The Right to Bleed: Period Poverty in Canada and the United States
/How often should menstrual pads be changed? Every: (A) 3-4 hours (B) 4-5 hours (C) 5-6 hours (D) 6-7 hours
I was shocked to learn, while researching for this blog, that the correct answer is (A) 3-4 hours, and that the ideal changing window is even shorter—2-3 hours—for optimal hygiene (Sun et al., 2024). While serious health risks like urogenital infections are more commonly associated with menstrual product use beyond 6 hours, bacterial growth begins much earlier, and regular changes help minimize this risk (Billon et al., 2020; Singh et al., 2023). However, when I check my bathroom cabinet, the packaging on my Always brand pads claims “8 hours maximum,” a notable difference.
Period poverty is a general term for having inadequate access to menstrual products, menstrual health education, and waste and sanitation facilities like toilets and sinks (Jaafar et al., 2023). Experiencing period poverty can worsen the social, psychological, and physical well-being of menstruators. For example, it can lead to missed school and work, shame and distress, and improper menstrual health management leading to infections like toxic shock syndrome (Barrington et al., 2021; Selina et al., 2019). While this topic has been well researched in low- and middle-income countries, the United States (U.S.) and Canada lag far behind (Lee et al., 2024; Patel et al., 2022). This gap in research comes, in part, from the misconception that there's nothing to study—that in high-income countries, people couldn’t possibly lack access to products, information, or sanitation. This is simply not the case. In fact, Canada has been even slower than the U.S. to collect national data on period poverty. Most of what we know comes from nonprofit organizations, with few academic calls to action until recently (Lee et al., 2024).
Who Really Pays? Economic Disparities and Menstrual Products
In the United States, around 40 million menstruators live in poverty or near poverty (Sacca et al., 2023). According to a 2023 survey conducted by Environics Research for Women and Gender Equality Canada (2023), 17% of menstruators have experienced period poverty in Canada, and if household income is lower than $40,000 a year, this number rises to 25%. Because this leads to the difficult decision between proper menstrual products or food and other necessities, sometimes menstruators resort to using homemade or unsafe products. For example, individuals from both Canada and the U.S. have reported using children’s diapers, strips of cloth, toilet paper, tissues, or washed single-use menstrual products for reuse (Lukindo et al., 2022; Sebert Kuhlmann et al., 2022). These substitutions are not made for menstrual blood and/or are unsafe, putting them at risk of accidental leakage at best and infection at worst. Furthermore, those working low-income jobs may have fewer opportunities to change their products due to long and inflexible work hours, which is uncomfortable and even dangerous, especially when combined with homemade or inadequate products (Johnson & Fujishiro, 2023). Lastly, in some areas, the financial burden of period products is worsened by taxation, sometimes referred to as the “tampon tax.” Canada eliminated federal tax on menstrual products in 2015, but most U.S. states retain the tax (Canada Revenue Agency, 2015; Crays, 2020).
Knowledge is Power: Sexual and Menstrual Health Education
Sexual health education (SHE), which includes menstrual health and management education, is controlled at the provincial/territorial level within Canada. Therefore, there is great variability in the content, time allocation, and recency of the material across provinces and territories (Robinson et al., 2019).
Similarly, evidence-based menstrual health education is not federally mandated in any U.S. state or territory, and only four states have legislation making it necessary (Jones & Baldwin, 2025). In fact, states like Arkansas and Florida have legislation which prevents SHE before grades five and six respectively (SIECUS, 2021, 2024). This is a cause for concern, as children can begin menstruating as early as ages 8 and 9 (grades 3-4), and students often report experiencing distress and fear when menstruation begins before their school covers puberty education (Schmitt et al., 2022a). The remaining states do not teach menstrual health education early enough that children can anticipate changes to their bodies and be prepared for them (Jones & Baldwin, 2025).
While SHE is controlled by the state or provincial government, the inconsistencies and knowledge gaps create ripples across both Canada and the United States. Unfortunately, the national variability does not allow for high-quality assessment of these gaps within peer-reviewed research. Therefore, much of what we know is from nonprofit organizations. In a nonprofit Canadian survey conducted by Plan International (2023), 65% of respondents said they did not receive any type of menstrual health education including anatomy, hygiene, and menstrual symptoms. Moreover, while provincial control is similar to the U.S., Canadian provinces rarely update or monitor the effectiveness of these programs. Some provinces, like Manitoba and the Atlantic provinces, have almost no current public data on menstrual education in schools, leaving wide gaps in knowledge (Robinson et al., 2019).
These education gaps leave many children and communities unprepared, uninformed, and unsupported, directly contributing to period poverty. Indeed, individuals may lack the necessary knowledge to safely manage menstruation or understand whether their menstrual symptoms are healthy. For example, many suffer from heavy or abnormal uterine bleeding, which can cause lack of focus, missed school, and anemia (Matteson et al., 2012; Sawyer et al., 2024). A lack of knowledge may prevent individuals experiencing these symptoms from identifying this bleeding as problematic in the first place, hindering them from accessing health care and improving their quality of life. However, the normalization of severe menstrual pain and heavy bleeding within the healthcare system, exacerbated by gender bias, often leads to the dismissal of these symptoms, creating yet another barrier to equitable menstrual healthcare (Wiggleton-Little, 2024). Additionally, many schools strictly police bathroom breaks, limiting necessary access to waste management and sanitation facilities—both of which are crucial for menstrual health. (Schmitt et al., 2022b; Secor-Turner et al., 2020). Moreover, the burden of this educational inequity falls hardest on low-income, gender-diverse students, and those who live in rural areas, who face compounded barriers to menstrual health knowledge and care (Casola et al., 2023; Secor-Turner et al., 2020; Townsend et al., 2023). Addressing these gaps requires the implementation of national, evidence-based, inclusive menstrual health education standards that reach children before the onset of puberty.
A Potential Blind Spot: The Safety of Menstrual Products
Are menstrual products safe? The answer: it depends on who you ask. Influencers on social media have raised alarm about tampons containing bleaches and metals, potentially harming the users’ health (Butcher, 2024; Jung, 2025). What does science say? A lot of the high-quality research on the safety of tampons conclude that tampons are safe (Hochwalt et al., 2010, 2023); safe, within this context, means a permissible amount of vaginal irritation, physical discomfort, and infection risk. These studies, though, focus on the short-term and are characterized by conflicts of interest (e.g., the research received funding from the tampon company). In contrast, independent studies raise concerns with the long-term use of tampons. For example, pesticides, industrial chemicals, and toxic metals have been found in menstrual products (Shearston et al., 2024; Upson et al., 2022). Concerningly, no tests have been done on how the vagina reacts to these chemicals or their long-term effects. Yet, there is also little to no evidence suggesting tampons pose a chronic health risk.
Period poverty is often discussed in terms of access to products, which is also the main focus of this blog. But unbiased science confirming product safety and ingredient disclosure is also crucial. Overlooking these aspects reflects broader systemic gaps in how menstrual health is prioritized, and more solid research—and clear safety regulations—are needed.
Gatekeeping the Right to Bleed: Transgender and Non-binary Individuals
Within our sociocultural climate, menstruation is viewed as a gendered process equated with ‘womanhood.’ Evidence is easy to find—for example, the language and imagery on sanitary pad packaging are almost exclusively characterized by floral patterns, pastel pink colours, and messaging targeted at cisgender women. However, people of various gender identities menstruate, such as trans men and non-binary individuals. Secondly, not all who identify as a woman menstruate, such as pregnant women, trans women, postmenopausal women, and those with amenorrhea. Menstruation is not a gender identity; it is a biological process.
Associating periods strictly with womanhood comes with exclusionary consequences directly related to menstrual equity. For example, trans men may be excluded from conversations and the narrative of period poverty. Indeed, most statistics only include women who menstruate, not menstruators, rendering our knowledge inaccurate. Relatedly, most menstrual education is framed towards cisgender girls and women, which may alienate people of diverse gender identities who menstruate. Moreover, almost all pads and panty liners are designed to fit traditionally feminine underwear, making them difficult for those who wear boxers or briefs to use. Furthermore, most men’s bathroom stalls do not have sanitary napkin receptacles or trash cans, making disposal stressful. This is compounded by the stress of quietly opening a sanitary pad wrapping to avoid outing oneself or being put in a dangerous situation. Indeed, a Connecticut-based study found that over 60% of a sample of trans men felt unsafe using a “men’s bathroom” during their periods (Chrisler et al., 2016).
We Can't Wait and Bleed: Period Equity for All
Period poverty is not just about having pads or tampons—it's about the human right to manage menstruation with dignity, safety, and choice. Whether in Canada or the United States, the failure to provide safe, affordable products, transparent information, and quality inclusive education continues to harm those who menstruate—especially those already marginalized by income, geography, or gender identity. These are not isolated problems. They are connected, systemic, and solvable. We must move beyond nonprofit-driven period product giveaways and demand menstrual justice: federally funded research, ingredient disclosure, inclusive and early menstrual education, and policy frameworks that see menstruation not as a private burden, but as a public health, equity, and rights issue. The right to bleed safely and without shame belongs to everyone who menstruates.
Ruxandra-Ioana Adam, 3rd year BSc Psychology, Queen's University
Note: AI was used for certain minor elements of this blog (e.g., references, grammar).
References
Barrington, D. J., Robinson, H. J., Wilson, E., & Hennegan, J. (2021). Experiences of menstruation in high income countries: A systematic review, qualitative evidence synthesis and comparison to low- and middle-income countries. PLOS ONE, 16(7). https://doi.org/10.1371/journal.pone.0255001
Berger, S., Kunerl, A., Wasmuth, S., Tierno, P., Wagner, K., & Brügger, J. (2019). Menstrual toxic shock syndrome: case report and systematic review of the literature. The Lancet Infectious Diseases, 19(9), e313–e321. https://doi.org/10.1016/s1473-3099(19)30041-6
Billon, A., Gustin, M.-P., Tristan, A., Bénet, T., Berthiller, J., Gustave, C. A., Vanhems, P., & Lina, G. (2020). Association of characteristics of tampon use with menstrual toxic shock syndrome in France. EClinicalMedicine, 21, 100308. https://doi.org/10.1016/j.eclinm.2020.100308
Butcher, A. [@abibxbz]. (2024, July 10). Just going to free flow at this point 😭. [Video]. TikTok. https://www.tiktok.com/@abibxbz/video/7390088029970517281?q=tampons%20cause%20cancer&t=1747441060919
Canada Revenue Agency. (2015). Notice of Ways and Means Motion Concerning GST/HST and Feminine Hygiene Products - Canada.ca. Budget 2015. https://www.canada.ca/en/revenue-agency/programs/about-canada-revenue-agency-cra/federal-government-budgets/budget-2015-strong-leadership/notice-ways-means-motion-concerning-gst-hst-feminine-hygiene-products-questions-answers.html
Casola, A. R., Luber, K., & Riley, A. H. (2023). Period poverty: An epidemiologic and biopsychosocial analysis. Health Promotion Practice, 26(1). https://doi.org/10.1177/15248399231192998
Chrisler, J. C., Gorman, J. A., Manion, J., Murgo, M., Barney, A., Adams-Clark, A., Newton, J. R., & McGrath, M. (2016). Queer periods: Attitudes toward and experiences with menstruation in the masculine of centre and transgender community. Culture, Health & Sexuality, 18(11), 1238–1250. https://doi.org/10.1080/13691058.2016.1182645
Crays, A. (2020). Menstrual equity and justice in the United States. Sexuality, Gender & Policy, 3(2). https://doi.org/10.1002/sgp2.12023
Health Canada. (2015). Menstrual tampons https://www.canada.ca/en/health-canada/services/drugs-medical-devices/menstrual-tampons.html
Hochwalt, A. E., Abbinante-Nissen, J. M., Bohman, L., Hattersley, A. M., Hu, P., Streicher-Scott, J. L., Teufel, A. G., & Woeller, K. E. (2023). The safety assessment of tampons: illustration of a comprehensive approach for four different products. Frontiers in Reproductive Health, 5. https://doi.org/10.3389/frph.2023.1167868
Hochwalt, A. E., Jones, M. B., & Meyer, S. J. (2010). Clinical Safety Assessment of an Ultra Absorbency Menstrual Tampon. Journal of Women’s Health, 19(2), 273–278. https://doi.org/10.1089/jwh.2009.1423
Jaafar, H., Ismail, S. Y., & Azzeri, A. (2023). Period poverty: A neglected public health issue. Korean Journal of Family Medicine, 44(4). https://doi.org/10.4082/kjfm.22.0206
Johnson, C. Y., & Fujishiro, K. (2023). Identifying occupational health inequities in the absence of suitable data: are there inequities in access to adequate bathrooms in US workplaces? Occupational and Environmental Medicine, 80(10), 572–579. https://doi.org/10.1136/oemed-2023-108900
Jones, S. C., & Baldwin, M. K. (2024). Menstrual health education: school health curriculum topics by grade level recommended by specialized medical professionals in menstrual health clinics. Journal of Pediatric and Adolescent Gynecology, 38(1). https://doi.org/10.1016/j.jpag.2024.09.003
Jung, C. [@cleaneve]. (2025, May 6). Ladies, most tampons and pads contain chemicals that can disrupt your hormones and harm your health. [Video]. TikTok. https://www.tiktok.com/@cleaneve/video/7501450035868175662?q=tampons%20hormonal%20imbalance&t=1747440657600
Kale, V., & Ubgade, A. (2013). Vaginal mucosa – A promising site for drug therapy. British Journal of Pharmaceutical Research, 3(4), 983–1000. https://doi.org/10.9734/bjpr/2013/3895
Lee, A. C., Toory, L., & Harrison, M. E. (2024). Menstrual health inequities and “period poverty” in Canada. Canadian Journal of Public Health, 115(3). https://doi.org/10.17269/s41997-024-00853-1
Lukindo, M., Price, V., & Pike, M. (2022). Estimating the impact of menstrual poverty on adolescents in Nova Scotia. Paediatrics & Child Health, 27(7). https://doi.org/10.1093/pch/pxac062
Parliament of Canada. (2021). C-366 (44-1) - LEGISinfo - Parliament of Canada. Parl.ca; LEGISinfo. https://www.parl.ca/legisinfo/en/bill/44-1/c-366?view=progress
Patel, K., Panda, N., Sahoo, K. C., Saxena, S., Chouhan, N. S., Singh, P., Ghosh, U., & Panda, B. (2022). A systematic review of menstrual hygiene management (MHM) during humanitarian crises and/or emergencies in low- and middle-income countries. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.1018092
Plan International. (2023). News release: Period poverty in plain sight. Plan Canada Site. https://plancanada.ca/en-ca/about-us/media-centre/period-poverty-in-plain-sight
Robinson, D. B., MacLaughlin, V., & Poole, J. (2019). Sexual health education outcomes within Canada’s elementary health education curricula: A summary and analysis. The Canadian Journal of Human Sexuality, 28(3), 243–256. https://doi.org/10.3138/cjhs.2018-0036
Sacca, L., Markham, C. M., Gupta, J., & Peskin, M. (2023). Editorial: Period poverty. Frontiers in Reproductive Health, 5. https://doi.org/10.3389/frph.2023.1140981
Schmitt, M. L., Gruer, C., Hagstrom, C., Ekua Adenu-Mensah, N., Nowara, A., Keeley, K., & Sommer, M. (2022a). “It always gets pushed aside:” Qualitative perspectives on puberty and menstruation education in U.S.A. schools. Frontiers in Reproductive Health, 4(4). https://doi.org/10.3389/frph.2022.1018217
Schmitt, M. L., Hagstrom, C., Gruer, C., Nowara, A., Keeley, K., Adenu-Mensah, N. E., & Sommer, M. (2022b). “Girls May Bleed Through Pads Because of Demerits”: Adolescent Girls’ Experiences with Menstruation and School Bathrooms in the U.S.A. Journal of Adolescent Research, 39(2), 074355842211393. https://doi.org/10.1177/07435584221139342
Sebert Kuhlmann, A., Peters Bergquist, E., Danjoint, D., & Wall, L. L. (2019). Unmet menstrual hygiene needs among low-income women. Obstetrics & Gynecology, 133(2), 238–244. https://doi.org/10.1097/aog.0000000000003060
Secor-Turner, M., Huseth-Zosel, A., & Ostlund, R. (2020). Menstruation experiences of middle and high school students in the Midwest: A pilot study. The Journal of School Nursing, 38(6), 105984052097423. https://doi.org/10.1177/1059840520974234
Shearston, J. A., Upson, K., Gordon, M., Do, V., Balac, O., Nguyen, K., Yan, B., Kioumourtzoglou, M.-A., & Schilling, K. (2024). Tampons as a source of exposure to metal(loid)s. Environment International, 190(108849), 108849–108849. https://doi.org/10.1016/j.envint.2024.108849
SIECUS. (2021). Florida state profile. SIECUS - Sex Ed for Social Change. https://siecus.org/stateprofiles/florida-fy21-state-profile/
SIECUS. (2024). Arkansas state profile. SIECUS - Sex Ed for Social Change. https://siecus.org/stateprofiles/arkansas-state-profile-23/
Singh, N., Rajput, S., & Jaiswar, S. (2022). Correlation of menstrual hygiene management with cervical intraepithelial neoplasia and cervical cancer. Journal of Cancer Research and Therapeutics, 0(0), 0. https://doi.org/10.4103/jcrt.jcrt_1021_21
Sun, J., Bai, S., Li, Q., Zhao, M., Ge, L., & Zang, S. (2024). The condition of women frequently changing sanitary pads in 28 cities of China: a cross-sectional study. Reproductive Health, 21(1). https://doi.org/10.1186/s12978-024-01910-1
Upson, K., Shearston, J. A., & Kioumourtzoglou, M.-A. (2022). Menstrual products as a source of environmental chemical exposure: A review from the epidemiologic perspective. Current Environmental Health Reports, 9(1). https://doi.org/10.1007/s40572-022-00331-1
U.S. Food and Drug Administration. (2005). Menstrual tampons and pads: Information for premarket notification submissions (510(k)s) - Guidance for industry and FDA staff. https://www.fda.gov/regulatory-information/search-fda-guidance-documents/menstrual-tampons-and-pads-information-premarket-notification-submissions-510ks-guidance-industry
Wiggleton-Little, J. (2024). “Just” a painful period: A philosophical perspective review of the dismissal of menstrual pain. Women’s Health, 20(6). https://doi.org/10.1177/17455057241255646
Women and Gender Equality Canada. (2023, September 22). Menstrual Equity Fund. Funding for women and gender equality. https://www.canada.ca/en/women-gender-equality/funding/menstrual-equity-fund.html