In Ethiopia, the school dropout rate for girls remains at a staggering 51 percent, according to the Dignity Period project, a main cause for dropouts being the lack of access to menstruation products.

Despite taking place halfway across the world, this problem is not foreign to St. Louis.

Women of low income populations in St. Louis struggle every day for the essentials: enough money for their rent, food and bills. However, one basic necessity is not often regarded as essential—menstrual products.

The simple reality for these women is that it is essential. According to Plan International, 1 in 10 women struggle to afford menstrual hygiene products when they need them—a problem that is far more prevalent for women in low income populations.

This reality was the motivation for  Anne Sebert Kuhlmann, Ph.D.

Kuhlmann, a professor and master’s program director of public health at SLU, realized her study on low income women’s menstrual health in St. Louis was more necessary than she ever expected.

“About 64 percent of the low income women that we surveyed could not afford menstrual hygiene products in the past year when they needed them,” Kuhlmann said. “We thought we would document some need, but when we talk about 64 percent of the women that we talked to, that’s very pervasive.”

Kuhlmann credits the “economic cost of being a woman” for this incredibly high statistic.

“If you think about a man and a woman living on very low-income, making ends meet, there are additional costs that women have in order to participate fully in society, that, in this case, men don’t have,” she said.

Kuhlmann claims that there is an “economic cost of having to provide extra supplies, yet we have nothing in our safety net system that helps provide for them.”

With no safety net in place, women in low income populations already face a unique challenge, however, that is not the extent of their economic obstacles. The extra “cost of being a woman” can also be seen in the selective exemption of items subject to a sales tax.

According to NPR, items like ChapStick, Viagra and dandruff shampoo have no sales tax in many states due to their “healthcare” uses; however, period products are taxed this way—or even luxury taxed—in some places.

This can increase the price of period products by 10 percent of the item’s amount, according to Kuhlmann’s research—a significant increase for many women. Because of this, women often resort to using rags, paper towels, toilet paper and even diapers during their monthly cycle in order to overt the extra funds.

Menstrual hygiene is not detached from other areas of a woman’s life, either; the effects of a woman’s period can extend into other areas of health and lifestyle.

“Women often miss school or work because of their periods” and “because of not having products,” said Kuhlmann.

According to Kuhlmann, this is especially true for women working hourly jobs that don’t provide sick leave. By missing a day or two a month due to a lack of menstrual products, it can disturb their economic stability—in addition to their mental health.

“It can affect your job. It can affect your progress in education. You can also imagine how it affects a woman’s self-worth and dignity, not being able to care and provide for yourself,” said Kuhlmann.

Fortunately, though, Kuhlmann believes the study was published at the perfect time for a resolution. Dignity Period, in partnership with the St. Louis Alliance for Period Supplies, is starting a program in St. Louis to dispense reusable pads to women in need. The Alliance will work similarly to the Diaper Bank in St. Louis in that they will purchase, collect and store menstrual products, then partner with organizations that work directly with women from low income populations to distribute them.

Although this is a great relief to the problem now, Kuhlmann thinks the key to creating a lasting solution is in policy-making. Since 2017, there’s been a bill in the Missouri House focused on taxing menstrual hygiene products and diapers at the lower food sales tax rate. However, it has not received a hearing.

Kuhlmann hopes that because of how widely the study has spread, particularly in an upcoming issue of the esteemed publication “Obstetrics & Gynecology,” it will help illustrate the importance of this issue.

“We will have to see at this legislative session with this new awareness whether the bill is introduced again and whether it receives a hearing in the legislative process,” said Kuhlmann.  

Kuhlmann’s study has made a large impact on the St. Louis community, as well as the nation. But what’s made her feel the proudest throughout the entire project is bringing awareness to the issue. “We thought it would generate some attention, but I think it’s gone way beyond what we’ve imagined,” she said.

Knowing that people will see the magnitude of the problem and use it to establish programs and expand existing programs to help St. Louis women is what Kuhlmann desires for the future.

However, Kuhlmann’s ultimate hope is that her work will be a stepping stone to finally ending women’s struggle to afford menstrual hygiene products, period.