of-homelessness-2020/

12.

Stewart N. ‘It’s a Time Bomb’: 23 Die as Virus Hits Packed Homeless Shelters [Internet]. The New York Times. 2020. Available from: https://www.nytimes.com/2020/04/13/nyregion/new-york-coronavirus-homeless.html

13.

Fuller T. Coronavirus Outbreak Has America’s Homeless at Risk of Disaster [Internet]. The New York Times. 2020. Available from: https://www.nytimes.com/2020/03/10/us/coronavirus-homeless.html

14.

Wood LJ. Homelessness: the imperative for a public health response. Aust N Z J Public Health. 2020;44:341–5.CrossRefPubMed

15.

Rodriguez NM, Lahey AM, MacNeill JJ, et al. Homelessness during COVID-19: challenges, responses, and lessons learned from homeless service providers in Tippecanoe County, Indiana. BMC Public Health. 2021;21:1657.CrossRefPubMedPubMedCentral

16.

Rodriguez NM, Martinez RG, Ziolkowski R, et al. COVID knocked me straight into the dirt: perspectives from people experiencing homelessness on the impacts of the COVID-19 pandemic. BMC Public Health. 2022;22:1327.CrossRefPubMedPubMedCentral

17.

Rodriguez NM, Cromer R, Martinez RG, et al. Impact of COVID-19 on people experiencing homelessness: a call for critical accountability. Am J Public Health. 2022;112:828–31.CrossRefPubMedPubMedCentral

18.

Crawford BJ, Waldman EG. Period poverty in a pandemic: Harnessing Law to Achieve Menstrual Equity. Washington University Law Review, Forthcoming.

19.

Durfor SL. Personal Hygiene Self-Management of Chronically Unsheltered Homeless Women [Internet] [These and Dissertations. 870.]. University of Wisconsin-Milwaukee; 2015. Available from: https://dc.uwm.edu/etd/870

20.

Wenzel SL, Andersen RM, Gifford DS et al. Homeless Women’s Gynecological Symptoms and Use of Medical Care. Journal of Health Care for the Poor and Underserved [Internet]. 2001 [cited 2021 Mar 4];12:323–341. Available from: http://muse.jhu.edu/article/269790

21.

Sommer M, Gruer C, Smith RC, et al. Menstruation and homelessness: challenges faced living in shelters and on the street in New York City. Health Place. 2020;66:102431.CrossRefPubMed

22.

Henderson Riley A, Slifer L, Hughes J, et al. Results from a literature review of menstruation-related restrictions in the United States and Canada. Volume 100537. Sexual & Reproductive Healthcare; 2020.

23.

Ensign J DrPH. Reproductive Health of Homeless Adolescent Women in Seattle, Washington, USA. Women Health. 2001;31:133–51.CrossRef

24.

Sebert Kuhlmann A, Peters Bergquist E, Danjoint D, et al. Unmet Menstrual Hygiene needs among low-income women. Obstet Gynecol. 2019;133:238–44.CrossRefPubMed

25.

Levit R. Waiting and Menstruation: A Look at Homeless and At-Risk Women’s Experiences. Anthropology [Internet]. 2017; Available from: https://scholarsarchive.library.albany.edu/honorscollege_anthro/13

26.

Olson MM, Alhelou N, Kavattur PS, et al. The persistent power of stigma: a critical review of policy initiatives to break the menstrual silence and advance menstrual literacy. PLOS Glob Public Health. 2022;2:e0000070.CrossRefPubMedPubMedCentral

27.

Maroko AR, Hopper K, Gruer C et al. Public restrooms, periods, and people experiencing homelessness: An assessment of public toilets in high needs areas of Manhattan, New York. PLOS ONE. 2021;16:e0252946.

28.

Hennegan J, Winkler IT, Bobel C, et al. Menstrual health: a definition for policy, practice, and research. Sex Reproductive Health Matters. 2021;29:31–8.CrossRef

29.

Loates M, Walsh CA. Women negotiating sexual identity in the face of homelessness: from silence to satisfaction. Cult Health Sex. 2010;12:87–101.CrossRefPubMed

30.

Phillips-Howard PA, Hennegan J, Weiss HA, et al. Inclusion of menstrual health in sexual and reproductive health and rights. Lancet Child Adolesc Health. 2018;2:e18.CrossRefPubMed

31.

Pediatrics AA of, Adolescence C et al. on, Gynecologists AC of O. Menstruation in Girls and Adolescents: Using the Menstrual Cycle as a Vital Sign. Pediatrics. 2006;118:2245–2250.

32.

Grady D. Management of menopausal symptoms. N Engl J Med. 2006;355:2338–47.CrossRefPubMed

33.

Cotropia CA. Menstruation Management in United States schools and implications for attendance, academic performance, and health. Women’s Reproductive Health. 2019;6:289–305.CrossRef

34.

Williams D. State lawmaker wants to get rid of Indiana’s tampon tax [Internet]. WISH-TV| Indianapolis News| Indiana Weather| Indiana Traffic. 2020 [cited 2020 Mar 9]. Available from: https://www.wishtv.com/news/state-lawmaker-wants-to-get-rid-of-indianas-tampon-tax/

35.

ABC News. Purdue University to offer free tampons, pads in bathrooms [Internet]. ABC News. 2020 [cited 2020 Mar 9]. Available from: https://abcnews.go.com/Health/wireStory/purdue-university-offer-free-tampons-pads-bathrooms-68830268

36.

Bangert D. Purdue University agrees to put free tampons in campus restrooms [Internet]. USA Today. 2020 [cited 2020 Mar 9]. Available from: https://www.usatoday.com/story/news/education/2020/02/08/purdue-university-agrees-put-free-tampons-campus-restrooms/4696924002/

37.

West Lafayette to Offer Free Tampons. Pads in City Restrooms [Internet]. US News & World Report. 2020 [cited 2021 Mar 4]. Available from: https://www.usnews.com/news/best-states/indiana/articles/2020-03-08/west-lafayette-to-offer-free-tampons-pads-in-city-restrooms

38.

Asmelash L, Ries B. Boston schools will offer free menstrual supplies for students starting this fall [Internet]. CNN Health. 2019 [cited 2020 Mar 4]. Available from: https://www.cnn.com/2019/06/17/health/bps-free-menstrual-products-trnd/index.html

39.

Calfas J. More states consider free tampons in school bathrooms. Wall Street Journal [Internet]. 2020 [cited 2020 Mar 4]; Available from: https://www.wsj.com/articles/more-states-consider-free-tampons-in-school-bathrooms-11582626601

40.

Lam K. New Hampshire passes bill to provide free tampons, other menstrual products in public schools [Internet]. USA TODAY. 2019 [cited 2020 Mar 4]. Available from: https://www.usatoday.com/story/news/nation/2019/07/17/new-hampshire-menstruation-period-products-schools-students/1762459001/

41.

Jackson-Figueroa H. Hey, sister, can you spare a tampon? Establishing a campus menstrual hygiene management pantry. American Public Health Association; 2018 [cited 2020 Mar 4]. Available from: https://apha.confex.com/apha/2018/meetingapp.cgi/Paper/422208

42.

McConnell J. Period power policies happening around the nation! [Internet]. Women’s Voices for the Earth. 2019 [cited 2020 Mar 4]. Available from: http://www.womensvoices.org/2019/04/29/period-power-policies-happening-around-the-nation/

43.

Sommer M. An overview of menstrual hygiene management (MHM): A multi-sectoral approach to addressing girls’ and women’s menstruation-related needs. American Public Health Association; 2018 [cited 2020 Mar 4]. Available from: https://apha.confex.com/apha/2018/meetingapp.cgi/Paper/423779

44.

Toory L, Unhoused. and Menstruating: How Policies Can Help Eternally [Internet]. PERIOD. 2023 [cited 2024 Jan 17]. Available from: https://medium.com/periodmovement/unhoused-and-menstruating-how-policies-can-help-eternally-ab7385bd3a99

45.

Vora S et al. The Realities of Period Poverty: How Homelessness Shapes Women’s Lived Experiences of Menstruation. In: Bobel C, Winkler IT, Fahs B, editors. The Palgrave Handbook of Critical Menstruation Studies [Internet]. Palgrave Macmillan; 2020 [cited 2020 Aug 3]. Available from: https://www.palgrave.com/gp/book/9789811506130

46.

Gruer C, Hopper K, Smith RC, et al. Seeking menstrual products: a qualitative exploration of the unmet menstrual needs of individuals experiencing homelessness in New York City. Reproductive Health. 2021;18:77.CrossRefPubMedPubMedCentral

47.

Porter NAC, Brosnan HK, Chang AH, et al. Race and ethnicity and sex variation in COVID-19 mortality risks among adults experiencing homelessness in Los Angeles County, California. JAMA Netw Open. 2022;5:e2245263.CrossRefPubMedPubMedCentral

48.

ElBanna B, Dell NA, Klier M. Menstrual Hygiene Management among Homeless Women with Mental Illness in St. Louis Metropolitan Area: a qualitative study. Women’s Reproductive Health. 2022;0:1–17.

49.

Sommer M, Hirsch JS, Nathanson C, et al. Comfortably, safely, and without shame: Defining Menstrual Hygiene Management as a Public Health Issue. Am J Public Health. 2015;105:1302–11.CrossRefPubMedPubMedCentral

50.

Homeless Research Institute. Population At-Risk: homelessness and the COVID-19 Crisis. National Alliance to End Homelessness.

51.

Boden L, Wolski A, Rubin AS, et al. Exploring the barriers and facilitators to menstrual hygiene management for women experiencing homelessness. J Occup Sci. 2021;0:1–16.

52.

Rodriguez NM, Ziolkowski R, Hicks J et al. Infectious Disease Preparedness for Homeless Populations: Recommendations from a Community-Academic Partnership| Progress in Community Health Partnerships: Research, Education, and Action. 2023 [cited 2023 Aug 10]; Available from: https://preprint.press.jhu.edu/pchp/preprints/infectious-disease-preparedness-homeless-populations-recommendations-community-academic

53.

Morgen S, Maskovsky J. The Anthropology of Welfare Reform: New Perspectives on U.S. Urban Poverty in the Post-Welfare Era. Annual Review of Anthropology [Internet]. 2003 [cited 2020 Nov 29];32:315–338. https://doi.org/10.1146/annurev.anthro.32.061002.093431

54.

Susser I. The Construction of Poverty and Homelessness in US Cities. Annual Review of Anthropology [Internet]. 1996 [cited 2020 Nov 29];25:411–435. Available from: http://www.jstor.org/stable/2155833

55.

Clarke V, Braun V. Thematic analysis. J Posit Psychol. 2017;12:297–8.CrossRef

56.

Alhelou N, Kavattur PS, Olson MM, et al. Menstruation, myopia, and marginalization: advancing menstrual policies to keep girls in School at the risk of exacerbating inequalities. Health Hum Rights. 2022;24:13–28.PubMedPubMedCentral

57.

Corey E, Frazin S, Heywood S, et al. Desire for and barriers to obtaining effective contraception among women experiencing homelessness. Contracept Reproductive Med. 2020;5:12.CrossRef

58.

Ballard AM, Hoover AT, Rodriguez AV, et al. Emphasizing choice and autonomy in Personal Hygiene, Menstrual Health, and sexual health product distribution to people experiencing homelessness in Atlanta, Georgia during COVID-19. Health Promot Pract. 2021;22:764–6.CrossRefPubMed

59.

Crenshaw K. Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory and Antiracist Politics. U, Chi Legal F. 1989;1989:139.

60.

Duke University Press. - Decolonizing Ethnography [Internet]. [cited 2021 Mar 7]. Available from: https://www.dukeupress.edu/decolonizing-ethnography

61.

Crawford B. Tampon Taxes, Discrimination, and Human Rights. Pace Law Faculty Publications [Internet]. 2017; Available from: https://digitalcommons.pace.edu/lawfaculty/1070

62.

Casola AR, Luber K, Riley AH, et al. Menstrual Health: taking Action against Period Poverty. Am J Public Health. 2022;112:374–7.CrossRefPubMedPubMedCentral

63.

Guest G, Bunce A, Johnson L. How many interviews are Enough? An experiment with data saturation and variability. Field Methods. 2006;18:59–82.CrossRef

Title: Menstruating while homeless: navigating access to products, spaces, and services
Authors: Andrea L. DeMaria
Rebecca Martinez
Emily Otten
Emma Schnolis
Sofia Hrubiak
Jaclyn Frank
Risa Cromer
Yumary Ruiz
Natalia M. Rodriguez
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: COVID-19
Public Health
Published in: BMC Public Health / Issue 1/2024
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-024-18379-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Menstruating while homeless: navigating access to products, spaces, and services

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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