— Clare Pfeiffer, a plaintiff in a class-action lawsuit against the tampon tax

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The holiday season arrived with a slew of extra costs for Diamond Cotton.

Ms. Cotton, an Indianapolis-based mom of three, had to buy Mucinex for a cold, extra tissues and Christmas gifts: an Amazon tablet for her son, a discounted Nintendo for one daughter and sketchbooks for the other. But the expenses weighed heavily on Ms. Cotton, 30, who was laid off from her housekeeping job at the beginning of the pandemic.

As she scrambled to budget savings for her family’s needs — meals, clothes, school supplies — she found menstrual products particularly difficult to cover. Period products for herself and her two daughters, 10 and 11, can sometimes cost up to $50 a month, Ms. Cotton said, because they each have different cycles and needs.

She decided to contact I Support the Girls, a nonprofit organization that provides free tampons and pads, which she had read about online: “I had to reach out and say, ‘Hey we’re not going to make it,’” she said.

Ms. Cotton, like millions globally, was experiencing “period poverty” — a lack of access to pads or tampons, in this case for financial reasons. For some the financial gap is so dire, they may need to miss school or work while menstruating.

For decades, lawmakers all over the world were largely silent about the issue of period poverty. But as policymakers and advocates have begun to break the taboo, with female political leaders putting a spotlight on women’s health needs, countries around the globe are devising policies to make these products more accessible. In most instances this means helping to cut costs, but some are taking a bolder approach: Last November, Scotland became the first country to make period products free for all, meaning local authorities are mandated to ensure anyone who needs them can access them.

Replicating something akin to Scotland’s law in the United States would be difficult, period equity activists point out, because of the difference in population size; Scotland’s population is just half the size of New York City. But the United States, too, has begun enacting its own set of local and federal policies that help make period products more widely available.

In recent years, six states have mandated that menstrual products be provided in schools, and 13 states have mandated that they be provided in prisons and jails. In 2017, the U.S. Department of Justice agreed to provide every woman incarcerated in a federal prison with menstrual products free of charge. And in March, the Coronavirus Aid, Relief and Economic Security (CARES) Act included provisions allowing menstrual products to be purchased with money from health savings and flexible spending accounts.

Period equity activists celebrated this provision, noting that Congress was recognizing the role period products play in women’s financial insecurity. “Economic relief for women is key this year,” said Jennifer Weiss-Wolf, co-founder of the legal and advocacy organization Period Equity.

But not every American has a flexible savings account, and activists point out that this new provision won’t ease every woman’s access to menstrual products: “There is no magic period law,” Ms. Weiss-Wolf said.

Some states are looking at abolishing taxes associated with tampons. There are currently 30 states in which period products are subject to a sales tax. In most states, sales taxes make exemptions for various necessities. States collectively make over $150 million annually from taxing menstrual products. The organization Period Equity argues that this is not just inconvenient for women, but also unconstitutional. They argue the tax amounts to a violation of the equal protection clause, since the law targets a bodily function associated with women.

In August, plaintiffs in Michigan introduced a class-action lawsuit against the tampon tax. “I’ve never sued anyone, let alone the state,” said Clare Pfeiffer, 46, a plaintiff in the Michigan lawsuit. “But period products are not a luxury item. I know how important it is to restore dignity to people who are facing a crisis.”

Laura Strausfeld, co-founder of Period Equity, helped initiate a similar lawsuit in New York state in 2016, which was dropped after the passage of legislation banning the state’s tampon tax. She believes the Michigan case will provide an impetus for other states to stop the tax before they face similar lawsuits.

“The challenge to Michigan’s tampon tax is putting other states on notice,” she said. “They’re maintaining an unconstitutional law and we will pursue legal action to dismantle the tax.”

Canada, Australia, South Africa and India are among the countries in recent years that have eliminated such taxes on menstrual products. Britain’s “tampon tax” was scrapped as of Jan. 1.

But ideally, advocates say, these products would be provided for free everywhere.

In 2019, representative Grace Meng, a Democrat from New York, introduced the Menstrual Equity for All Act, a sweeping bill that would help women from specific populations, including students, detainees and those on Medicaid, access free period products.

For much of her life Ms. Meng hadn’t given the issue of period poverty significant thought because she was always able to afford pads or tampons when she needed them. When she received a letter from a middle school student in her district who explained that the products were not available in New York City homeless shelters, the congresswoman was appalled.

“Hearing that a young girl doesn’t have money for these products and skips school every month when she gets her period was heartbreaking,” Ms. Meng said. “It meant she wasn’t getting the full education she deserved.”

As Ms. Meng began to write legislation on the issue and look for collaborators across Capitol Hill, she encountered an unusual obstacle — co-workers embarrassed to discuss the issue. “Sometimes people are like, ‘Fine, I’ll sign on to your bill, just stop talking about it,’” she said.

But the letter from her young constituent had planted the seeds of a new mission for Ms. Meng: to make period products accessible to all who need them.

She began with a focus on New York City, advocating for a law that made menstrual products available to public school students, shelter residents and inmates, which passed in 2016. Ms. Meng also persuaded the Federal Emergency Management Agency to add menstrual products to the list of items that organizations assisting the homeless could buy with grants from the federal government.

Both beyond and within New York, the challenges confronting individuals purchasing period products remain substantial. The average woman spends $9 per month on period products, according to a calculator built by Dominika Miszewska, a medical student in Warsaw, along with her friend Julia Żuławińska, a biophysics student.

“There’s been times I had to choose between period products and diapers for my kids,” said Amber, 39, who lives in Baltimore and asked to be identified by her first name so she could speak openly about the subject. “I’ve had to find other means like making makeshift pads, which I’m not proud of.”

As activists call for policy change, nonprofit organizations are continuing to provide a stopgap measure by donating period products to those in need. Dana Marlowe, founder of the nonprofit I Support the Girls, said her organization has donated more period products than ever this year. More than 8 million people have fallen into poverty since May.

“Women have borne the brunt of this pandemic in so many ways, from job loss to food insecurity,” Ms. Marlowe said. “When you couple that with menstrual inequities, it makes having your period that much harder to manage month after month. It’s like a bloody slap in the face.”

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