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Obstet Gynecol. 2019 Feb;133(2):238-244. doi: 10.1097/AOG.0000000000003060.

Unmet Menstrual Hygiene Needs Among Low-Income Women.

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College for Public Health and Social Justice, Saint Louis University, and the Department of Anthropology, College of Arts and Sciences, and the Department of Obstetrics and Gynecology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri.



To assess the menstrual hygiene needs of low-income women in St. Louis, Missouri.


Using an exploratory, cross-sectional design, women 18 years of age and older were recruited from a purposive sample of 10 not-for-profit community organizations that serve low-income women in St. Louis. From July 2017 to March 2018, 183 interviewer-administered surveys and three focus group discussions were conducted. Surveys and focus groups identified where and how women access menstrual hygiene products and what they do when they cannot afford to buy them. Using a snowball sampling strategy, 18 community organizations were also surveyed electronically to assess what services and supplies they provide for menstrual hygiene.


All women invited to participate in the interviews and the focus groups agreed to do so. Nearly two thirds (64%) of women were unable to afford needed menstrual hygiene supplies during the previous year. Approximately one fifth of women (21%) experienced this monthly. Many women make do with cloth, rags, tissues, or toilet paper; some even use children's diapers or paper towels taken from public bathrooms. Nearly half of women (46%) could not afford to buy both food and menstrual hygiene products during the past year. There was no difference in menstrual hygiene needs by age. Two thirds of organizations indicated that menstrual hygiene was a need of their clients. Thirteen provide menstrual hygiene supplies to their clients; two provide menstrual hygiene education.


Menstrual hygiene supplies are a basic necessity that many low-income women lack. We document the extent to which low-income women in a major metropolitan area in the United States are unable to afford these basic necessities and what they do to cope. Women's health care providers should advocate for improved access to menstrual hygiene supplies for low-income females across the United States.

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