At the 2025 NAPNAP National Conference on Pediatric Health Care in Chicago, Bobbie Monaco, MSN, CPNP-PC, a pediatric nurse practitioner with the Children’s Hospital of Philadelphia (CHOP) Care Network in Pottstown, Pennsylvania, addressed the critical issue of period poverty and menstrual equity in her session, “Breaking the Cycle: Addressing Period Poverty, Promoting Equity and Fostering Sustainability in Menstrual Health," presented at the NAPNAP National Conference on Pediatric Health Care.

Understanding Period Poverty

Monaco has been involved in addressing period poverty and menstrual equity since 2015, drawing from her global health work.

“I suddenly thought about what girls were doing for their periods. When I asked, I was told they were using cardboard, staying home, participating in transactional sex, using mattress stuffing, or even using round stones that they placed in their vaginas as a plug. I thought, ‘Wow, I need to do something about this,’” she said.

Although she initially saw period poverty as a global issue, the COVID-19 pandemic shifted her focus to the United States.

“I found that the statistics here were staggering. In 2023, one in four girls missed school or work because they could not afford or did not have access to period products,” Monaco explained.

Legislative and Policy Challenges

Despite growing awareness, many states still classify period products as luxury items.

Until 2020, when the COVID CARES Act was passed, individuals could not use health savings accounts (HSAs) or flexible spending accounts (FSAs) to purchase menstrual products. Advocacy efforts have led to increased access in schools, but widespread availability remains a challenge.

“We need to speak up in our communities, learn what is happening locally, and determine how we can help. We must contact our local and state representatives to make them aware of this issue in our clinics, communities, and schools.”

Health and Environmental Concerns

Beyond accessibility, menstrual health is also impacted by product safety and sustainability.

“A research study published last year examined 18 different brands of pads and tampons—both organic and non-organic—available in the United States. The study found levels of lead and arsenic in all of the products, exceeding the levels allowed in fabrics that touch the skin,” Monaco said.

Monaco also pointed out the potential risks of these toxins coming into contact with mucous membranes, highlighting the need for further research on their long-term effects.

The environmental impact of disposable menstrual products is also significant.

“Pads are composed of 90% plastic and break down into microplastics that enter our waterways and landfills. Every tampon and pad ever used is still in a landfill today, as they take 500 to 800 years to decompose,” she stated.

The Role of Healthcare Providers

Monaco emphasized that providers play a vital role in breaking the stigma surrounding menstruation.

“We must normalize conversations about menstruation, making it a common topic rather than one that elicits giggles or discomfort.”

She encouraged primary care providers to routinely discuss menstruation during adolescent visits, asking not only about cycle regularity and pain but also about the types of menstrual products used.

“Are these products working for them? Have they considered reusable options? Do they have access to them? Do they need help? I have found that by opening this dialogue, girls and mothers return year after year to share how they have made changes. If we do not initiate these conversations, the opportunity for education is lost.”

According to Monaco, NAPNAP is in the process of creating a position statement to address period povert and period equity, with and aim to be published this year.

Reference:

Monaco B. Breaking the Cycle: Addressing Period Poverty, Promoting Equity and Fostering Sustainability in Menstrual Health. Presented at: NAPNAP. March 10-13, 2025. Chicago, Illinois.