In fact, we know far less about how girls handle their periods within the context of American schools than we do about how girls handle the same issues in schools in Nepal, Ghana, Pakistan, and Tanzania. Why the information gap? The United Nations and the World Health Organization take special interest in menstrual hygiene in the developing world, where girls are known to drop out when they have their menarche or are exiled for the week of their periods. Not so much in America. “Around the world, this is something that is studied and documented in a way it hasn’t been here,” says Jennifer Weiss-Wolf, the author of Periods Gone Public: Taking A Stand for Menstrual Equity. Despite some efforts at the state level, American politicians don’t seem particularly determined or likely to change this status quo. The charge to study or alleviate the experience of menstruation of low-income American girls has been slow-going. Still, some politicians have taken up the cause to make these essential items more accessible. As of this writing, the states of New York, California and Illinois have passed legislation requiring officials to provide tampons and pads in public schools. Other states have passed laws to ensure women in prison and in homeless shelters have easy and dignified access to pads and tampons. The Department of Justice followed suit. Though this doesn’t seem to be a partisan issue, there’s no federal law or precedent for state laws requiring school nurses’ offices to keep a stock of pads and tampons, or for administrators to provide tampons in restrooms. For poor girls, this could be the thing that keeps them from school, or from meaningful and uninterrupted attendance. “As we went through all the articles and what was out there, we found that, in fact, there is a huge gap in attention to this issue here, a gap in what we even know,” Dr. Marni Sommer, who has worked on global reproductive and menstruation health issues for the past 16 years. “There are a lot of articles from 20 years ago, but not a lot of research on American girls being done recently.” What little research exists shows a striking correlation between access to hygiene products and school attendance. Two years ago, when New York City became the first city in the world to require that tampons and pads be free and accessible in all public schools, shelters, and prisons, the legislation package, 1122-A, 1123-A and 1128-A, was passed unanimously. New York State followed suit with statewide legislation in early 2018. Those laws were preceded by a pilot program by Council Member Julissa Ferreras-Copeland. At one school alone, there was a 2.4 percent increase in attendance after installing free and accessible tampon dispensers in restrooms. The plan, however, was not without its critics. When the New York State plan passed and it was announced that providing tampons would cost residents of Westchester County $200,000 dollars a year in taxpayer money, many people, even women, balked. “Why can’t they buy their own? Bet they can buy fake nails,” said one on Facebook. Another asked: “And just what else will we have to provide for ‘free’?” To which Weisswolf says, respectfully, think about the butt. “No one thinks twice about the fact that they don’t have to pay for toilet paper in public places,” she says. “Nothing that exists in a public restroom is accidental or done as a favor. Our lawmakers considered all of the health factors that go into why we would provide toilet paper, hand soap, and a sink to wash your hands in. Even the places to dispose of menstrual products, that’s regulated, too. But nobody thought that providing tampons was worth doing. It’s a natural need to be attended to, just like wiping your butt.” Feminine hygiene products have always been subject to stricter regulation. The tampon and the pad are not makeup, perfume, or clothes. And yet, although access bills have enormous support in bipartisan circles, they are still considered a luxury item in 36 states. That means they fall into the same category as makeup and streaming music subscriptions. Progress is being made, however. Since the tampon tax issue has been raised, Maryland, Massachusetts, Pennsylvania, Minnesota, New Jersey, Connecticut, and Illinois have made tampons tax-exempt. And states that passed legislation to provide free and accessible hygienic products in prisons and in shelters have addressed a power imbalance: one in which women must depend on their superiors for pads. To Dr. Sommers, there’s much more at play here than having tampons in baskets in bathrooms. It’s also about girls being able to go to the bathroom at all, about negotiating the power imbalance in classrooms. Girls, especially those in the first years of their period, don’t have a regular flow. Their period sometimes hits without notice, as they have not yet become attuned to the new clock of their pubescent bodies. Schools, she says, need to address these and create an atmosphere of acceptance. “When girls have their periods, is it safe and easy for them to be able to use the toilet? Are the toilets reserved for only certain break times during the day? Is there a school nurse? Are they able to go get painkillers? Is there an emergency supply of pads?” Sommers asks. “Is there somewhere they can go and wash if they get a stain on their clothing? All of those things can affect a girl’s ability to concentrate, to raise her hand, to be willing to stand up.” In anticipation of a book she is writing and as a part of her larger work, Weisswolf held focus groups with groups of girls across the country. She found that although some schools have products in the nurse’s office, many girls report that actually getting out of class and going to the nurse is no easy task. “Kids would tell stories where, they ended up being absent from the classroom for 20 minutes, or not having their pass signed properly, and they’d find themselves in detention,” says Weisswol. “They were missing class time. That is detrimental to their education.” Even if kids go to school when on their period and they’re unprepared, if they have to manage it, they could be punished. It doesn’t need to be that way. Local and state governments can make it easier for kids to have access to what they need. “Lots of people will turn up their nose and say ‘Give me a break. Everybody else figures out how to carry a pad with them. Why can’t these kids?’” says Weisswolf. “But anybody will tell you that over the course of their menstruating lives they have been in a circumstance where they didn’t have what they needed when they needed it. Especially for kids, whose periods aren’t regular, who don’t control their parents’ budget or grocery shopping. That’s the reality for schools.” The quicker we make it easier for girls to manage their periods, Weisswolf contends, the better our girls will do.