“Period Poverty”: A Crisis for American Girls

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Tom Haederle
For teenage girls, having access to period products is essential. Without them, they can miss school, be humiliated and experience health problems. Unfortunately, girls across America face what is known as period poverty, and they're suffering in silence. Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. Kathy Cummings, former communications director at the American Hospital Association, is joined by Dr. Angela Hawkins, an obstetrics and gynecology specialist at SSM Health St. Anthony in Oklahoma City, and Lindse Barks, executive director at Mid-Del Public Schools Foundation.

00;00;58;07 - 00;01;03;27
Tom Haederle
Their discussion addressing period poverty and its serious impact on school age girls.

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Kathy Cummings
Dr. Hawkins and Lindse, thank you so much for joining me today to talk about what I find just extremely fascinating that's still happening in this country, this period poverty. You know, I host quite a few podcasts and covering a lot of different topics. But this one really hit me hard when we hear about some of the challenges that young girls are facing during very critical times of their life.

00;01;34;22 - 00;01;49;22
Kathy Cummings
So I just want to thank you for joining me and bringing this topic to our attention. I really appreciate having both of you here. So, Dr. Hawkins, let's start with you. Tell me a little bit about your role at SSM Health, St. Anthony.

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Angela Hawkins
I'm an obstetrician gynecologist at St. Anthony's. I've been in private practice for about 11 years. I've just recently switched over to being what we call a hospitalist, where I work strictly in the hospital with women who are admitted or being evaluated at the hospital itself.

00;02;07;03 - 00;02;10;26
Kathy Cummings
And, Lindse, tell me about yourself, your role in your organization.

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Lindse Barks
Hi. Thanks for having us, Kathy. Any chance we have to talk about period poverty I really appreciate it. So my name is Lindse Barks, I've been the executive director for the Mid-Del Public Schools Foundation for about five years now. The Mid-Del Public Schools Foundation exists to support Mid-Del Public Schools. We are the only entity that solely exists to support every Mid-Del teacher and every Mid-Del student.

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Kathy Cummings
Well, Lindse let's start with you. What is period poverty and when was the first time you became acutely aware of it?

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Lindse Barks
So to really simplify it, period poverty means families or individuals who do not have access to period products. That's the bare bones of it, is that. I had no idea, period poverty. I didn't know the terminology. I didn't know it was a thing until about two and a half years ago when I attended a grant check ceremony.

00;03;03;05 - 00;03;22;18
Lindse Barks
We had written a grant to a local organization, Junior Service League of Midwest City, and I was going to pick up a check for that grant. And when I was there, there were two teachers from one of our high schools, Del City High School, that they had also been awarded funds for their Sisterhood Project. And that was the very first time that I had heard the term period poverty.

00;03;22;26 - 00;03;35;10
Lindse Barks
And to be honest, I was blown away. I had no idea that this was something that existed and I didn't know the impact it was having on our students at Del City High School or in our district, for that matter.

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Kathy Cummings
When SSM Health St. Anthony brought this topic to my attention, I too had to Google search it. I wasn't aware of exactly what it is and how it is affecting young girls’ lives, how it's spreading. The awareness is low. Why is that? Is it being shunned by the news, the mainstream media? Is it not part of the social media kind of trending conversations?

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Lindse Barks
To answer this, I think it's twofold. I think one, I think it's just the lack of education. It's lack of knowing it exists.  I've been a menstruator for the majority of my life since I was 13. And the idea of not having access to what I needed has never been an issue. It's never something I've thought about.

00;04;23;07 - 00;04;43;25
Lindse Barks
And so I think part of it, it's just lack of knowledge, lack of education, of talking about it. And I think also there is still a stigma that is wrapped up in periods. Women have been taught that it's embarrassing. We don't talk about it. We sneak pads and tampons next to each other because nobody can see that we have to have a tampon.

00;04;44;03 - 00;05;02;11
Lindse Barks
We're not going to talk about it openly because it's something that we've almost been ingrained to be ashamed of. And that's a huge mistake I feel like we've made as a society. And I hope that talking about period poverty and talking about these things that we can teach this younger generation, that having a period is nothing to be embarrassed or ashamed about.

00;05;03;08 - 00;05;26;11
Kathy Cummings
Yeah, that was the first thing that came to mind for me too. I mean, I immediately thought about these young girls and, like you said, feeling embarrassed, not having a voice. Those who are most affected by period poverty, you know, keeping all of those feelings inside, you know, how difficult that must be. And Dr. Hawkins, can you share some of the facts that make this a national health issue?

00;05;27;06 - 00;05;56;20
Angela Hawkins
So in the United States, girls start having their periods around the ages of 10 to 15, sometimes even as young as 8 to 9 years old. So that's most starting having their periods in middle school. So if you add up all the days and years that someone has their period throughout their lifetime, that adds up to up to 8 to 9 years total of a person's life that's spent menstruating, so that’s 8 to 9 years, having a period within your lifetime.

00;05;57;08 - 00;06;22;10
Angela Hawkins
And menstrual products are expensive. They're taxed at higher rates. They're considered a luxury item or what some call a tangible individual property. Are not included in government benefits like SNAP or food stamps. In a national survey, it was reported that one to five girls struggle to afford period products and four in five missed school because they didn't have access to period products.

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Angela Hawkins
So nationally, it's a big deal when you think about the fact that four in five girls miss school at least once a month because they don't have access to period products. It can cause physical, mental and emotional distress like we talked about before. It can cause shame and depression or anxiety surrounding periods. Young women experiencing period poverty have higher rates of depression than young women who don't have to worry about those kind of things.

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Angela Hawkins
People unable to access products may use their products that are not recommended, like old rags, paper towels and newspapers even. And some will use their products longer than recommended because they don't have enough. And so they want to extend the amount of time that they're able to use the products that they do have. And that can lead to health risks like infection, irritation, even something as serious as something called toxic shock syndrome, which can be life threatening.

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Angela Hawkins
So it's not just an issue of not having products. It causes lots of broader implications.

00;07;24;02 - 00;07;48;01
Kathy Cummings
You know, those data points are staggering when I think about so many of us just take it for granted, right. That the education around menstruation and periods is there and that access to period products is there. And then when you do hear those stats, you know, it really is mind blowing. So tell me about some of the conversations that you've been having with young girls who are affected by this in your communities.

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Kathy Cummings
What are they telling you? What are they saying?

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Angela Hawkins
In Oklahoma between the ages of 12 to 44, one in five women are below the poverty line. And that's just in Oklahoma. So like we talked about, it can cause physical and emotional changes in addition to concerns for depression and health issues and missing school. Young girls talk about the fact that it affects their grades when they miss school.

00;08;12;05 - 00;08;36;13
Angela Hawkins
Older students may miss work, which then affects the income that makes them able to buy those products. Some students even drop out of school due to embarrassment or in order to work and be able to afford the things they need to do. And let's not forget, we still have a homeless teen population who struggle with access to products and toilets and showers and just being able to clean themselves up.

00;08;37;02 - 00;08;57;18
Angela Hawkins
And so we have all types of girls who come in discussing issues with periods. Who come in, asking, how can I just stop having periods all together? This is something I can't deal with every month and still be able to do school and work. It affects when you think about this happening every month, and for some girls it can be as little as three days.

00;08;57;18 - 00;09;08;29
Angela Hawkins
But for some girls that can be as long as ten days to even two weeks. So when you think about that, every month for these young women, it is a huge issue for them.

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Kathy Cummings
Lindse, tell me about what you're hearing and seeing in the schools and what is the role that teachers are playing?

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Lindse Barks
Oh, that's a great question. So when we first when I first heard about period poverty, the teachers at Del City said that the way that they noticed there was a problem is that they noticed that there were students on average per month were missing two to three days per month just because they didn't have access to period products.

00;09;34;21 - 00;10;05;00
Lindse Barks
And that's when they started asking for donations and stocking. They had one bathroom that they would stock with period products for those students. Missing two to three days at a time every month. Like how far behind can somebody fall and how hard is it to catch up, to get picked back up? And then we had there was a there was a TikTok that a teacher at Oklahoma City public schools videoed that they left their classroom and they walked to the front office, got a period product and then went back to their classroom.

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Lindse Barks
It took eight minutes to walk one way to the office to get a period product. So eight minutes one way. And then you go to the bathroom and then you walk back to your student. So you can miss anywhere from 20 to 30 minutes of one class. And classes range from 40 to 50 minutes per day. So, I mean, we're talking about a lot of missed class time that students are falling behind.

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Lindse Barks
And while period poverty specifically talks about students that can't afford products, what about the students that can afford it? But they started early or they started unexpectedly, or they just forgot to put their products in their bag? Because I qualify as that. Like I've been caught several times in my lifetime without the products that I've needed. So not having access to it, well, maybe they can afford it, but they don't have it with them.

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Lindse Barks
That's another impact that we've seen with our students.

00;10;57;22 - 00;11;18;14
Kathy Cummings
And that eight-minute walk. You know, you think about, you know, again, a young girl hoping not to be embarrassed. What if people know, you know, I mean, all those feelings that they could be feeling during that time when they're unprepared, unready, and not sure what to expect as they're trying to, you know, get that access to those period products.

00;11;18;24 - 00;11;32;15
Kathy Cummings
I was so excited then to hear about this incredible partnership between SSM Health and the Mid-Del Public Schools Foundation. So tell me about that. How did you guys meet and come together to address this issue?

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Lindse Barks
So this whole program, I feel like if everything just aligned like the stars aligned at every part for this program. So when I had learned about the Del City Sisterhood Project, immediately I said this is something that the foundation can help champion. We can come in and we can make an impact right now. What do we need to do to see this go district wide?

00;11;54;12 - 00;12;17;14
Lindse Barks
Del City has got a great handle on it. How do I get it at all of our schools? And initially I was just thinking secondary high school and middle school because I was under the misconception that most of our students were in middle school before they started their period. Like Dr. Hawkins said, that's not the case. I actually learned that over 50% of Mid-Del students will have started their period before they leave elementary.

00;12;17;21 - 00;12;36;21
Lindse Barks
50% of our girls. That was staggering to me. I had no idea that so many of our students were leaving the fifth grade, having already started their period. So I knew this was going to be a district-wide initiative. And so I partnered up with a couple of women organizations and the community to do a small fundraiser. I said, okay, let's start small.

00;12;36;21 - 00;12;53;24
Lindse Barks
Let's see how long this is going to take us. And we kind of did the math of, you know, because we have other programs that the foundation we have to fund. And so I knew that a little bit at a time. Slow and steady wins the race. And so my timeline was five to 10 years, we would have dispensers in every bathroom.

00;12;53;24 - 00;13;21;18
Lindse Barks
That that was my goal was to have it done within five to 10 years. A few weeks later, I was part of a group with the Midwest City Chamber of Commerce for leadership in Midwest City, and we got to tour SSM Health St. Anthony's in Midwest City. They had purchased Midwest City Hospital about a year or so ago and we were excited to see the changes that were taking place. In that we learned about SSM health, their commitment not just to the hospital but to the community of Midwest City.

00;13;21;18 - 00;13;39;21
Lindse Barks
And they talked about how they want to come in and they want to invest in their community and they want to make a difference. And the light bulb went off like, oh, I've got a great project for you. Let me tell you about what we're doing with period poverty. And every meeting that I had with the different executives and the different the marketing teams at SSM Health, they all jumped on it.

00;13;39;21 - 00;14;00;18
Lindse Barks
They said, this is fantastic. It's something we didn't know what was a problem, and we know that we can help make this happen. So between talking with SSM Health and talking with our district, our superintendent said if the foundation can provide the dispensers, the district will provide the period products, we'll keep them stocked. And so that was kind of what we came up with SSM Health.

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Lindse Barks
And they gave us a grant for right under $38,000 to purchase 207 dispensers to go in every bathroom across the district. So every site in our district has dispensers and we're talking at our performing arts centers, our field houses, at our football stadiums like we've got on all of our high traffic areas. And so for our secondary locations we have tampons and pads available because we want our students to feel that we have what they what they need and what they want.

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Lindse Barks
And then at our elementary locations, we have in our fourth and fifth grade hallways, pad dispensers. So they've only got access to pads. But we want our students to have access to what they want. And all of our products are organic and so they're healthy and they're comfortable. And we worked with Aunt Flo, which is a great company to buy our products from.

00;14;52;16 - 00;15;10;14
Lindse Barks
And they also they look cute and trendy. And so our students feel, we want them to feel valued. We're not buying the bottom of the barrel products. We're not getting the cheapest products we can find. While Aunt Flo is absolutely affordable and it's maintainable for us, we wanted them to know that we value them and that they're worth the investment.

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Kathy Cummings
That's wonderful. And Dr. Hawkins, tell me a little bit about how you personally got involved and do you see this program expanding beyond the schools and the school facilities you mentioned, you know, the issue among homeless people. How can we get more products out there?

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Angela Hawkins
Well, and that's a big part of period poverty is that it's great that we're focusing on elementary school and middle school, but we do have other populations that have issues. College students struggle to afford period products. They're just trying to buy their books and get lunch and dinner and pizza occasionally. So college students are struggling. So this is something that I think could be expanded to our colleges in the state.

00;15;56;11 - 00;16;28;14
Angela Hawkins
Incarcerated women. There are 38 states, including Oklahoma, who have no laws requiring period products to inmates. And so this is a much broader picture that we're looking at. And it's going to take a lot of normalizing the conversations around periods and for people to start realizing that this is an issue that spans a woman's lifetime. And these are things that we need to start looking at to figure out how we can help improve access for all women, young girls and women.

00;16;29;08 - 00;16;51;24
Kathy Cummings
So let's start with you, Dr. Hawkins, and we'll throw it to Lindse. Based on that, what do you think needs to happen to put not just a bigger kind of community spotlight on this topic, but a national spotlight on this topic? You know, how can we help increase awareness and the support and resources that need to come along with that?

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Angela Hawkins
We've got to what she talked about earlier. We've got to start reducing the stigma and shame associated with periods in general. People need to feel comfortable having these conversations and talking about this topic. And then we need to start some nationwide campaigns that actually start talking about these issues like we talked about at the beginning. A lot of people just don't think about this being an issue because a lot of people haven't had to actually deal with it.

00;17;20;22 - 00;17;47;01
Angela Hawkins
And so normalizing the conversation, getting the word out, educating the public that this is an issue. Other countries have already starting addressing it. It's time that we do as well. And then figuring out ways that we can build programs within our states to help tackle this issue. We have three bills in the Oklahoma legislature this year to discuss period poverty, and unfortunately two have already failed.

00;17;47;21 - 00;18;05;01
Angela Hawkins
So again, it's a matter of starting the conversation, getting people to talk about it more, and then talking with our legislators about it so that they understand the importance of this. The fact that two of our bills already failed is a sign that we are not doing a good job of letting them know why this is such a critical issue.

00;18;05;23 - 00;18;15;02
Kathy Cummings
Right, Right. Yeah. Lots of stakeholders need to get involved and invest and support this. And Lindse, any additional thoughts from your perspective?

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Lindse Barks
Just to echo what Dr. Hawkins was saying, we need to normalize this conversation. I will say all the different programs and projects that the foundation has done since 1989 when we were first established, this has been the most positive feedback we've gotten. There hasn't been a single negative thing. And that happens when you do things, you always find the negatives or you find somebody that wants to complain or that they aren't happy.

00;18;40;12 - 00;19;00;14
Lindse Barks
But that hasn't been the case with this program, and it's because, for starters, periods aren’t political. It's not a political thing. It is an everyday thing that we face and we have to come together to help fight this epidemic that we're facing. We've got students that are facing these issues and it's a problem that we can make a difference in.

00;19;00;14 - 00;19;17;19
Lindse Barks
There's a lot of things that we can't, we don't have an impact. I can't do anything about the teacher shortage and I can't do anything about the bus driver shortage. But this is something that the foundation can step in and we can do, this is something that our community can step up and we can end this problem. Keep having those conversations and contacting our legislators.

00;19;17;27 - 00;19;36;27
Lindse Barks
I've been overwhelmed with the positive feedback that we've gotten. And one thing that I hear over and over again, it's something that you've said more than once Kathy, I had no idea. I had no idea this was a problem. And the women in our community have come out in full force to support our students in our district. They have donated money, they've donated products.

00;19;36;27 - 00;19;48;09
Lindse Barks
They've said, how can we help? And then they brought their friends along to do the same. So the more we talk about it, the more we can spread the word and make people aware and the more, the bigger impact we can make together.

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Kathy Cummings
So we have a pretty broad audience of these podcast episodes. You know, you have an opportunity to speak to hospital and health system leaders, to health care professionals across the field, to policymakers, to community groups and leaders to the general public. What do you most want to say to them right now? And where can they go for more information?

00;20;12;29 - 00;20;37;24
Lindse Barks
It's a great question. I think just to keep it going, let's get rid of the stigma. Let's have these conversations. What you can do right now is buy a package of period products and donate it to your local shelter or to a school. We've got a great nonprofit that has been around for about two years in Oklahoma, and it's Period OKC and all they do is collect donations of period products and then donate it in different areas.

00;20;38;14 - 00;21;01;18
Lindse Barks
70% of what requests that they get are from schools. So the need is there. So you can do something immediately by buying and donating it. You can also help by contacting our legislators. This is something that we can actually do something about, like we can actually make an impact and we can do it right now. You know, I said I thought it would take us 5 to 10 years to reach our goal.

00;21;01;18 - 00;21;21;25
Lindse Barks
But but thanks to SSM Health St. Anthony's, we did it in six months. In six months we essentially ended period poverty in Mid-Del within our schools because students have access to period products whenever they need them. And then they also can take them home with them over breaks. I'm really proud of that, but I feel like it's just the start in Oklahoma.

00;21;21;25 - 00;21;34;06
Lindse Barks
It's just the start in our community because like Dr. Hawkins said, we've got homeless and we've got our colleges. So it's just the beginning. So let's keep the ripple effect going. Let's keep having these conversations.

00;21;35;03 - 00;21;56;10
Kathy Cummings
Well, I can't thank you both enough for bringing this issue to the forefront, having this conversation with us and doing the great work that you're doing and you're making such a big difference. We're so happy to be able to share your story with others. So once again, I can't thank you enough for your time and for this important conversation.

00;21;57;01 - 00;22;05;05
Lindse Barks
Thank you again, Kathy for having us. And for shining this light on period poverty. We're so proud of the partnership we have with St Anthony's and the work that we're doing.

00;22;05;05 - 00;22;13;04
Angela Hawkins
Thank you all so much for having us. We appreciate starting this conversation and helping build a community of advocates for young women.