Menstrual Health in the U.S.
Menstrual health is an important, yet often overlooked, aspect of reproductive autonomy. It encompasses the physical, mental, and social well-being of those who menstruate. Achieving good menstrual health requires access to accurate information, effective and affordable materials, hygienic facilities, a supportive social environment, and the freedom to participate in all aspects of life without restrictions or exclusions.
In recent years, a growing social and political movement has emerged to address menstrual inequity in the U.S., with policy efforts focused on addressing period poverty, eliminating menstrual stigma, and promoting menstrual health. With over 21 million women living in poverty in the U.S., there is a demand to repeal period product taxes and push for the provision of free period products in public spaces. While substantial progress is being made, menstrual inequity remains a threat to the achievement of gender equality and empowerment in the U.S. Furthermore, the rise of abortion bans across states has the potential to compound the existing social challenge of menstrual inequity and have reverberating effects on peoples’ ability to manage menstruation with choice and dignity.
Menstrual Health in a Post-Roe Landscape
The political environment in the U.S. is becoming increasingly hostile to issues related to sexual and reproductive health. In June 2022, the U.S. Supreme Court reversed nearly fifty years of precedent with a six-to-three majority decision in Dobbs v. Jackson Women’s Health Organization, permitting states to independently decide the legal parameters of abortion access and care. Since the overturning of Roe v. Wade, 24 states have banned or are likely to ban abortion. These restrictive state policies on abortion may also have indirect consequences on menstrual health.
Preferred Menstrual Patterns
Changes to menstruation due to contraceptive use, referred to as contraceptive-induced menstrual changes, can be both a driver and a deterrent for contraceptive users when deciding upon what method best suits their wants, needs, and family planning goals. Users may seek out contraceptive methods to suppress their menstruation for a variety of reasons such as to manage menstrual and gynecologic disorders, decrease gender dysphoria associated with menses for transgender and gender-diverse users, or simply not experience menstrual bleeding each month as a matter of personal preference. There are several hormonal contraceptives that may be leveraged to achieve the intended goal of menstrual suppression, including some long-acting reversible contraception methods such as the levonorgestrel-releasing intrauterine device (IUD). Individuals should be empowered and supported in their decision of contraception, but some U.S. policymakers, emboldened by the overturning of Roe, are attempting to limit access to certain contraceptives, making it harder for people to attain their preferred menstrual patterns.
IUDs and emergency contraception, in particular, have increasingly been under attack. Some antiabortion advocates have conflated abortion and contraception by claiming that certain methods “cause early abortions”. However, according to the American College of Obstetricians and Gynecologists, the IUD works by preventing fertilization of an egg by sperm. Yet, it’s not just the antiabortion activists that hold these unscientific beliefs. One recent study found that approximately 1 of 6 obstetrician-gynecologists, and even more among other specialties, held misconceptions about IUDs as abortifacients – substances that cause the termination of an implanted fertilized egg. This inaccurate representation of contraception is currently fueling the political debate and potentially impacting contraceptive access for many.
Some think it outlandish to believe that lawmakers are looking to restrict contraceptive access, yet Supreme Court Justice Clarence Thomas wrote in his concurring opinion in Dobbs that the Court “should reconsider” other precedents that concern the right to privacy, specifically naming Griswold v. Connecticut – the landmark decision that established the right of married couples to use contraception. Without federal legislation safeguarding access to contraceptives, some individuals seeking contraceptive-induced menstrual suppression could soon face barriers.
Menstrual Health Digital Data
Period-tracking applications (apps) are a health literacy tool used to increase bodily awareness and empower menstruators by analyzing users’ inputs to enable better identification of patterns, changes, or abnormalities within the reproductive cycle. With an estimated 50 million users worldwide, period-tracking apps have a tremendous impact in helping menstruators achieve greater bodily autonomy. However, in a post-Roe landscape, misuse of the digital data produced by these apps also have the potential to be harmful to users. As more states adopt policies restricting abortion, these seemingly harmless digital trails could be presented as criminal evidence.
As a warning, experts have pointed to examples of digital trails created by other types of technology that have been used to incriminate people of illegal abortions. This cause for alarm is further fueled by Virginia Governor Glenn Youngkin’s blocking of a bill to prohibit police from issuing search warrants for digitized data on menstrual cycles from electronic devices. Since data derived from period-tracking apps fall outside the scope of the Health Insurance Portability and Accountability Act, it is even more important that privacy laws around health-related data are strengthened. The lack of data protection is not only harmful for period-tracking app users seeking to have abortions, but it is also worrisome for users who might experience a miscarriage, report irregularities with their menstrual cycles, or simply have imperfect engagement with the app. Within the current political environment, advocates have even encouraged individuals to turn to paper tracking methods and forgo using digital trackers.
Menstrual Health Education
Menstrual health education, an integral component in the sexual wellness and empowerment of young people, is also under threat in a post-Roe America. Menstrual hygiene education is already mostly ignored in curricula across the country; one study found that many adolescent girls in the U.S. are under-prepared to navigate puberty and menstrual health due to challenges with accessing quality menstruation education. Without proper support and education, young people are forced to overcome challenges with menstrual management themselves. A scarcity of menstruation education can cause serious consequences in decision making about sex, relationships, and family planning, which has larger implications on adolescent lives with regard to early pregnancy and marriage. Moreover, without menstrual education and support, individuals are more likely to experience depression and low-esteem. Integrating teachings on menstrual health into comprehensive sexuality education can address critical gaps in knowledge among adolescent menstruators, further preventing health risks and other societal obstacles.
However, since the overturning of Roe, policymakers are introducing restrictive legislation to limit crucial discussions on reproductive health. In Florida, a lawmaker proposed a bill that would only allow students in grades 6 through 12 to engage in sexual health education, leaving access to important sexual health information unavailable for students in lower grades. When questioned about whether students in 5th grade or lower who experience menarche would be able to discuss their menstruation under this bill, the proposing lawmaker admitted to overlooking this important topic. In the post-Roe era, it is more important than ever that students have a firm, unstigmatized understanding of menstruation and the reproductive cycle.
Conclusion
State-level abortion bans not only affect access to abortion care but also have broader implications for menstrual health. Advocates in the U.S. must work to safeguard contraceptive access, privacy, and comprehensive sexuality education that includes menstrual health to ensure menstruators can make informed choices about their reproductive health. In the face of a challenging political landscape, culminating even before the overturning of Roe, it is imperative to protect an individual’s human right to sexual and reproductive well-being, regardless of their zip code.
Read the full paper ‘Missed period? The significance of period-tracking applications in a post-Roe America’ by Bridget Kelly and Maniza Habib in the SRHM Journal
Bridget Kelly is a Doctor of Public Health Student at the Milken Institute School of Public Health at The George Washington University in Washington, DC.
Maniza Habib is a Research Associate at the Population Institute in Washington, DC.