Three key themes related to the availability and accessibility of menstrual products for people experiencing homelessness in NYC proved salient throughout the analysis: (1) insufficient and inconsistent access to menstrual products; (2) systemic challenges to providing menstrual products; and (3) creative solutions to promote access to menstrual products.
Insufficient and inconsistent access to menstrual products
An overarching finding from respondents with experience living both in shelters and on the street was the formidable struggle to access menstrual products consistently. Those living in shelters most commonly reported purchasing their own menstrual products, often relying on discount or dollar stores to minimize costs. Revenue sources varied, with a majority of participants reporting using their own income, depending on financial support from friends or family members, or public assistance funds. Trade-offs made with respect to other necessities were common. For example, securing menstrual products could mean going without medications or more expensive food items. Others reported having to rely on makeshift solutions when they were unable to afford products:
I would run out of money and I ended up doing things rather than [buying them]… like, cutting up old t-shirts and stuff like that.—IDI 15
Respondents living in shelters also mentioned shelter-based distributions, though less frequently. Depending on the shelter, the distribution method varied: mass distributions on designated supply days; requests to a caseworker, shelter staff, or the check-in desk; or, rarely, unencumbered access to a centrally located repository. A few participants reported that such distributions made their lives easier by reducing their financial burden and ensuring that they could access products more regularly. Consistently, though, participants described the availability of products as uneven and insufficient. Some reported a complete absence of menstrual products at their shelter.
Rationing methods, too, were described, with menstrual products being distributed by staff members selectively and only upon request. Participants reported receiving only a few pads or tampons at a time, necessitating asking for products repeatedly, sometimes multiple times a day. Some shelters permit product requests only on specific distribution days during a given week or month; still others require the request be made to a certain staff member who is only on duty during certain days or hours. Such restrictive distribution systems meant that—even where officially “provisioned”—respondents could not rely on shelters as a primary source of products.
A number of shelter clients added nuance to such requests, describing how disclosing their need for menstrual products elicited shame and humiliation, feelings heightened if the gatekeeper was stationed in a public place (e.g., the check-in desk), or male:
…the humiliation is that you have to keep going back to them and asking them, and when you're asking for, because they have police and security, so it's not private. So you're asking for it in front of NYPD and DHS security, and most of those are male staff. —IDI 07
Other shelter clients were simply unwilling to disclose their menstruating status due to social norms and taboos, preventing them from accessing the free menstrual products even when available. A few respondents reported experiencing or witnessing harassment, including sexual harassment, by shelter staff:
… the women have to go and ask for menstrual products, and then you have the male staff smiling, smirking at them… Women feel that they're being discriminated against, harassed, sexually harassed because they're menstruating —IDI 07
The types and quality of menstrual products provided by the shelters were also identified as problematic. For example, some women preferred using tampons but only pads were available, or vice versa. This meant settling for what was available, or finding another way to acquire their preferred product. Many complained about the quality or absorbency of available products, saying that pads provided by their shelter were too small or too thin to manage what they described as their “heavy [blood] flow.” This made it necessary to change the product much more often, requiring access to safe, clean spaces for changing—a contingency not readily available to them . As a result, even when menstrual products were available at their shelter, some participants opted to acquire their products elsewhere:
I was always like, if I had like, six, five dollars, I'd go get pads with wings, cause it would just make life so much easier. And the reason I needed so many of those from [service provider] was cause they didn't work and I had to go to the bathroom every two three hours instead of every four hours or five. —IDI 13
Lastly, a number of participants reported being unaware of whether their shelter provided free menstrual products or not. A few explained that it had never occurred to them that these products might be available, when so many other basic items are not, and so they had never asked. Despite clearly outlining how necessary menstrual products were for their daily life, the women did not view them as something they could expect to receive. Similarly, when questioned, most participants had not heard of the 2016 law requiring shelters to provide menstrual products, and were unaware of their legal right to access products at their shelter.
Unsurprisingly, participants with experience living on the street described even greater difficulties accessing menstrual products, as they lack access to shelter supplies and were less likely to report alternative sources of funding and support. Most commonly, these participants relied on service organizations for handouts. However, not all homeless service providers in NYC distribute menstrual products, and even when they did, availability was uncertain. Menstrual products are not viewed as an essential item in “care packages”:
They give you a care package; they don't necessarily have personal things like that, like tampons and stuff like that. They might have deodorant and soap and toothpaste, but they don't have the personal items that you might need. So, you have to ask for that. And if they have it, they don't mind. A lot of times they don't carry it, though, so you have to go from place to place to place, and you have to go in public restrooms and stuff like that, because that's not something that we think about. And you think about giving people water and food and soap to be clean and, but you don't think about the other aspects, like vitamins, you know, and tampons and this stuff, it's, it's not so easy. —IDI 21
Those with experience living on the street also described similar complaints heard from shelter residents with respect to procuring preferred products, settling for inferior quality and quantity, and having to deal with gatekeepers. As a result, some participants who had lived on the street reported resorting to panhandling for menstrual products, which posed its own difficulties. As one woman described: “I get more cigarettes than I could get tampons [while begging on the subway].” (IDI 16) A few participants had resorted to pilfered menstrual products while others, like their counterparts in the shelters, made do with makeshift materials, such as old pieces of clothing, or wads of toilet paper.
Although none of our participants self-identified as trans masculine or gender non-conforming, a number of key informants noted that such clients often encounter even more significant barriers to obtaining menstrual products. As one youth services provider shared:
They're, like, presenting with . . . a gender that doesn't match someone who would be having a period, and so that's super complicated and embarrassing, um, and so I think there's just, yeah, there's so much shame and stigma around it... —KII 05
As a result, transgender and gender non-conforming individuals may only be willing or able to access menstrual products from service providers where they feel accepted and have developed trusting relationships.
Systemic barriers to providing menstrual products
In addition to the difficulties that participants themselves communicated in accessing menstrual products, shelter staff and service providers described how the system itself inhibits their ability to consistently provide menstrual products to their clients. While all the service providers articulated the importance of menstrual products, many described not always being able to provide their clients with regular access.
Shelters are included under the mandate of the 2016 NYC Menstrual Policy, which means that the Department of Citywide Administrative Services (DCAS) must provide a supply of menstrual products sufficient to meet the needs of their residents. However, shelter staff reported that the products were not always delivered in a timely enough manner to ensure a consistent stock. These delays contributed to occasional stock outs and to fear that the products might run out. In addition, awareness of the NYC Menstrual Policy was uneven among the shelter staff. Some knew nothing about the policy; others were uncertain about how it would be implemented over time. As the director of one shelter shared:
I didn't know about the, the menstrual [policy], I had no idea. Cause I, in shelter, I've been working in shelter for, since 2010, um, and it was always something that we just provided to the clients, like we had to, yeah. —KII 012
The fear of stock outs appeared to intersect with the distribution system in many shelters, as gatekeeping staff monitor the usage and supply of these products and prevent one client from taking the entire supply. Shelter staff seemed unaware of the potential stress that the rationing system may cause some clients.
Non-shelter service providers faced tougher challenges because they supply these products at their own discretion and expense. Most rely on product donations through arrangements ranging from formal partnerships with commercial companies to ad hoc donations from private individuals. While such approaches reduce procurement costs, they also make it harder for service providers to control the type and quality of products made available—an eventuality not lost on clients:
No. No no no no no no no no no, there's no choice. You get what they've got. Because most of their stuff is donated too. Some, you have to get what they've got and utilize what they have. Sometimes they have tampons, most of the time they don't have tampons. Most of the time they have, uh, the pads. Yeah. And uh, you have to just take what they've got. —IDI 21
Nor were service providers always able to predict when donations will arrive, which could lead to stock-outs or rationing of the products similar to what occurs within the shelter system:
Yeah, I, yeah, I've noticed, [stock out of a certain type of product] doesn't happen a lot, but it does, you know, in any social service agency, like, it kind of fluctuates. —KII 06
A number of key informants also described how well-intentioned donation efforts, often the most expedient source for products, did not always align with client preferences. For example, some menstrual cup companies have robust donation programs; however, to date, these products have not been popular with the clients and may be difficult for the clients to change, clean and store while living in a shelter or on the street:
We've been partnering with [menstrual cup company] for a few years, um, they send us a big box of [menstrual cups] every 6 months or so. Um, but with the [menstrual cups] it hasn't been, it just hasn't picked up for the young people and so we've haven't gotten a shipment in the last six months since we have a big supply of it still. —KII 10
Service providers may also face challenges with staff comfort distributing products—the reciprocal version of the “gatekeeper” issue mentioned earlier. While our sample of service provider informants was predominantly women, a few mused that their male counterparts might feel uncomfortable discussing menstruation or feel embarrassed when providing these supplies to women and transgender clients.
I guess like one thing I was thinking about was sort of the, the diversity and gender diversity of our staff and, you know, the comfortability of asking for products or talking about problems with male versus female versus transgender staff…or even, just like how our, kind of our male staff feel [inaudible] feel about offering, um, [menstrual products]. —KII 09
A staff member’s own personal discomfort with distributing products may in turn contribute to creating an uncomfortable environment for clients.
Creative solutions to promote access to menstrual products
The participants experiencing homelessness and those seeking to meet their needs shared a number of ideas for improving access to menstrual products. Resoundingly, the most common recommendation stressed the need to increase the availability of free and low-cost menstrual products throughout the city. To accomplish this, multiple service providers suggested system-level changes, such as the inclusion of menstrual products in public assistance programs such as Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), or Medicare/Medicaid. As one Director of Social Services suggested:
Most people who are like, street homeless, they're entitled to some type of medical insurance, right? I think that Advil and um, pads or tampons, whatever they want to use, should be part of like, some type of like, your health coverage. Cause it is, like, health, like, we women, we, I mean, I wish I didn't get my period, right, but unfortunately it's, we have to, right? So it's like, if they, if they have Medicaid, then I think Medicaid should be, you know, having like, maybe every month you should get like two packs of like tampons or be entitled to purchase two packs of, um, menstruation, or the menstruation cups should be something that your health insurance covers, uh, you know? —KII 007
While some programs are constrained in what they can currently offer (e.g., SNAP and WIC cannot cover non-food items), these suggestions illustrate how these products could be incorporated into existing systems.
Two service providers and one participant living in a shelter suggested a citywide campaign to distribute free menstrual products in the same manner as NYC condoms, which are widely available and easily accessible. The equating of condoms with menstrual products, the latter an essential gendered item, pointedly raises an important issue of societal equity.
A second set of recommendations built on the idea of increased accessibility, proposing an expanded number of locations where menstrual products could be made available, especially ones accessible twenty-four hours a day. This was particularly important to participants who had spent time living on the street to ensure that they could access products during hours when service providers were closed. Proposed locations varied, but a common suggestion was public restrooms. As one participant experiencing homelessness (IDI 10) described, “I'd have [menstrual products] for free in the bathroom…[in] any public bathroom.”
Another participant without a stable home recommended a van that would drive around the city to certain drop-off points, distributing products to those who need them. Still another participant who had spent time living on the street recommended the installation of menstrual product vending machines across the city where products could be purchased using a credit card, or accessed by those on public assistance who would be given a specific card for the machines. Importantly, such a machine would be accessible 24 hours a day. Participants noted that these approaches would not only improve menstrual product access for people experiencing homelessness, but also for residents struggling to make ends meet and for anyone finding themselves in urgent need of a menstrual product while in the city.
Participants also had a range of suggestions for how to improve the accessibility of these products within the shelters and at other service providers. One idea was for more service providers to stock menstrual products, making it easier for clients to access products at familiar venues throughout the city. Another centred on improving the current distribution systems. The most common recommendation was that products be made freely available, instead of requiring interaction with a gatekeeper. A few participants described how this system is already in place in some shelters or service providers and how this makes accessing products less fraught:
I would recommend that's really nice is, is what they do at, it's an awful place, [shelter], is, is, the having them available in a way so that…[you] don't even have to ask, I mean you've got women from all different types of backgrounds, some people might, some people might be shy about it. —IDI 15
Beyond making products freely available, participants recommended smaller adjustments to improve the current systems. The most common suggestion was that a larger number of products should be distributed at one time per client, reducing the need to resupply during one menstrual period, improving clients’ sense of independence and dignity, and assuring not being “tied” to a given provider or location during their period. Plainly, too, this would increase their ability to seek other services, work or go about their day. Related, a few participants suggested that products be distributed regularly and routinely in a shelter instead of only on demand, so that clients could have consistent access without having to ask for them. There was also a repeated recommendation that service providers distribute menstruation-supportive supplies along with the menstrual products, such as soap, towels, feminine wipes, and underwear. These supplies are already available at some service providers, and are a much-appreciated resource:
I honestly would make sure that every single shelter, because they do have the resources, that they would give any woman, any woman that's menstruating, whatever, access to what they need, how many they need, whenever. Not giving them a limit, because the human body changes. Um, access to towels, soap, and everything you can clean yourself —IDI 20
Others recommended making sure more clients knew that menstrual products were available, given repeated indications that shelter clients often have no idea these products were stocked. Clients could receive a list of what supplies and materials are available for them, and where and how to access them. Alternatively, a list could be publicly posted detailing the supplies that are available and where they are located.
…letting people know, this item is available to you, I think would be a huge help because people, again, you're not just gonna, if I'm always asking you for something, like you said, and they say no, then it's like, it makes me feel like when I really need something, you're definitely not gonna have it, so I feel like, even allowing people to know that these options are available for you if necessary, you know, if needed…it would be very helpful, or even like, if you go into shelter systems, and it's your first time where you've been there, they'll be like hey, and by the way, just in case needed, or even if they put like a little poster or something, letting people know that these items are available to you. —IDI 09
Across all the interviews, the principal recommendation was, as one service provider, who had previously experienced homelessness, succinctly put: “[what we need is] just more access, in more spaces, with less stigma.” —KII 4.