Menstrual Health and Equity: Why We Need to Do Better

Menstrual health directly impacts more than half of the world’s population yet is frequently overlooked or outright ignored – even here in the United States. 

“Young people across the United States and around the world have shared experiences of feeling fearful and ashamed when they get their first period,” says Marni Sommer, MSN, DrPH, director of the Gender, Adolescent Transitions and Environment (GATE) program at Columbia University Mailman School of Public Health. “From society’s lack of guidance and education around the first period to the lack of menstrual-friendly bathrooms in cities around the world to the lack of menopause support, we have a fundamental issue: gender inequality.”   

The GATE program’s research and programming create awareness—and contribute to the inclusion of attention to menstrual health within the realm of humanitarian response—to correct the inadequacies and limitations of menstrual inequity around the world.  

“The ability to manage menstruation successfully, in school, at work, during long trips on public transportation—and to seek out and receive support and care as needed for menstruation—is a vital part of health and wellbeing,” says Sommer. “We need to provide preparatory education, clinical attention, and make sure there are adequate toilets, products, and supportive environments everywhere.” 

Sommer spoke with us about the importance of menstrual health.  

Let’s start at the beginning: What is menstrual health? 

Menstrual health is everything about a menstruation experience:  

• when a person starts menstruating 
• their physical experience of bleeding and pain 
• their feelings (confidence, shame, fear, etc.) in their interactions with other people  
• symptoms that require seeing a doctor, nurse practitioner, or other health professional, like heavy bleeding or pain 
• emotional or mental health challenges 

Menstrual health is a state of being in which everything about your menstruation—social, physical, emotional—is in a good place. That means both being prepared for the first period and preventing problems, such as menstrual health disorders, endometriosis, or other kinds of disorders that start when someone is young and take many years to diagnose.  

You teach public health students about menstrual health. How do you approach the topic, and how do your students respond? 

I want them to understand the global picture of the issue of menstrual equity. We look at policy, research, taxes, homelessness, and the humanitarian context around menstrual needs. We also share practical guidance that we and others have developed. We’re one of the only public health programs offering a class on menstruation, but I hope that changes one day.  

Two years ago, we also launched a free, open online course on the global menstrual movement for students, practitioners, and policymakers around the world. So far, over 2700 people from 141 countries have taken the course online.  

Our students ask us: Why is menstruation not better addressed? Why is there so much taboo around it? Why are workplaces, schools, and cities not built for people who menstruate, amongst other needs?  

The answers are both simple and complex. The bottom line is we need to do better in menstrual health.  

What do people need to manage their menstruation? 

Menstrual management requires clean, safe facilities and menstrual products (pads, tampons); privacy to change products as often as needed; soap and water for washing the body; and facilities to dispose of used products. Public toilets and bathing facilities should provide these basics to everyone who menstruates.  

Fortunately, people are starting to understand that small additions like hooks to hang a bag, adequate lighting, a mirror to check for menstrual leaks on clothing, and toilet paper or paper towels ease anxiety and shame and contribute to gender equity in social spaces and experiences.  

What is period poverty, and how can we address it? 

Period poverty is foremost a lack of access to menstrual products. People also use the term when referring to inadequate education, and water and toilet facilities. It’s a worldwide gender equality issue that impacts so many people who menstruate to varying degrees.  

When someone cannot manage their menstruation with dignity and comfort, they may feel anxious, embarrassed, and even experience shame. These feelings make it harder for women to participate in school, work, and other aspects of daily life.  

Menstruation has become a gender equity issue—but that’s an easy thing to fix if we want to.  

We need to talk about menstruation, check in with girls, women and others who menstruate, ensure they can comfortably attend events, go to school and work, and more, without their menstrual period creating barriers. There should be menstrual health books in every library for people of all ages You learn about other health issues and changes that happen to your body. It’s the same. 

What are you researching, and how is it impacting menstrual health?  

So much is happening! Most recently, we have been analyzing data from a six-city study that we conducted on menstrual-friendly public toilets across the globe. How many are there in key parts of each city, such as a business area, a tourist area, a residential park or plaza, and a transit station? Are they clean and safe, and do they have what people who are menstruating need? The early findings suggest we have a long way to go, particularly here in NYC.  

We just hosted a great meeting with our city research teams and a range of invited experts from government, urban planning, global urban-focused organizations and others, which also included a public toilet tour in NYC. 

What should people understand about menstrual health?   

Menstrual health is a fundamental part of health.

In recent years, the American College of Obstetricians and Gynecologists suggested menstruation should be treated as a vital sign—like body temperature, blood pressure, and heart rate—because it is an indicator of health and well-being. If it's disrupted, it suggests other things are disrupted.  

The American Academy of Pediatrics agreed. But here we are in 2024, and menstruation frequently isn't part of well-child visits or women’s primary care visits the way it was recommended. There are many more questions healthcare professionals can ask. And we need broader education around what a “normal” period is in terms of bleeding and pain for a girl or woman.  

We don’t hide other health issues the same way we whisper about menstruation. Let's talk about it. Let's bring it out into the open. We all need to recognize menstrual health is worthy of more attention than it's been getting and is essential.